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Symptoms Of Bile Duct Cancer

Types Of Bile Duct Cancer

Symptoms & Types of Bile Duct Cancers | Dr. Sanjay Goja

The types of bile duct cancer are named after the part of the bile duct where the cancer started.

Intrahepatic bile duct cancers

A team of doctors and healthcare professionals who specialise in treating bile duct cancer work together to plan your treatment. This is called a multidisciplinary team .

The treatment you have depends on:

  • the type of bile duct cancer you have
  • the size of the cancer
  • whether the cancer has spread to other areas of the body
  • your general health
  • your preferences.

Some people may be offered treatment to try to cure the cancer. This involves surgery, often followed by chemotherapy. If it is not possible to cure the cancer, you can have treatment to control the growth and help with symptoms. This may be with chemotherapy and sometimes radiotherapy.

Your cancer doctor or nurse will talk to you about your treatment options:Sometimes radiotherapy is given on its own or in combination with chemotherapy to reduce the risk of cancer coming back after surgery. It may also be used to treat symptoms caused by bile duct cancer.

You may also have treatments as part of a clinical trial.

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Microwave Ablation Radiofrequency Ablation And Cryoablation

In these minimally invasive procedures, special needles are inserted directly into the tumor to kill cancer cells with extreme heat or freezing. These procedures can be used instead of open surgery to remove the cancer. They can also be used to treat nearby nerves to relieve pain and other side effects of cancer.

Our cancer doctors work to develop new therapies and novel approaches to treating cancer and related symptoms through our clinical trials, which includes bile duct cancer. View our ongoing clinical trials to see if you can participate in these studies.

These procedures help relieve bile duct cancer pain and jaundice.

Bile Duct Cancer Treatment

You might have one or more of these treatments:

Biliary drainage. If your bile duct is blocked, your doctor may do a bypass, cutting it off and reattaching it on the other side of the blockage. They could also put a tube called a stent into the duct to keep bile flowing.

Your doctor injects an inactive form of a certain medication into your vein. The drug tends to collect in more cancer cells than healthy cells. After a few days, they use an endoscope to aim a special light at the tumor. It activates the drug, killing the cancer cells.

Radiation. This uses high-energy rays or particles to kill cancer cells. Your doctor may use it before surgery to shrink a tumor. After surgery, it can kill any cancer cells that remain. If your doctor canât remove the cancer but it hasnât spread, radiation can help keep it under control.

Chemotherapy. As with radiation, doctors often use medicines to kill cancer cells before or after surgery. You can take chemo by mouth or through a shot into a vein.

Surgery. Depending on the cancerâs spread, your doctor might need to remove some or all of your bile duct, lymph nodes, liver, pancreas, or small intestine.

Liver transplant. This is a rare treatment that can sometimes cure bile duct cancer. Your doctor might use chemo and radiation while you wait for a new liver.

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How Is Cholangiocarcinoma Diagnosed

Your doctor will perform a physical examination and may take blood samples. Blood tests can check how well your liver is functioning and can be used to look for substances called tumor markers. Levels of tumor markers might rise in people with cholangiocarcinoma.

You may also need imaging scans such as an ultrasound, CT scan, and MRI scan. These provide pictures of your bile ducts and the areas around them and can reveal tumors.

Imaging scans can also help to guide your surgeons movements to remove a sample of tissue in what is called an imaging-assisted biopsy.

A procedure known as an endoscopic retrograde cholangiopancreatography is sometimes done. During ERCP, your surgeon passes a long tube with a camera down your throat and into the part of your gut where the bile ducts open. Your surgeon may inject dye into the bile ducts. This helps the ducts show up clearly on an X-ray, revealing any blockages.

In some cases, theyll also pass a probe that takes ultrasound pictures in the area of your bile ducts. This is called an endoscopic ultrasound scan.

In the test known as percutaneous transhepatic cholangiography , your doctor takes X-rays after injecting dye into your liver and bile ducts. In this case, they inject the dye straight into your liver through the skin of your abdomen.

Your treatment will vary according to the location and size of your tumor, whether it has spread , and the state of your overall health.

What Affects Bile Duct Cancer Prognosis

Bile Duct Cancer Symptoms

Once bile duct cancer has been diagnosed, the prognosis and treatment options depend on the following:

  • whether the cancer is in the upper or lower part of the bile duct system
  • theâ¯stageâ¯of the cancer
  • whether the cancer has spread to nearby nerves or veins
  • whether the cancer can be completely removed by surgery
  • whether the patient has other conditions, such as primary sclerosing cholangitis
  • whether the level of CA 19-9 is higher than normal
  • whether the cancer has just been diagnosed or hasâ¯recurredâ¯

Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery.â¯â¯may relieve symptoms and improve the patient’sâ¯quality of life.

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How Is Cholangiocarcinoma Staged

A biopsy tells your healthcare provider if you have cancer, but it can also tell them the cancers stage. Staging is the process of finding out how much cancer is in your body. This information helps your healthcare provider plan treatment. For bile duct cancer, staging looks at the size of the tumor and whether cancer has spread from the bile ducts to the:

  • Lymph vessels and lymph nodes.
  • Organs near the bile ducts, such as the liver or gallbladder.
  • Distant organs, such as the lungs, bones or abdominal cavity .

