Bile duct cancer (cholangiocarcinoma) occurs when a malignant (cancerous) tumor grows in one of the ducts that transport bile from the liver to the small intestine. It is rare but aggressive type of cancer.
The bile duct system, or ‘biliary’ system, is made up of a series of tubes that begin in the liver and end in the small intestine. Bile is a fluid the digestive system uses to help break down fats and digest foods.
Doctors divide Bile duct cancer into different types based on where the cancer occurs in the bile ducts:
*Intrahepatic Bile duct cancer occurs in the parts of the bile ducts within the liver and is sometimes classified as a type of liver cancer.
*Hilar Bile duct cancer occurs in the bile ducts just outside of the liver. This type is also called perihilar cholangiocarcinoma.
*Distal Bile duct cancer occurs in the portion of the bile duct nearest the small intestine. This type is also called extrahepatic cholangiocarcinoma.
Bile duct cancer is often diagnosed when it’s advanced, making successful treatment difficult to achieve.
In most cases, there are no signs of bile duct cancer until it reaches the later stages, when symptoms can include:
*jaundice – yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine
*Unintentional weight loss/or progressive weakness
The exact cause of bile duct cancer is unknown, although some things can increase the risk of developing the condition.
Cancer begins with a change (mutation) in the structure of the DNA in cells, which can affect how they grow. This means that cells grow and reproduce uncontrollably, producing a lump of tissue called a tumour.
If left untreated, cancer can grow and spread to other parts of your body, either directly or through the blood and lymphatic system.
Factors that may increase your risk of cholangiocarcinoma include:
*Primary sclerosing cholangitis. This disease causes hardening and scarring of the bile ducts.
*Chronic liver disease. Scarring of the liver caused by a history of chronic liver disease increases the risk of cholangiocarcinoma.
*Bile duct problems present at birth. People born with a choledochal cyst, which causes dilated and irregular bile ducts, have an increased risk of cholangiocarcinoma.
*A liver parasite. In areas of Southeast Asia, cholangiocarcinoma is associated with liver fluke infection, which can occur from eating raw or undercooked fish.
*Older age. Bile duct cancer occurs most often in adults over age 50.
*Smoking. Smoking is associated with an increased risk of Bile duct cancer.
*Diabetes. People who have type 1 or 2 diabetes may have an increased risk of Bile duct cancer.
*Certain inherited conditions. Some DNA changes passed from parents to children cause conditions that increase the risk of Bile duct cancer. Examples of these conditions include cystic fibrosis and Lynch syndrome.
To diagnosis the patient may have to undergo one or more of the following tests:
*Liver function tests. Blood tests to measure the liver function can give the doctor clues about what’s causing the signs and symptoms.
*Tumor marker test. Checking the level of carbohydrate antigen (CA) 19-9 in blood may give the doctor additional clues about diagnosis. CA 19-9 is a protein that’s overproduced by bile duct cancer cells.
*A high level of CA 19-9 in blood doesn’t mean the patient has bile duct cancer, though. This result can also occur in other bile duct diseases, such as bile duct inflammation and obstruction.
*A test to examine your bile duct with a small camera. During endoscopic retrograde cholangiopancreatography (ERCP), a thin, flexible tube equipped with a tiny camera is passed down your throat and through the digestive tract to the small intestine. The camera is used to examine the area where the bile ducts connect the small intestine.The doctor may also use this procedure to inject dye into the bile ducts to help them show up better on imaging tests.
*Imaging tests. Imaging tests can help the doctor see internal organs and look for signs of cholangiocarcinoma. Techniques used to diagnose bile duct cancer include ultrasound, computerized tomography (CT) scans and magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP). MRCP is increasingly being used as a noninvasive alternative to ERCP. It offers 3D images without the need for a dye to enhance the images.
*A procedure to remove a sample of tissue for testing. A biopsy is a procedure to remove a small sample of tissue for examination under a microscope.
If the suspicious area is located very near where the bile duct joins the small intestine, the doctor may obtain a biopsy sample during ERCP. If the suspicious area is within or near the liver, the doctor may obtain a tissue sample by inserting a long needle through your skin to the affected area (fine-needle aspiration). He or she may use an imaging test, such as an endoscopic ultrasound or CT scan, to guide the needle to the precise area.
