Bile Duct Cancer

Bile duct cancer (cholangiocarcinoma) occurs when cells within bile ducts grow without order or control. Bile is a liquid produced by the liver to help in fat digestion. Bile drains from the liver via multiple bile ducts which coalesce into the main duct (common hepatic duct). The gallbladder connects to the common hepatic duct via the cystic duct which then drains into the common bile duct and duodenum (first part of small intestine).Bile duct cancer is divided into 3 types based on the location of the tumor:

  1. Intrahepatic – bile ducts within the liver
  2. Hilar – bile ducts just below the liver
  3. Distal – bile duct near where it joins the duodenum

This malignant growth has the potential to increase in size, invade surrounding structures and spread to other parts of the body. The hilar and distal cholangiocarcinoma types tend to block the ducts as they grow causing obstruction to the flow of bile from the liver to the intestine.

 

Risk factors

The following factors may increase your risk of developing bile duct cancer:

  1. Diseases that cause chronic inflammation in bile ducts i.e. primary sclerosing cholangitis, bile duct stones, choledochal cyst
  2. Age (older people have higher risk)
  3. Infection with liver fluke (parasite)
  4. Family history of bile duct cancer
  5. Obesity

 

Symptoms

In the early stages, bile duct cancer tends to be asymptomatic (no warning signs). As the cancer grows, the following symptoms may be experienced:

  1. Yellowing of the eyes and skin (jaundice)
  2. Tea-colored urine
  3. Pale stools
  4. Pain upper abdomen or back
  5. Poor appetite
  6. Weight loss
  7. Nausea or vomiting

Some of the above symptoms may be caused by other more common medical conditions; therefore it is important to seek medical attention if you have any of these symptoms.

 

Diagnosis

The first part of the diagnosis process is a medical evaluation of your symptoms, medical history and a physical examination by your doctor. After which, the following tests and investigations may be ordered:

  1. Blood tests
  2. CT (computed tomography) scan
  3. MR (magnetic resonance) scan
  4. Endoscopic retrograde cholangiopancreatogram (ERCP)
  5. PTC (percutaneous transhepatic cholangiogram)
  6. PET-CT (positron emission tomography-computed tomography)

 

Treatment

The results of the above investigations will determine the stage of the bile duct cancer. The stage is determined by the size of the cancer and extent of spread. Treatment of each stage usually involves a combination of the below therapies.

  1. Surgery
    For early stage bile duct cancer with no spread to other organs (resectable), the best chance for cure is surgical removal of the cancer. The following operation may be performed depending on the type and location of the tumor:

    1. Intrahepatic – resection of liver segments where the tumor is located, gallbladder
    2. Hilar – resection of bile ducts outside the liver, liver segments, gallbladder
    3. Distal – resection of bile ducts, head of the pancreas, duodenum, gallbladderOccasionally, surgery may be performed for relief of symptoms even if the cancer is unresectable (palliative) as it may cause blockage of the bile duct and stomach.
  2. Chemotherapy / Radiotherapy
    Chemotherapy is the primary form of treatment in unresectable cases of bile duct cancers. It, however, is also commonly used to complete treatment after surgical removal of cancer. These medications may be in the form of tablets or intravenous preparations. Chemotherapy may be combined with radiotherapy which is radiation treatment directed towards the cancer.

 

Prognosis

The best results of treatment are seen in patients who present to their doctor at the early stages of bile duct cancer as they will be amenable to surgical removal. Even in unresectable cases, treatment exists to prolong survival, relief symptoms and improve quality of life.