Advances in diagnosis, treatment and palliation of cholangiocarcinoma: 1990-2009

Figure 1 Bismuth’s classification of cholangiocarcinomas. Type I: Cholangiocarcinoma is confined to the common hepatic duct; Type II: Cholangiocarcinoma involves the common hepatic duct bifurcation; Type IIIa: Cholangiocarcinoma affects the hepatic duct bifurcation and the right hepatic duct; Type IIIb: Cholangiocarcinoma affects the hepatic duct bifurcation and the left hepatic duct; Type IV: Cholangiocarcinoma is either located at the biliary confluence with both the right and left hepatic ducts involvement or has multifocal distribution.

Figure 2 Anatomical presentation of cholangiocarcinomas. The majority of cholangiocarcinomas (60%-70%) present in the area of the biliary duct bifurcation and are called Klatskin tumors. The extra-hepatic bile duct is involved in 20%-30% of cases while intrahepatic cholangiocarcinomas represent 5%-10% of the tumors originating from the biliary system.