The Failure Points
Most patients are never warned about these mistakes. This cancer is hard to detect and is often found late.
Time lost = options lost
Most Common Mistakes
Cholangiocarcinoma: CCA
- Assumptions
- Not realising the speed of this cancer
- Not engaging a high-flow cholangiocarcinoma (CCA) doctor
- Not moving to a doctor with specific CCA experience
- Relying on a single surgical opinion
- When two or three opinions are standard
- Accepting “not operable” without challenge
- Not asking: What would make surgery possible?
- Delaying a face-to-face consultation
- With a hepatobiliary surgeon
- Over-reliance on MDT conclusions
- Without knowing the CCA experience of each member
- MDTs are group discussions, not a replacement for expert consults
- Not requesting a digital copy of pathology
- Not confirming tumour biology
- Not checking dMMR or pMMR status
- Not checking PD-L1, MSI, and HER2 status
- Not checking tumour differentiation (poor, moderate, well)
- Not discussing results with the oncologist
- Delaying or not requesting genomic profiling
- Allowing drift between decisions
- Accepting long gaps between tests, scans, or appointments
- Not documenting key information
- Symptoms, blood tests, scans, questions
- Making decisions without including a caregiver
Carry this thinking:
- Rare cancers require rare experience
- “Not operable” is an opinion, not an endpoint
- Drift is where options are lost
- Time lost = options lost
The Shift In Approach
These are not rare mistakes.
They are how time is lost during diagnosis and under pressure.
The Counter (what to do)
- Engage a high-flow cholangiocarcinoma (CCA) doctor
- Get more than one surgical opinion
- Speak to a hepatobiliary surgeon early
- Confirm pathology and tumour biology
- Request genomic profiling early
- Avoid drift between steps
- Document everything
- Include your caregiver
Increase Options
These steps do not replace treatment.
They protect the conditions under which treatment decisions are made.
Time lost = options lost
Patient Response System
Journal. App. AI.
Patients shouldn’t be deprived of survival knowledge.
Most patients lose options not because of the cancer alone,
but because understanding comes too late.
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