Our Team Approach Leads To Timely Diagnoses And State

If you have symptoms of a bile duct tumor, our Pancreas and Liver Disease Program can provide you with expert care. Our gastroenterologists work in close partnership with other specialists, including experts in gastroenterology, pathology, radiology, surgical, medical, and radiation oncology, and interventional radiology. In addition to providing the standard of care for diagnosing and treating bile duct cancer, this multidisciplinary team of experts collaborates to develop and pioneer novel treatment options, including complex surgical techniques and innovative therapies. This ensures you have access to the most advanced care, sometimes years before it’s available elsewhere.

The liver produces a fluid called bile, which is stored in the gallbladder and used for digestion within the small intestine. Bile moves through the body through small tubes called bile ducts. A bile duct tumor is an abnormal growth that may be benign or malignant . It can affect the bile ducts inside the liver or outside the liver . Most gallbladder tumors are benign, but malignant tumors may be indicative of this type of cancer, also called biliary cancer or cholangiocarcinoma.

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Bile Duct Cancer Causes And Risk Factors

Experts arenât sure what causes bile duct cancer. Research shows that certain things can raise your chances of getting it, including long-term inflammation from conditions including:

Primary sclerosing cholangitis. This inflammation of your bile duct leads to scarring. Doctors donât know what causes it. Many people who have it also have ulcerative colitis, an inflammation of the large intestine.

Bile duct stones. These are similar to gallstones but much smaller.

Choledochal cysts. Some people are born with a rare condition that causes bile-filled sacs along your bile ducts. Without treatment, they may lead to bile duct cancer.

Liver fluke infection. This is rare in the U.S. but more common in Asia. It happens when people eat raw or poorly cooked fish thatâs infected with tiny parasitic worms called liver flukes. They can live in your bile ducts and cause cancer.

Reflux. When digestive juices from your pancreas flow back into your bile ducts, they canât empty properly.

Cirrhosis. Alcohol and hepatitis can damage your liver and cause scar tissue, raising the risk of bile duct cancer.

Other things that can make you more likely to get bile duct cancer include:

Bile And The Bile Ducts

Gall Bladder And Bile Duct Cancer Are Rare But Deadly

The bile ducts are part of the digestive system. They are the tubes that connect the liver and gallbladder to the small bowel. Bile ducts carry bile.

Bile breaks down fats in food to help us digest them. It is made by the liver and stored in the gallbladder. The bile ducts and gallbladder together are known as the biliary system .

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What Are The Stages Of Bile Duct Cancer

Doctors use the TNM staging system for most cancers. They stage cancer using the Roman numerals I-IV. This system is complex for stages of bile duct cancers and differs for each type. Doctors still use it, but they usually discuss treatment using a simpler method.

To plan treatment, doctors classify bile duct cancers into two categories:

  • Resectable: Doctors should be able to completely remove the bile duct cancer with surgery.
  • Unresectable: This means cancer has spread too far for surgery to be successful.

Doctors will determine whether a cancer is resectable or not by looking at its spread:

  • Local: The cancer is only within the bile duct and is usually resectable.
  • Locally advanced: The cancer is in nearby tissues but has not spread widely and may be resectable.
  • Metastatic: The cancer is widespread and is likely unresectable.
  • Recurrent: Cancer has come back after treatment and is likely unresectable.

Generally, bile duct cancer stages 0, I, and II are resectable. Most stage III and IV cancers are not.

What Is Biliary Cirrhosis

Biliary cirrhosis is a rare form of liver cirrhosis caused by disease ordefects of the bile ducts. Symptoms usually include cholestasis. There are two types of biliarycirrhosis:

  • Primary biliary cirrhosis. Inflammation and destruction of bile ducts in the liver, usually due to an autoimmune disease in which the body’s immune system mistakenly attacks healthy tissues.

  • Secondary biliary cirrhosis. This results from prolonged bile duct obstruction or narrowing or closure of the bile duct for other reasons, such as a tumor.

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A Biliary Stent Or A Biliary Catheter Are Also Options

If cancerous cells obstruct a bile duct, it can result in jaundice , as well as other issues include pollution and liver failure. A tiny tube or catheter may be inserted into the duct to help keep it open.

A stent is a tiny metallic or plastic tube that is inserted into the duct through the blockage. It keeps the duct open, allowing bile to empty into the small intestine.

A catheter is a thin, bendy tube that is inserted through the skin of the abdomen . One end of the tube is inserted into a bile duct, while the other end is implanted outside the body.

Are There Different Types Of Cholangiocarcinoma

Risk Factors Of Bile Duct Cancer!

There are three types of cholangiocarcinoma:

  • Extrahepatic cholangiocarcinoma is bile duct cancer outside the liver. Cancer may be in the ducts as they exit the liver, or in the ducts when they end in the small intestine. This is the most common type of bile duct cancer. A subset within extrahepatic cholangiocarcinoma is hilar cholangiocarcinoma, meaning a bile duct cancer that is outside the liver, but starts in the hilum, which is the area where the bile ducts and important blood vessels connect with the liver.
  • Intrahepatic cholangiocarcinoma is bile duct cancer inside the liver. This should not be confused with liver cancer, which is more often referred to as hepatocellular carcinoma, or HCC.
  • Gallbladder canceris cholangiocarcinoma that starts in the gallbladder.

