**2.2 Cholangiocarcinoma**

This is rare malignant disease of the epithelial cells in the intra- and extrahepatic bile ducts and the incidence is increasing, especially the intra-hepatic subtype (Patel, 2001). In addition to liver flukes infestation, hepatitis B and C infections have recently been associated with rise of cholangiocarcinoma in the developing countries, and are thought to be responsible for the increasing incidence of intra-hepatic cholangiocarcinomas. In the western countries, primary sclerosing cholangitis and congenital anomalies such as Caroli's syndrome and choledochal cysts are the main predisposing risk factors for cholangiocarcinoma (Patel, 2006).

As with pancreatic cancer, most of the cholangiocarcinomas are unresectable at presentation and the prognosis for these patients is dismal. Clinical presentations of cholangiocarcinoma are dependent on tumour location (Patel, 2006). Extrahepatic tumours, including those involving the bifurcation usually show signs of biliary obstruction with jaundice and pale stools. In contrast, intra-hepatic cholangiocarcinomas more often present with late symptoms of malignancy such as weight loss, loss of appetite, and abdominal pain or mass.
