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Screening for Malignancy in Primary Sclerosing Cholangitis (PSC)

  • Liver (B Bacon, Section Editor)
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Abstract

Primary sclerosing cholangitis (PSC) is a frequently progressive and fatal disease. Death from cancer occurs in a significant subset of patients with PSC. Patients with PSC have a 10 to 15 % lifetime risk of developing cholangiocarcinoma (CCA). About one third of CCAs are present in the first year after a diagnosis of PSC; the remainder are present with a frequency of about 1.5 % each year. Patients with concomitant PSC and inflammatory bowel disease (IBD) have a 4-fold higher risk of colorectal cancer (CRC) than patients with IBD alone and a 10-fold higher risk of CRC than the general population. The risk does not diminish with liver transplantation. This patient population also has a high frequency of carcinoma in gallbladder mass lesions. The risk for hepatocellular carcinoma (HCC) in the presence of cirrhosis is uncertain—two large cohort studies suggest that HCC is not as common as in other causes of cirrhosis. Although AASLD guidelines do not recommend routine screening for liver tumors in patients with PSC, we recommend MRI/MRCP and serum CA 19-9 levels in patients with PSC every 6 months to screen for CCA, HCC, pancreatic cancer, and gallbladder cancer. Screening colonoscopy at the diagnosis of PSC and surveillance colonoscopies every 1–2 years should be performed in those with PSC and IBD.

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Conflict of Interest

Saira A. Khaderi and Norman L. Sussman declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Baylor College of Medicine, 6620 Main Street #1425, Houston, TX, 77030, USA

    Saira A. Khaderi & Norman L. Sussman

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  1. Saira A. Khaderi
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  2. Norman L. Sussman
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Correspondence to Norman L. Sussman.

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This article is part of the Topical Collection on Liver

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Khaderi, S.A., Sussman, N.L. Screening for Malignancy in Primary Sclerosing Cholangitis (PSC). Curr Gastroenterol Rep 17, 17 (2015). https://doi.org/10.1007/s11894-015-0438-0

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  • DOI: https://doi.org/10.1007/s11894-015-0438-0

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