Bile Duct Cancer

Risk Factors

Bile Duct Cancer develops in the cells that line the bile ducts, both inside and outside the liver. It mostly affects people over the age of 40 and is more common in men than in women. Bile Duct Cancer often occurs from glandular tissue and is referred to as adenocarcinoma. Cancer that occurs from the bile duct with in the liver is referred to intra-hepatic, while those that occur outside the liver are called extra-hepatic The cause of Bile Duct Cancer is unclear, however below may be some contributing factors

  • choledochal cysts
  • the liver fluke
  • Sclerosing Cholangitis

Bile Duct cancer causes lead to Bile Duct obstruction, causing unwanted elements to flow into the bloodstream or tissues, which can lead to yellow pigmentation, also known as jaundice. Symptoms may include urine discoloration (dark urine), pale feces, skin irritation, abdominal pain, lack of appetite, fever, and unexplained weight loss.

Diagnosis

  • Ultrasound
  • CT scan
  • MRI
  • ERCP
  • PTC
  • Biopsy

Stages

  • Stage 1A Cancer is limited to bile duct area
  • Stage 1B Cancer has spread to out of bile duct but not yet to lymph nodes or surrounding organs
  • Stage 2A Cancer has spread to liver pancreas, or nearly by blood vessels. However, it has not spread to lymph nodes.
  • Stage 2B Cancer has spread to nearby lymph nodes
  • Stage 3 Cancer has spread to main arteries that are responsible for blood circulation in and out of the liver. Or it may have spread to the small or large intestine, stomach, stomach linings, as well as lymph nodes in stomach area.
  • Stage 4 Cancer has spread significantly for example to the lungs

Treatment

Surgery

Surgical treatment is considered when the cancer has not spread out of the bile duct to the lymph nodes. During surgery, affected bile ducts will be removed and unaffected parts will be used to connect the liver and small intestine to promote normal function. If the cancer has spread, it may be necessary to remove parts of the liver, stomach, upper part of the small intestine, pancreas, and some lymph nodes. Surgical treatment for bile duct cancer may include: cholecysto-jejunostomy or cholecystoduodenostomy and hepatico-jejunostomy for the establishment of a communication between the gallbladder and the jejunum Gastrojejunostomy is a surgical procedure in which an anastomosis is created between the stomach and the proximal loop of the jejunum. This is usually done either for the purpose of draining the contents of the stomach or to provide a bypass for the gastric contents.

Non-Surgical treatment

There are two types of non-surgical treatment which involves remove bile duct blockage, rather than removal of the cancer itself.

  • ERCP (endoscopic retrograde cholangiopancreatography) is a non-invasive means of diagnosing and treating the cancer which can be used if for any reason the patient cannot undergo surgery to remove the tumor. Involves a 2-4 inches insertion of endoscope.
  • PTBD is a specialized procedure done to relieve blockages in the bile ducts without having to perform surgery. This procedure will not cure the disease causing the blockage in your bile ducts.
Radiotherapy

Radiotherapy may be required which may include external beam therapy or internal beam therapy (brachytherapy).

Chemotherapy

Chemotherapy is used if the cancer cannot be completely removed or after the surgery has been performed so as to increase the chance of a complete cure.

Author

Dr. Wutthi Sumetchotimaytha Surgical Oncologist