Bile duct cancer (cholangiocarcinoma) occurs when cancer cells accumulate in the bile ducts. Your biliary tract helps bile travel through the liver, gallbladder, pancreas and small intestine so food can be digested.
Bile duct cancer is rare, with only about 8,000 cases diagnosed each year, according to the American Cancer Society. Most cases are in people 70 years or older but can occur earlier in those with risk factors.
The types of bile duct cancer are:
- Extrahepatic bile duct cancer, which is in the bile ducts outside of the liver. There are two subtypes: distal bile duct cancer, which is where the common bile duct is formed from the bile ducts from the gallbladder and liver, and perihilar bile duct cancer, which is where the common hepatic duct forms from the left and right bile ducts leaving the liver.
- Intrahepatic bile duct cancer, which is in the bile ducts in the liver. This is the rarest type of bile duct cancer.
Risk Factors
Risk factors for bile duct cancer include the following:
- Primary sclerosing cholangitis, a progressive disease where the bile ducts become blocked by inflammation and scarring)
- Chronic ulcerative colitis
- Stones or cysts in the bile ducts, which block the flow of bile and can cause swollen bile ducts, inflammation and infection
- Hepatitis C and B, with or without liver cirrhosis
- Infection with a Chinese liver fluke parasite
Symptoms
Symptoms of bile duct cancer may include:
- Unintentional weight loss or loss of appetite
- Vomiting and nausea
- Feeling itchy
- Fever
- Abdominal pain
- Pale grayish-white color or greasy stool
- Dark or tea-colored urine
- Jaundice (the yellowing of the whites of your eyes or your skin)
Diagnosis
Your provider may use any of the following to determine if you have bile duct cancer:
- Physical health examination
- Blood tests to measure your liver function, check for tumor markers (proteins that can be found in tissues or body fluids) and more
- Imaging (ultrasound, CT scan or MRI)
- Biopsy to obtain a tissue sample
Prognosis
The outlook of bile duct cancer varies depending on:
- Whether the cancer is recurring or was just diagnosed for the first time
- Tumor marker levels
- Other health conditions
- Whether surgery can remove the cancer
- Whether the cancer has spread to other sites in the body
- Whether the cancer is in the lower or upper bile duct system
In most cases, bile duct cancer is found at later stages when it has spread to other parts of the body. There is no universal screening for this type of cancer.
Because of the small size and deep location of the cancer, it will be difficult to feel it on a physical exam. There are also no blood tests to diagnose this. A later stage can worsen the prognosis, but there are still several treatment options available.abigai
Treatment
If bile duct cancer is found, there are multiple treatment options that can be used depending on the type and stage of the cancer.
Surgical options to remove bile duct cancer include:
- Removing the bile duct if the tumor is only in the bile duct and is small
- Removing part of the liver if cancer is present in the liver
- Removing the bile duct, part of the intestine, the gallbladder, nearby lymph nodes, and the head of the pancreas if the cancer is more expansive
Surgical options to improve symptoms a blocked bile duct causes include:
- Endoscopic stent placement, which allows bile to go from the blocked duct and drain into the small intestine
- Biliary bypass, which makes a new pathway by cutting an unblocked area of the gallbladder or bile duct and sewing it to the small intestine or an area of the bile duct past the blockage
- Biliary drainage with a tube to allow bile to flow out from a blocked bile duct into a collection bag outside the body
Once the blockage has been resolved, additional treatment options could be:
- Surgical options (listed above)
- Liver ablation (destroying tumors in the liver)
- Trans-arterial chemoembolization (TACE), which delivers chemotherapy to the specific area
- Trans-arterial radioembolization (TARE), which delivers radiation to the specific area
- Liver transplant in early stage or intrahepatic or perihilar bile duct cancers that cannot be removed with surgery
- Radiation therapy, which can be combined with chemotherapy or used alone
- Systemic therapy in the form of chemotherapy, immunotherapy or targeted therapy
- Chemotherapy is a cancer-killing drug aimed to decrease the size of the cancer before or after surgery, or help slow down the spread of the cancer
- Immunotherapy helps to educate the immune system to recognize and destroy the cancer cells and is typically used alongside chemotherapy
- Targeted therapies are drugs developed to target the mutations which caused the cancer to develop
- Enrollment in clinical trials
Talk to your provider to discuss these options and see what is appropriate for your type and stage of bile duct cancer.
UofL Health – Brown Cancer Center is Here for You
The Multidisciplinary Gastrointestinal Cancer Clinic team at UofL Health – Brown Cancer Center has years of experience treating bile duct cancer with surgery, radiation and chemotherapy. Call 502-562-HOPE (4673) to learn more and make an appointment.
