A 65-year-old woman with primary sclerosing cholangitis (PSC) develops progressive jaundice and weight loss. MRCP shows multifocal biliary strictures. Brush cytology from ERCP confirms cholangiocarcinoma. She has no distant metastasis. Which staging approach is used and what novel treatment option (Mayo Clinic protocol) may be considered?
- A Bismuth-Corlette classification; liver transplantation after neoadjuvant chemoradiation (Mayo Clinic protocol) ✓
- B TNM staging; immediate surgical resection
- C MELD score; TACE then transplantation
- D Child-Pugh score; FOLFOX chemotherapy
Explanation
Perihilar cholangiocarcinoma in the setting of PSC is considered unresectable in many cases due to involvement of both hepatic ducts and background liver disease. The Mayo Clinic protocol involves aggressive neoadjuvant chemoradiotherapy (external beam radiation + brachytherapy + capecitabine) followed by liver transplantation for highly selected patients with unresectable perihilar cholangiocarcinoma arising on a background of PSC. This protocol achieves 5-year survival rates of approximately 65-70% in carefully selected patients and represents one of the few settings where liver transplantation is approved for cholangiocarcinoma in the United States.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.