How the doctor collects a biopsy sample may influence which treatment options are available to you later. For example, if the bile duct cancer is biopsied by fine-needle aspiration, the patient will become ineligible for liver transplantation.
If the doctor confirms a diagnosis of cholangiocarcinoma, he or she tries to determine the extent (stage) of the cancer. Often this involves additional imaging tests. Your cancer’s stage helps determine the prognosis and the treatment options.
Treatments for cholangiocarcinoma (bile duct cancer) may include:
Surgery. When possible, surgeons try to remove as much of the cancer as they can. For very small bile duct cancers, this involves removing part of the bile duct and joining the cut ends. For more-advanced bile duct cancers, nearby liver tissue, pancreas tissue or lymph nodes may be removed as well.
*Liver transplant. Surgery to remove your liver and replace it with one from a donor (liver transplant) may be an option in certain situations for people with hilar cholangiocarcinoma. For many, a liver transplant can be a cure for hilar cholangiocarcinoma, but there is a risk that the cancer will recur after a liver transplant.
*Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be used before a liver transplant. It may also be an option for people with advanced cholangiocarcinoma to help slow the disease and relieve signs and symptoms. Chemotherapy drugs can be infused into a vein so that they travel throughout the body. Or the drugs can be administered in a way so that they are delivered directly to the cancer cells.
*Radiation therapy. Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy can involve a machine that directs radiation beams at your body (external beam radiation). Or it can involve placing radioactive material inside your body near the site of your cancer (brachytherapy).
*Targeted drug therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your doctor may test your cancer cells to see if targeted therapy may be effective against your cholangiocarcinoma.
*Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process. For cholangiocarcinoma, immunotherapy might be an option for advanced cancer when other treatments haven’t helped.
*Heating cancer cells. Radiofrequency ablation uses electric current to heat and destroy cancer cells. Using an imaging test as a guide, such as ultrasound, the doctor inserts one or more thin needles into small incisions in your abdomen. When the needles reach the cancer, they’re heated with an electric current, destroying the cancer cells.
*Photodynamic therapy. In photodynamic therapy, a light-sensitive chemical is injected into a vein and accumulates in the fast-growing cancer cells. Laser light directed at the cancer causes a chemical reaction in the cancer cells, killing them. You’ll typically need multiple treatments. Photodynamic therapy can help relieve your signs and symptoms, and it may also slow cancer growth. You’ll need to avoid sun exposure after treatments.
Biliary drainage. Biliary drainage is a procedure to restore the flow of bile. It might involve placing a thin tube into the bile duct in order to drain the bile. Other strategies include bypass surgery to reroute the bile around the cancer and stents to hold open a bile duct being collapsed by cancer. Biliary drainage helps relieve signs and symptoms of cholangiocarcinoma.
Because cholangiocarcinoma is a very difficult type of cancer to treat, don’t hesitate to ask about your doctor’s experience with treating the condition. If you have any doubts, get a second opinion.
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Prognosis: The outlook (prognosis) for people with cholangiocarcinoma is usually poor. The five-year survival rate for bile duct cancer that hasn’t spread outside of the bile ducts is 10% to 15%. This rate drops to 2% if the cancer spreads to areas of the body that are far from the bile ducts, such as the lungs. But newer treatments mean these rates will improve over time.
To reduce your risk of cholangiocarcinoma, you can:
*Stop smoking. Smoking is linked to an increased risk of cholangiocarcinoma. If you smoke, stop. If you have tried quitting in the past and haven’t been successful, talk with your doctor about strategies to help you quit.
*Reduce your risk of liver disease. Chronic liver disease is associated with an increased risk of cholangiocarcinoma. Some causes of liver disease can’t be prevented, but others can. Do what you can to take care of your liver.
For instance, to reduce your risk of liver inflammation (cirrhosis), drink alcohol in moderation, if you choose to drink. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men. Maintain a healthy weight. When working with chemicals, follow the safety instructions.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.