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Our Experts Work Together To Personalize Your Best Treatment Plan

Our cancer doctors specialize exclusively in treating gastrointestinal cancers, including the bile duct. Because we’re part of The Ruesch Center for the Cure of Gastrointestinal Cancers, our patients benefit from state-of-the-art therapies and surgical techniques backed by the latest research. Your treatment plan will involve recommendations from a team of specialists who have expertise in different disciplines. Together, we’ll collaborate on a plan that will best address your individual needs.

Treatment depends on whether or not your tumor can be removed by surgery. For those that cannot, we may recommend treatments that could help shrink it and make it operable. In other instances, biliary tumors that can’t be surgically removed may benefit from novel interventional radiology procedures that can improve outcomes.

How To Know If You Have Jaundice

As mentioned above, one of the most common symptoms of bile duct cancer is jaundice, which is characterized by yellowing of the skin and the eyes . It seems like this yellowing would be easy enough to notice, but if youve never experienced jaundice before, you might have a difficult time knowing what to look for.

The yellowing associated with jaundice tends to start at the head and then spread down toward the feet. In some individualsparticularly those with lighter skinthe signs of jaundice will be readily apparent. It will likely be more difficult to notice yellowing in brown or black skin, though, so if you have a darker complexion, youll want to pay especially close attention to the whites of your eyes. You could also try gently pressing the skin on your forehead or noseif you have jaundice, it will be easier to detect the yellowness when you pull your fingers away.

In some instances, a person will experience yellowing in their skin but not their eyes. Jaundice tends to affect both the skin and the eyesnot just one or the otherso yellowing of just the skin would likely point to a different condition, such as excessive consumption of beta carotene.

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Jaundice And Abdominal Pain May Be Signs Of This Type Of Cancer

Biliary tumors create blockages that can force bile to enter the bloodstream. Therefore, cholangiocarcinoma symptoms are similar to those of other duct-blocking conditions, such as gallstones. Symptoms include:

These symptoms may also be signs of other health conditions, so it’s important to discuss them with your doctor.

Surgery For Bile Duct Cancer

BIle Duct Cancer (Cholangiocarcinoma), Causes, Signs and Symptoms, Diagnosis and Treatment.

The first course of action typically used to treat bile duct cancer is surgery. Surgeons will try to resect, or remove, part of the bile duct if the tumor is small and in the bile duct only.

If cancer is also found in the liver, one option for treatment is a partial hepatectomy in which part of the liver in where the cancer is found is removed.

Another surgical option is the Whipple procedure in which the head of the pancreas, the gallbladder, part of the stomach and small intestine and the bile duct are removed. After this procedure, enough of the pancreas is left to handle digestion.

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About Bile Duct Cancer

Bile duct cancer, also known as cholangiocarcinoma, is a rare but aggressive form of cancer. Only about 8,000 people in the United States are diagnosed with bile duct cancer each year. The two main types of bile duct cancer are intrahepatic cancer, which forms in the bile ducts inside the liver, and extrahepatic, which forms in the bile ducts outside the liver.

What Are Causes And Risk Factors For Bile Duct Cancer

The incidence of bile duct cancer increases with age. It is slow-growing cancer that invades local structures and for that reason, the diagnosis is often made late in the disease process when the bile ducts become blocked. This blockade prevents bile drainage from the liver into the gallbladder and intestine. Depending upon where the blockage occurs, this can lead to inflammation of the liver and/or pancreas .

Most patients who develop bile duct cancer have no risk to do so. However, chronic inflammation of the bile ducts may be a risk factor for this cancer. Diseases that can cause this type of chronic inflammation include primary sclerosing cholangitis , chronic liver disease, including hepatitis B, hepatitis C, chronic alcoholic hepatitis, and cirrhosis.

Certain parasitic infections found in the Far East that cause liver infections are associated with an increased risk.

Gallstones are not a risk factor for developing bile duct cancer, but stones within the liver do pose an increased risk. Liver stones are not often seen in the North American population but are more common in Asian countries.

There are rare congenital diseases that increase the risk of bile duct cancer, including Lynch II syndrome and Caroli’s syndrome .

Native Americans are six times more likely to develop bile duct cancer. Asian Americans may also be at higher risk. Bile duct cancer is also more prevalent in Israel and Japan, but it is a very rare disease in North America.

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Bile Duct Cancer Treatments

Because your bile ducts function in coordination with nearby organs, some cancer treatments may affect your gallbladder, pancreas, and/or intestines. Cancers of the bile ducts often require liver surgery and sometimes surgery at the head of the pancreas. This is known as a Whipple procedure. The type of surgery performed depends on the stage and location of your cancer. Our experts in surgery, chemotherapy, interventional radiology, and radiation therapy use robotic procedures and advanced techniques to minimize the impact on other organs as much as possible.

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