Curbside Consultation of the Liver: 49 Clinical Questions

Mitchell L. Shiffman, MD

Question 34: Should I Be Screening My Patients With Primary Sclerosing Cholangitis For Cholangiocarcinoma? (continued)

Michael Fuchs, MD, PhD, FEBG

The natural history of primary sclerosing cholangitis (PSC) is typically one of progressive cholestasis eventually leading to jaundice and end-stage liver disease. The overall median survival of patients is in the range of 10 to 12 years. Since current drug therapy is unsatisfactory, with scant evidence of benefit, liver transplantation is the treatment of choice for end-stage disease, with excellent outcomes improving long-term survival.1 PSC is now considered as a premalignant disease, with the majority of patients developing cholangiocellular, colon, or pancreatic cancer. Up to 36% of…