Klatskin tumours are a type of bile duct cancer, known as ‘cholangiocarcinoma’. This is a form of malignant tumour that tends to develop in the central biliary region (including the biliary ducts). While Klatskin tumours are not large, they can exhibit aggressive biological behaviour by obstructing the intrahepatic biliary ducts and jaundice.
Due to the location of these tumours, patients tend to develop symptoms at advanced stages and the tumours can be difficult to resect. However, this may differ from case to case, as some patients may have jaundice in the early stages, which may compel them to seek early medical help.
Ideally, complete resection of the Klatskin tumour should be performed whenever feasible as this is associated with better long-term survival. For certain patients, liver transplants can be an option for treatment in specialised centres. Overall, the prognosis of Klatskin tumours is poor, but new surgical and endoscopic treatments allow better disease control.
Generally, Klatskin tumours are rare. However, it is observed that Asians are more prone to develop these tumours, especially males and elderly patients above the age group of 50 years. Also, Klatskin tumours comprise 50% of cholangiocarcinomas. The remaining cholangiocarcinomas develop inside the liver (intrahepatic cholangiocarcinoma) or the distal bile duct (distal cholangiocarcinoma).
The Klatskin tumour staging can be determined by using a well-known staging system, the Bismuth-Corlette system.
The Bismuth-Corlette system classifies Klatskin tumours into 4 main categories based on the location of these tumours. These include:
Type 1 Klatskin tumours:
These tumours exist in the common hepatic duct, but are far from where the hepatic ducts meet.
Type 2 Klatskin tumours:
Such tumours mainly develop in the common hepatic duct where both the left and right hepatic ducts meet.
Type 3 Klatskin tumours:
The staging of Klatskin tumours is classified as type 3 when the tumours are located in one of the hepatic ducts.
Type 4 Klatskin tumours:
This is the most advanced, in which the tumours are detected in both the left and right hepatic ducts.
Radiographic tests are required to diagnose and assess Klatskin tumours. Ideally, histological or tissue confirmation by endoscopic, radiologically-guided biopsy or surgical biopsy can be performed. In many cases, histological confirmation may not always be feasible.
About 30-40% of such tumours are potentially resectable, and patients with successfully resected tumours have better overall survival.
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Senior Consultant Surgeon
Senior Consultant Surgeon