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Cholangiocarcinomas can therefore arise within the liver (i.e., intra-hepatic) or in the bile ducts just outside the liver. The disease can spread along the bile ducts, thereby involving both the liver and either the pancreas, gall bladder or duodenum. They can also spread to adjacent lymph nodes, spread to liver or lungs via the blood, or simply "seed" the abdomen with tumor cells landing on other abdominal organs (e.g., bowel, bladder, rectum, ovaries). This "seeding" process is called intra-peritoneal dissemination and is quite common with this disease.
Some cholangiocarcinomas are true primary liver tumors in that they may originate in the liver, while others may spread there or to adjacent organs (including pancreas) through the bile ducts.
More than two thirds of cholangiocarcinomas are located in either the common hepatic duct (CHD) or the common bile duct (CBD). The CHD—where the right and left ducts from the liver meet to form one channel on to the duodenum—is the most likely location for a cholangiocarcinoma, and the CBD—the channel from the gallbladder formed by union of the hepatic duct and the cystic duct—is the second most common location for a cholangiocarcinoma.
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