Which physical findings are characteristic of cholangiocarcinoma (CCC)?

Updated: Dec 28, 2019
  • Author: Peter E Darwin, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Jaundice is the most common manifestation of bile duct cancer and, in general, is best detected in direct sunlight. The obstruction and subsequent cholestasis tend to occur early if the tumor is located in the common bile duct or common hepatic duct. Jaundice often occurs later in perihilar or intrahepatic tumors and is often a marker of advanced disease. The excess of conjugated bilirubin is associated with bilirubinuria and acholic stools.

Pruritus usually is preceded by jaundice, but itching may be the initial symptom of cholangiocarcinoma. Pruritus may be related to circulating bile acids.

Weight loss is a variable finding. It may be present in one third of patients at the time of diagnosis.

Abdominal pain is relatively common in advanced disease. It often is described as a dull ache in the right upper quadrant.

If the cholangiocarcinoma is located distal to the cystic duct takeoff, the patient may have a palpable gallbladder, which is commonly known as Courvoisier sign.

An abdominal mass or palpable lymphadenopathy is uncommon, but hepatomegaly may be noted in as many as 25% of patients.

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