Bile Duct

Bile Duct Cancer

Bile duct cancer is also called cholangiocarcinoma. Doctors divide bile duct cancers into 3 groups depending on where they develop in the biliary system. Intrahepatic region – this means within the liver and includes the right and left hepatic ducts and their smaller branches Perihilar (hilar) region – this is just outside the liver where the right and left hepatic ducts meet Distal region – this includes the bile ducts close to the small bowel and the pancreas

Cause & Risk

The cause of most bile duct cancers is unknown. There are a number of risk factors that can increase your risk of developing bile duct cancer. These include: People who have a chronic inflammatory bowel condition, known as ulcerative colitis, have an increased risk of developing this type of cancer. People who have primary sclerosing cholangitis, which is an inflammatory condition that affects the bile ducts, are also at an increased risk of developing bile duct cancer. People who are born with (congenital) abnormalities of the bile ducts, such as choledochal cysts, have a higher risk of developing bile duct cancer.

Symptoms

Cancer in the bile ducts can block the flow of bile from the liver to the intestine. This causes bile to flow back into the blood and body tissues, and the skin and whites of the eyes to become yellow (jaundice). It also causes the urine to become a dark yellow colour and stools (bowel motions) to look pale. The skin may become itchy. Other possible symptoms include discomfort in the tummy area (abdomen), loss of appetite, high temperatures (fevers) and weight loss. These symptoms can be caused by many things other than bile duct cancer, but it's important to get them checked by your doctor.

Diagnosis & Treatment

Usually you begin by seeing your GP, who will examine you. They will refer you to a hospital specialist for any necessary tests, expert advice and treatment. At the hospital, the doctor will ask you about your general health and any previous medical problems. They will also examine you and take blood samples to check your general health and that your liver is working properly. The following tests are commonly used to diagnose bile duct cancer: Ultrasound scan CT (computerised tomography) scan Spiral CT scan MRI (magnetic resonance imaging) scan ERCP (endoscopic retrograde cholangio-pancreatography) Endoscopic ultrasound scan (EUS) PTC (percutaneous transhepatic cholangiography) Angiogram Biopsy Laparotomy Treatment for bile duct cancer The treatment you have will depend on the position and size of the cancer, whether it has spread beyond the bile duct and your general health. In some situations, the aim of treatment will be to relieve symptoms.

Treatment may include: Surgery The main treatment for bile duct cancer is surgery to remove the cancer. But this may involve a major operation and isn't always possible. The decision about whether surgery is possible and the type of operation that may be done depends on the size of the cancer and whether it has begun to spread into nearby tissues. If surgery is recommended, you will be referred to a surgeon who is a specialist in this rare cancer. Stent insertion A stent is a tube put into the bile duct to hold it open and allow bile to drain away. The tube is about as thick as a ballpoint pen refill and about 5-10cm (2-4in) long. A stent may be put in using an ERCP or occasionally a PTC procedure. Radiotherapy Chemotherapy Photodynamic therapy (PDT) Further Information Advanced cancer means that your cancer cannot be cured. But your doctor may suggest you have treatments to try to slow its growth and relieve symptoms. You will need to talk very carefully to your own specialist to understand 'What the diagnosis means for you?' 'What treatment is available?' 'How treatment may help you?' You may feel very uncertain and anxious about the future. You may find it impossible to think about anything other than having cancer. You will need to work out your priorities. It is important to think about how you want to spend your time. You can consider what is important to you and what is not. Some of your future plans may no longer be realistic. But you do not have to abandon all your plans and you may be able to adapt some. And you might get round to doing something you have always wanted to do but have not been able to make time for.