Bile duct cancer, also called cholangiocarcinoma is a rare type of cancer that develops in the slender tubes (bile ducts) that carry the digestive fluid– bile to your small intestine. It is common among people older than the age of 50.
It is an aggressive cancer that progresses very quickly, and is hard to treat. It can occur in the bile ducts that are either outside or inside the liver, but cancer of the bile duct outside the liver is most common. It causes signs and symptoms such as yellowing of the skin and eyes (jaundice), intense itchiness of the skin, fever, pain in the abdomen, and white-colored stools.
The treatment options include radiation therapy, chemotherapy, and surgery.
Although the exact cause of bile duct cancer is not known, researchers have found a link between certain risk factors such as irritation or inflammation of the bile ducts and bile duct cancer.
Inflammation may lead to changes in the DNA of cells, which results in abnormal growth of cells and development of cancers. There are some genes that control the growth of cells, cell division, and cell death. Genes that help in cell growth, division, and keeping them alive are called oncogenes. Genes that retard division of cells or help in death of cells at the right time are called tumor suppressor genes. Mutations in the DNA that cause activation of oncogenes and deactivation of tumor suppressor genes result in cancers. Actually, for a cancer to develop, there should be changes occurring in different genes.
Gene mutations that cause bile duct cancers are acquired during ones life rather than being inherited from parents. Acquired changes in the TP53 tumor suppressor gene are the reason for most bile duct cancers. Other genes that play a role in bile duct cancers include KRAS, HER2, and MET.
There are three standard treatment options for patients with bile duct cancer. These include:
Surgery: The surgical procedures used to treat bile duct cancer include:
- Surgical removal of the bile duct: This is indicated if the tumor is small and confined to the bile duct only. During the procedure, lymph nodes are removed and tissue from the lymph nodes is viewed under a microscope to check if there is cancer.
- Partial hepatectomy: In this procedure, the portion of the liver with cancer is removed. The resected part may in the form of a wedge if tissue, an entire lobe, or larger part of the liver along with some normal tissue.
Whipple procedure: In this surgical procedure, the head of the pancreas, the gallbladder, portion of the stomach and small intestine is removed along with the bile duct.
Some patients may be given chemotherapy or radiation therapy after the surgery to destroy any remaining cancer cells. Treatment given after the surgery, to lower the risk of recurrence is called adjuvant therapy.
Palliative surgical procedures performed to relieve the symptoms caused by a blocked bile duct and improve your quality of life are:
Biliary bypass: A surgical procedure which involves connecting the part of the bile duct before the blockage to the part of the bile duct past the blockage or to the small intestine. This makes bile to flow easily to the gallbladder or small intestine.
Stent placement: This involves placing a stent (a thin, flexible tube or metal tube) in the bile duct so as to open it, and allow bile to flow into the small intestine or through a catheter that is connected to a collection bag outside the body.
Percutaneous transhepatic biliary drainage: A thin needle is inserted through the skin just below the ribs so that it reaches the liver. A special dye is injected into the liver or bile ducts and an X-ray is taken. If there is blockage in the bile duct, a thin, flexible tube called a stent is left in the liver to drain off bile into the small intestine.
Radiation therapy: This type of treatment uses high-energy X-rays or other types of radiation to destroy the cancer cells or prevent their growth. The two types of radiation therapy include:
External radiation therapy: It uses a machine placed outside the body to send radiation towards the cancer.
Internal radiation therapy: It uses radioactive substances sealed in objects such as needles, seeds, wires, or catheters that are placed directly into or close to the cancer.
In unresectable, metastatic, or recurrent bile duct cancers, new methods that improve the effect of external radiation therapy on cancer cells are being studied.
Hyperthermia therapy: In this therapy, the body tissue is exposed to high temperatures so that the cancer cells become more sensitive to the effects of radiation therapy and certain anticancer drugs.
Radiosensitizers: These are drugs that make the cancer cells more sensitive to radiation. Combining radiation therapy with radiosensitizers may help to kill more cancer cells.
Chemotherapy: Chemotherapy is a type of cancer treatment that makes use of drugs to stop the uncontrolled growth of cancer cells, either by killing these cells or by preventing their division. There are two routes to administer anticancer drugs. These include:
Systemic chemotherapy: The drugs are either taken by mouth or injected into a vein or muscle. Once drugs enter the blood circulation, they can reach cancer cells all throughout the body. Therefore, it is used to treat unresectable, metastatic, or recurrent bile duct cancer.
Regional chemotherapy: The drugs are injected directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen. These drugs can affect the cancer cells in those areas.
There are different ways to adapt your lifestyle in coping with bile duct cancer.
Treatment in some people with bile duct cancer may completely remove or destroy the cancer. Completion of treatment may be both exciting as well as stressful. You may find it difficult to handle the fear of cancer coming back. This is a common concern in cancer survivors. It may take some time for your fears to disappear.
In people with cancer that has not resolved completely, regular treatment with chemotherapy, radiation therapy, or other therapies is suggested to keep the cancer under control and help alleviate your symptoms. Coping with the uncertainty of cancer that does not go away may be hard and stressful.
Even if you have completed your cancer treatment, your doctors may want to keep you under close observation. It is very important to go to your follow-up appointments to doctor. During these visits, your doctors will examine you and may order laboratory tests, X-rays, and scans to check for signs of cancer or side effects of treatment.