Bile Duct Cancer

Also called cholangiocarcinomaor malignant 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.

The bile 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.

Bile Duct Cancer Causes and Risks 

Certain factors increase the risks for a person to be diagnosed with cancer of the bile ducts; among them include: 

  • Liver cirrhosis – scarring of liver tissue 
  • Parasitic infection – infection by a parasite such as Clonorchis sinensis (C. sinensis ) and Opisthorchis viverrini (O. viverrini )
  • 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 liver.

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 

Bile duct cancer barely causes warning signs in the early stages of the disease. Symptoms usually appearwhen 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:

  • Anorexia (loss of appetite)
  • Nausea and Vomiting
  • decline in general health with weight loss.
  • Yellow 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 these options.

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:

  • 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 ).

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):  

  • another surgery
  • chemotherapy
  • chemotherapy and radiotherapy ( chemoradiation )
  • radiotherapy only
  • chemoembolization
  • radioembolisation by hepatic artery based yttrium -90

Chemotherapy – 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:

  • 5 – fluorouracil (5- FU , Adrucil )
  • gemcitabine ( Gemzar )
  • capecitabine (Xeloda )
  • cisplatin ( Platinol AQ)

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 radiotherapy )
  • 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

Clinical Trials – Clinical trials are designed to find better methods of prevention, detection and treatmentof 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:

  • liver cancer
  • cancer of the gallbladder
  • other gastrointestinal cancers
  • advanced or metastatic

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