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The development of CCA follows a multistep carcinogenesis model involving chronic inflammation, which progresses from damaged biliary epithelium to dysplasia and eventually invasive cancer, with molecular mechanisms including inflammatory pathways, oxidative stress, genetic alterations (commonly affecting p53), and epigenetic changes that create an aberrant phenotype in cholangiocytes

Always verify coverage with the specific payer's LCD and formulary before administering

Too, we are perhaps looking at a CMS that is less likely to recognize, for example, long-recognized home and community asked services that provide assistance to daily living activities for someone electing to age in the community instead of in an institution, or education and workforce supports to those looking to contribute to the health care field

The difference is in the dosing