Bile Duct Cancer (Cholangiocarcinoma)

Bile Duct Cancer Treatment & Surgery at CMC

The bile ducts are a series of networks of tubes that carry bile, a digestive juice, from the liver, where it is produced, to the gallbladder, where it is stored. Bile is sent to the gut via ducts from the gallbladder, where it aids in digestion.

Bile duct cancer typically develops in the bile ducts that are located outside of the liver. Rarely does the malignancy manifest itself in hepatic ducts.

Types of Bile Duct Cancer

There are mainly two types of bile duct cancer:

• Intrahepatic bile duct cancer: Also known as intrahepatic cholangiocarcinoma, intrahepatic bile duct cancer is a type of cancer that occurs in the bile ducts inside the liver.
• Extrahepatic bile duct cancer: Here the cancer develops in the bile ducts outside the liver. The two types of extrahepatic bile duct cancer include:
• Perihilar bile duct cancer: This type of cancer develops in the common hepatic duct, which is formed when the right and left bile ducts combine.
• Distal bile duct cancer: It forms near the point where the common bile duct and ducts from the gallbladder and liver converge.

Causes and Risk Factors of Bile Duct Cancer

It is not yet established the exact cause of bile duct cancer. However, it is thought that chronic parasite infections and bile duct inflammation are likely to be contributing factors. Other risk factors of bile duct cancer include:

• Bile duct infection
• Exposure to chemicals especially those used in industries like aircraft manufacturing
• Rare diseases such as papillomatosis, primary sclerosing cholangitis, hepatitis, or lynch syndrome
• Ulcerative colitis: A long-term condition where the colon and the rectum become inflamed
• Liver fluke infections

Signs and Symptoms of Bile Duct Cancer

• Itchy skin
• Fever
• Nausea and vomiting
• Weight loss that is unintentional
• Jaundice (yellowing of the skin or whites of the eyes)
• Dark urine
• Abdominal pain

Diagnosis of Bile Duct Cancer

To diagnose bile duct cancer. the doctor conducts a physical examination of the patient, then blood tests to look for tumor markers and to check how well the patient’s liver is functioning are also performed. Other tests include:

• Imaging tests like ultrasound, CT, and MRI scans to get detailed pictures of the patient’s bile ducts and the areas around them.
• An endoscopic retrograde cholangiopancreatography (ERCP): The surgeon during the procedure inserts a long tube with a camera into the patient’s throat and into the part of his/her gut where the bile ducts open.
• Percutaneous transhepatic cholangiography (PTC): During this procedure, the doctor takes X-rays after injecting dye into the patient’s liver.

Treatment of Bile Duct Cancer

Treatment for bile duct cancer is determined by the location and size of the patient’s tumor, the extent to which it has spread, and the state of his/her overall health.

Surgery

With early diagnosis, when the cancer hasn’t spread beyond the patient’s liver, surgical treatment becomes the recommended option. Occasionally, if the tumor is confined to the bile duct, the patient may only need to have the ducts removed. However, if the malignancy has spread beyond the ducts and into the liver, only part or the entire liver will have to be removed.