Monthly Archive for: ‘December, 2015’

A Look at Hepatobiliary Cancer

Gloryanne Bryant, RHIA, CDIP, CCS, CDIP
AHIMA Approved ICD-10-CM/PCS Trainer

Hepatobiliary cancer is a challenge in medicine because it is very hard to detect and is the leading cause of biliary tract obstruction, after gallstones.  These cancers are notoriously difficult to diagnose, molecularly and genetically highly heterogeneous, and refractory to standard therapies. Hepatobiliary cancers are the 7th leading care of cancer death in the United States and the 3rd leading cause of cancer deaths worldwide.  Hepatobiliary cancers are on the rise in the U.S. with increasing numbers of cases projected.

Risk Factors: Some of the known risk factors for Hepatobiliary cancer are as follows:

  • Long-term infection with hepatitis B or hepatitis C
  • Heavy alcohol use
  • Obesity
  • Type 2 diabetes
  • Inherited metabolic disease
  • Exposure to toxins such as arsenic, aflatoxins, vinyl chloride, and thorium dioxide
  • Anabolic steroids

Signs/Symptoms: The warning signs and symptoms which sometimes resemble other medical conditions or problems occur with Hepatobiliary cancers. Signs and symptoms include:

  • Jaundice
  • Abdominal pain
  • Poor appetite
  • Weight Loss
  • Itching
  • Pale stools
  • Dark Urine
  • Fever

Diagnosing: Diagnostic tools for Hepatobiliary cancers may include:

Endoscopic retrograde cholangiopancreatography — ERCP is a procedure used to create images of the digestive tract. During an ERCP procedure, doctors insert a thin, lighted tube into the mouth and down through the stomach to produce an image of the surrounding organs and glands.

Magnetic resonance cholangiopancreatography — MRCP is similar to an MRI, except that it uses specialized software to target the pancreas and bile ducts and create detailed images.

X-ray, CT, MR and PET scans are often needed to show the location and extent of the cancer.

Also used are blood samples for tumor makers including alpha-fetoprotein (AFP) cancer antigen 19-9 (CA 19-9) and cancinoembryonic antigen (CEA) may be tested to guide the diagnostic evaluation.

To confirm a diagnosis, doctors will need to remove a small piece of tissue from a tumor for testing. Often, a biopsy sample can be collected during an ERCP procedure, if one is performed.

Treatment:  Depending on the location of the tumor, where the cancer originated, the stage of the cancer, and the overall health of the patient, several techniques may be used, either independently or together, to attempt to slow tumor growth or relieve pain. The following are options that may be considered:

  • Brachytherapy
  • Radiotherapy
  • Chemotherapy
  • Liver transplantation

External beam radiation therapy is also a treatment option that involves a series of daily outpatient treatments to accurately deliver radiation to the area at risk.

Surgery may be necessary to remove the cancerous tissue as well as any nearby non-cancerous tissue. Surgery may also be used to relieve any blockage of the bile duct or to relieve symptoms.

Stent placement is another treatment choice that will help drain bile that builds up on the area. The stent also helps to bypass the blockage that causes symptoms such as pain or yellowing of the eyes and skin. A stent may be placed temporality until surgery can be performed to remove any cancerous tumor(s) or a permanent stent may be placed.

For coding professionals understanding disease processes and having knowledge of clinical indicators is a foundational competency for accurate clinical coding. Learning and enhancing our knowledge and skills are basic to quality clinical data that can help with research, reimbursement and population health.

References and for more information:;