CCF Annual Conference - Autoimmune disease and CCA

Our body's immune system protects us from infection by recognizing that viruses and bacteria are not part of our body, so it attacks and destroys them.

If you have an autoimmune disease, your immune system attacks the healthy cells of your organs and tissues by mistake.

Researchers found that patients with autoimmune diseases will have a higher risk for cancer.

We appreciate your participation in this survey to report the association between autoimmune diseases and cholangiocarcinoma.

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Please select who is filling out the survey:

Patient

Caregiver

Former Caregiver for a patient who has passed away

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* 5. What is the patient's gender

Male

Female

Non binary

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* 6. What is the patient's race? [select all that apply]

White or Caucasian

Black or African American

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Hispanic or Latino

Other (please specify)

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* 7. What was the month of cholangiocarcinoma diagnosis?

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* 8. What was the year of cholangiocarcinoma diagnosis? (YYYY)

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* 9. What was the patient's age at the time of cholangiocarcinoma diagnosis?

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* 10. What is/was the type of cholangiocarcinoma that the patient was diagnosed with?

Intrahepatic cholangiocarcinoma
Cancer develops in the hepatic bile ducts or the smaller intrahepatic biliary ducts inside the liver

Perihilar extrahepatic cholangiocarcinoma
Cancers develop where the right and left hepatic ducts have joined and are leaving the liver

Distal extrahepatic cholangiocarcinoma
Cancer outside the liver after the right and left hepatic bile ducts have joined to form the common bile duct

Unsure

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* 11. What is/was the time interval between symptoms development and the cholangiocarcinoma diagnosis

<3 months

3 - 6 months

> 6 months

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* 12. Before the diagnosis of cholangiocarcinoma, has the patient had a regular surveillance/screening program for early detection of cholangiocarcinoma?

Yes

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