Cholangiocarcinoma, also known as bile duct cancer, is a cancer that can occur both inside and outside of the liver.
Though bile duct cancer is rare, approximately 2,000 to 3,000 people in the United States will develop bile duct cancer each year.
This type of cancer affects people that are often older with the average age of people diagnosed hovering around 70 years old.
If you or someone you love has recently been diagnosed with bile duct cancer, you know firsthand how frightening such a diagnosis can be.
Having an understanding of the disease you are facing is important so that you are aware of all of your options and how to proceed with gaining back your health.
Bile Duct Overview
Your liver makes a substance called bile that helps with digestion. The bile that is produced is sent to your gallbladder for storage until it is needed to digest fat.
When needed, your gallbladder will then push the bile into tubes called bile ducts. The bile ducts are a series of thin tubes that reach from the liver to the small intestine. Their major function is to carry the bile your gallbladder releases into the intestine for digestive purposes.
The top half of the bile duct is associated with the liver while the bottom half of the bile duct is associated with the pancreas. The left and right hepatic (liver) ducts exit from the liver and join to form the common hepatic (liver) duct.
Lower down, the gallbladder joins the common hepatic duct through a small duct called the cystic duct. This combined duct is called the common bile duct.
The common bile duct passes through part of the pancreas before it joins with the pancreatic duct and empties into the first part of the small intestine (the duodenum) where the breakdown of food, specifically fats, will begin.
This entire system of ducts leading from the liver, the gallbladder, passing the pancreas, and ultimately emptying in the small intestine are part of what is called the biliary system.
Symptoms/Causes of Bile Duct Cancer
As of now there is no known exact cause for bile duct cancer.
However, researchers have found that oftentimes those that have severely inflamed or irritated bile ducts often form bile duct cancer at some point. This inflammation or irritation can be caused by things such as bile duct stones (gallstones that have lodged in the bile ducts) or a parasitic infection.
Other factors that may contribute to your bile duct cancer diagnosis include:
- Being of Hispanic or Native American descent
- Family history of cancer, including bile duct cancer
- Old age
- Chemical exposures
- Some liver diseases
Unfortunately, not having a solid grasp on the actual causes of bile duct cancer creates a situation where prevention of the disease is almost out of your control. The goal is always to remain as healthy as possible in hopes that no form of disease, much less bile duct cancer, presents itself.
Bile duct cancer does not usually cause signs or symptoms until later in the course of the disease, however sometimes symptoms can appear sooner and lead to an early diagnosis. Some of these symptoms include:
- Light colored/greasy stool
- Dark urine
- Abdominal pain
- Loss of weight or appetite
- Nausea and/or vomiting
Bile Duct Cancer Diagnosis
Bile duct cancers resulting in tumors in the liver are varying in size, whereas tumors alongside the bile ducts and outside the realm of the liver tend to be smaller in size. These tumors are often slow-growing and have the ability to spread locally via the lymphatic system, as well as involve affect the blood vessels surrounding the liver.
Cancer can develop in any part of the bile duct system and, based on their location, are classified into 3 types:
Intrahepatic Bile Duct Cancer
This type occurs in the smaller bile duct branches inside the liver. It is sometimes confused with cancers that start in the liver cells so it is important to have a physician specializing in diseases of the liver and bile ducts diagnose your symptoms. Only about 1 in 10 bile duct cancers are intrahepatic, meaning inside the liver, making it the least common form.
Perihilar Bile Duct Cancer
Developing at the hilium, where the left and right hepatic ducts join and leave the liver, these tumors are sometimes called Klatskin tumors. They are the most common type of bile duct cancer, accounting for more than half of all bile duct cancers.
Distal Bile Duct Cancer
This cancer is found further down the bile duct, closer to the small intestine. Although not common, this type accounts for 2 to 3 of every 10 bile duct cancers.
There is no blood test that can specifically diagnose bile duct cancer. Your physician can however perform a variety of different tests to diagnose whether you have bile duct cancer or not:
- Imaging testing – including direct visuals of the bile ducts for abnormalities
- CT scans
- Biopsies of tissue to determine the pathology of the cells
Treatment for bile duct cancer depends on where the cancer is located and whether it is possible to be completely removed by surgery.
Unfortunately, those diagnosed with this cancer tend to be older and may be unable to tolerate and recover from a major operation.
There are other treatment options available however they are mainly palliative, rather than curative. This is a decision that must be discussed individually with your physician in order to determine the best possible treatment plan.
There are 4 major treatment options available for those diagnosed with bile duct cancer: Surgery, Chemotherapy, Radiation, and Endoscopic Retrograde Cholangiopancreatography (ERCP).
Although a major medical procedure, surgically removing the tumors (which may include a large portion of the liver and bile ducts) is the preferred method of potentially curing bile duct cancer so long as it has not spread to other areas of the body.
- Surgical removal of large portions of your liver is possible, as the liver is regenerative and restores itself thus compensating for its loss.
- Your bile duct cancer surgeon will be able to help provide you the information required to make such a major decision regarding your health.
A traditional and widely known treatment option for many types of cancer is chemotherapy.
- This process uses medicine to destroy cancer cells and is taken intravenously or orally.
- This option is sometimes used prior to surgery to shrink tumors before surgically removing them.
- Chemotherapy can be used before, during, and after surgery depending on your individual needs.
Also known as radiation, ablation involves high levels of heat aimed at the tumors.
- There are 3 types of ablation: Radiofrequency ablation (RFA), Microwave ablation, and Ethanol ablation.
This is the process is which the bile ducts are stented, keeping them open and free of blockages due to tumors so the bile can continue to secrete from the gallbladder and enter the small intestine.
- This helps only in controlling symptoms related to bile duct cancer (and other problems associated with the bile ducts); the tumors are not treated during this process.
There are other treatment options that are intended to preserve the quality of someone’s life if the cancer has progressed beyond a curative level.
For some people with bile duct cancer, treatment can remove or destroy the cancer. For others, the cancer may never go away completely. People with ongoing or recurring bile duct cancer may receive regular treatments of chemotherapy, radiation therapy, or other therapies to try to help keep the cancer under control and help relieve symptoms from it.
A diagnosis of bile duct cancer can be a daunting thing, especially if you have very little understanding of what that disease entails. Should you or someone you know suffer from bile duct cancer, consider contacting Dr. Fraiman to discuss further treatment options.
As the Chief of Hepatobiliary and Pancreatic Surgery in Baltimore, Maryland, Dr. Fraiman’s expertise in dealing with bile duct cancer, bile duct surgery, and bile duct cancer treatment will get you on your way to a healthy life in no time.