Cholangiocarcinoma in clinical practice: advances and unmet needs

Abstract Cholangiocarcinomas (CCAs) are a broad category of lethal cancers that arise in the biliary tree. After hepatocellular carcinoma (HCC), CCA is the second most common primary hepatic malignancy, making up 15% of all primary liver tumors. Their prognosis is poor because they are frequently diagnosed in advanced stages. The inability to achieve full resection is still a challenge. There are already many distinct CCA molecular subtypes, each with its own treatment response and prognosis. Another limitation for popular treatment approaches is the high heterogeneity and chemoresistance of CCAs. To enhance knowledge of CCA and draw attention to current gaps, we provide a summary of the latest advancements in the field, emphasizing cells of origin, classification, genetic landscape, epigenetic changes, novel biomarkers, artificial intelligence (AI) integration and treatment lines including liver transplantation.