What are the key clinical features and risk factors to consider when suspecting cholangiocarcinoma in a patient?

Key clinical features of cholangiocarcinoma typically include progressive painless jaundice, pruritus, dark urine, pale stools, and weight loss due to biliary obstruction and systemic effects of malignancy NICE NG85 Ilyas & Gores 2013. Patients may also present with right upper quadrant abdominal pain and cholangitis symptoms if biliary obstruction leads to infection NICE NG85 Sarcognato et al. 2021. On examination, signs of chronic liver disease or biliary obstruction such as hepatomegaly or palpable gallbladder may be present NICE NG85.

Risk factors to consider when suspecting cholangiocarcinoma include primary sclerosing cholangitis (PSC), which is the strongest known risk factor NICE NG85 Ilyas & Gores 2013. Other important risk factors are chronic biliary inflammation from hepatolithiasis, choledochal cysts, liver fluke infection (Clonorchis sinensis and Opisthorchis viverrini), chronic viral hepatitis (B and C), cirrhosis, and exposure to certain toxins such as thorotrast NICE NG85 Kidanemariam et al. 2024. Additionally, metabolic conditions like obesity and diabetes may contribute to risk Sarcognato et al. 2021. Age over 60 and male sex are demographic risk factors commonly observed NICE NG85.

In summary, suspicion of cholangiocarcinoma should be raised in patients presenting with obstructive jaundice and constitutional symptoms, especially if they have underlying risk factors such as PSC or chronic biliary disease NICE NG85 Ilyas & Gores 2013Sarcognato et al. 2021Kidanemariam et al. 2024. Early recognition is critical due to the aggressive nature and poor prognosis of this cancer NICE NG85.