My Cholangiocarcinoma was discovered incidentally on a follow up CT scan for an unrelated issue by a primary care provider in July 2009. I had no clinical symptoms. My Alkaline Phosphatase was elevated; I sought a consultation with a gastroenterologist who ordered a variety of liver function tests and tumor markers as well as an MRI. My Carbohydrate Antigen 19-9 was 419 U/mL on a reference range of 0-35 U/mL and my Alkaline Phosphatase was 154 IU/L on a reference range of 0-150 IU/L. Bilirubin, AST, ALT and AFP where normal and I was negative for HCV, ANA, Hep B, Hep A, ANA and M2 Antibodies. It presented as a very vascular lesion on MRI and CT and it wasn’t confirmed histologically until a CT guided needle biopsy was performed after consultation with a oncological surgeon at Emory University Hospital in Atlanta.
History of note includes a Wilm’s Tumor during childhood with radiation, right nephrectomy and chemotherapy in early 1960s. Subsequent follow up showed no metastasis. Also of note is a diagnosis of type 2 diabetes mellitus in 2005; I manage this quite successfully with metformin and prn humalog insulin on a sliding scale. My A1C averages 5.8 for the last 3 years.