Hilar cholangiocarcinoma (Klatskin tumour) arises at or near the confluence of the right and left hepatic ducts. Because the lesion obstructs the central bile ducts early, symptoms are usually biliary and appear while the tumour is still relatively small. Painless jaundiceConjugated hyper-bilirubinaemia develops insidiously, producing progressive yellowing of skin and sclera, dark urine and clay-coloured stools; pruritus is often intense and may precede visible icterus. Right-upper-quadrant discomfortA dull, non-colicky ache or sensation of fullness is common; pain is usually mild and does not parallel the degree of jaundice. Cholangitis episodesIntermittent fever with rigors, right-sided tenderness and elevated C-reactive protein occur... Learn more