stenosis of the bile duct, the bile duct cancer is a rare medical condition that affects mostly people aged 50 or over.
Depending on the group of
cells affected, the cancer can be known as
intrahepatic cancer (inside the liver) or
extrahepatic bile duct cancer (outside the liver). As its name
suggests, this disease is characterized by stenosis, abnormal
narrowing of the blood vessel or
structureof the bile duct preventing bile flow from the site of production (the liver) to the gallbladder and intestines.
ducts are channel set collecting bile synthesized in the liver to its flow into the duodenum. After its secretion by cells of the liver, bile flows through the slender tubes into a single channel (bile duct) leading to the duodenum. The gallbladder is a small reservoir in the path of bile which is used as its "storage" between its excretion in the digestive tract. The cancer occurs when a group of cells starts
to reproduce abnormally to form a malignant mass.
Cancer Causes and Risks
Certain factors increase the risks for a person to be diagnosed with cancer of the bile ducts; among them
Liver cirrhosis -
scarring of liver tissue
Parasitic infection -
infection by a parasite
such as Clonorchis sinensis (C. sinensis ) and Opisthorchis viverrini (O.
Infection with hepatitis C – this infection plays a more active role
in developing intrahepatic bile duct cancer than in the extrahepatic bile ducts
Intrahepatic gallstones (hepatolithiasis ) – the stones can cause
chronic inflammation of the bile ducts inside the liver, leading to cancer
Primary sclerosing cholangitis (PSC ) – this disease causes
inflammation and subsequent obstruction
of the bile duct (cholangitis), which leads to the formation of scar tissue (sclerosis) inside the
Intrahepatic bile duct cancers are more common in Asian countries. The incidence of cancer of the intrahepatic bile
ducts increases worldwide, while the incidence of cancer of the extrahepatic bile ducts remains constant. This
suggests that different risk factors may come into play for each type of these cancers
Bile Duct CancerSymptoms
duct cancer barely causes warning signs in the early stages of the disease. Symptoms usually appear when the cancer grows and evolves. Other medical conditions can cause the same signs and symptoms. That is, even these signs and symptoms are present this does not necessarily mean a person has the cancer. However, it is important to consult a doctor if you feel any of the following symptoms:
(loss of appetite)
Nausea and Vomiting
decline in general health with weight loss.
color of the skin and/or whites of the eyes(jaundice)
Intense pruritus (severe itching)
Pain in the right upper quadrant (area right below the navel straight floating ribs).
Bile Duct CancerTreatment
There is no unique
treatment for the disease. Every person who has cancer of the bile ducts has a personalized treatment plan
established by his health care team. Treatment options recommended is based on the specific characteristics of the cancer
and the particular needs of the patient. The intrahepatic bile duct cancer is usually treated in the same way as a primary
carcinoma of the liver, or hepatocellular carcinoma. A plan for cancer treatment of intrahepatic bile ducts may include one or more of
Surgical Treatment - Complete surgical removal (resection) of the tumor generates the best outcome. During
surgery, the surgeon removes the liver or liver segment along with the bile duct where the tumor
locates. This is often a liver resection (partial hepatectomy). The Number of liver tissue
removed is determined by the location of the tumor and its stage (the amount of affected tissue). Sometimes
the surgeon must remove an entire lobe of the liver (hepatic lobectomy) to facilitate survival. But resection
with negative surgical margins, (so that cancer cells in any normal tissue is removed with the tumor) is the
most important factor in achieving a long-term survival.
Liver transplantation is usually not an option for most people with cancer of the
intrahepatic bile ducts due to high rate of recurrence and the rapid spread (metastasis) of these
tumors. Many patients suffering with cancer of the
intrahepatic bile ducts cannot have surgery because the disease is too advanced and they are in poor health
when they are diagnosed.
Surgery to remove the
entire tumor is not an option. The cancer is not resectable if cancer is present:
The intrahepatic bile duct
cancer tends to recur after surgery, but the role of further treatment or adjuvant after surgery has not been
established. The following additional treatments can be
recommended to get rid of cancer cells after surgery (residual disease):
throughout both lobes of the
liver or outside the liver
in the blood vessels of the
liver, such as hepatic artery or the portal vein
in the lymph nodes or distant
sites ( metastatic bile duct cancer ).
- Chemotherapy is offered to people with cancer which cannot be removed by surgery or whose
cancer is metastatic if they are well enough to tolerate treatment. It is possible to administer a single
chemotherapeutic agent or combination of different regimens (polychemotherapy). Chemotherapeutic agents most
commonly used to treat bile duct cancer of the intrahepatic bile ducts are the same as those given to treat
cancer of the extrahepatic bile ducts:
Radiation Therapy -
It is possible that your health care provider decides to administer external radiotherapy or brachytherapy
(internal radiation therapy) to treat cancers of the intrahepatic or extrahepatic bile ducts. Radiation therapy may
be used to:
treat unresectable bile duct cancer
relieve pain or control the symptoms of advanced cancer of the intrahepatic bile ducts ( palliative
control a located cancer of intrahepatic bile ducts.
Certain patients may be given radiation therapy that uses more targeted technical and higher doses (conformal
radiotherapy or stereotactic radiotherapy). The benefits of radiation to control located cancer of the intrahepatic
bile ducts have not been demonstrated in clinical trials
trials are designed to find better methods of prevention, detection and treatment of cancer. Some clinical trials on cancer of the intrahepatic bile ducts are underway in Canada as well as USA and accepting participants. Clinical trials for bile duct cancer may be given to those who have: