BILE DUCT CANCER (CHOLANGIOCARCINOMA)
Bile duct cancer is a type of cancer arising from the bile ducts.
- The bile ducts are a series of slender ducts that carry digestive juices called bile from the liver to the gallbladder.
- The bile ducts collect the bile from the liver (where it is made), drains it into the gallbladder and finally into the small intestine where it helps digest the fats in food.
- The condition also called cholangiocarcinoma, is a very rare form of cancer that is prevalent in people older than age 50, though it can occur at any age.
- Bile ducts cancer is divided into three types based on where cancer occurs in the bile ducts:
- Intrahepatic cholangiocarcinoma, which affects the bile ducts within the liver. This type is sometimes confused as a type of liver cancer.
- Hilar cholangiocarcinoma, which affects the bile ducts outside the liver. This type is also called perihilar cholangiocarcinoma.
- Distal cholangiocarcinoma, which affects the portion of the liver near where the bile ducts enter the small intestine.
CAUSES
The exact cause of the condition is not known. However, doctors know that bile ducts cancer occurs when something triggers a genetic mutation within the cells in the bile ducts. These causes normal cell in the bile ducts to become abnormal and multiply rapidly and continue to accumulate, forming a tumor or mass.
A bile duct cancer is a progressive cancer that invades local structure, resulting in bile duct blockade at the late stage. This blockade prevents the bile from draining into the gallbladder and intestine from the liver and can result in hepatitis (inflammation of the liver) and/or pancreatitis (inflammation of the pancreas) depending on where the blockage occurs.
Risk factors for bile duct cancer include
- Smoking
- Older age
- Chronic liver disease whether in the form of viral hepatitis, cirrhosis or alcoholic liver disease
- A liver parasite
- Congenital bile duct problems such as choledochal cyst
- Ulcerative colitis
- Exposure to chemicals such as those used in aircraft manufacturing
- Primary sclerosing cholangitis, an inflammatory disease of the bile duct.
SYMPTOMS
- Abdominal pain
- Fatigue
- Unintended weight loss
- Intensely itchy skin
- Jaundice
- Changes in the color of stool or urine
- Fever
DIAGNOSIS AND TREATMENT
If bile duct cancer is suspected, the doctor may carry out the following tests:
- Blood test to measure your liver function and carry out a tumor marker test. The tumor marker test checks for the level of cancer antigen CA (19-9) in your blood. This will give the doctor additional information about your diagnosis.
- Endoscopic retrograde cholangiopancreatography (ECRP) to examine the area where the bile ducts connect to the small intestine. During this procedure, the surgeon may also inject dye into the bile ducts to help them show up clearly on imaging tests.
- Imaging tests such as CT scan, MRI.
- If the suspected area is located close to the area where the bile duct joins the small intestine, a biopsy sample may be obtained during ERCP.
If the doctor confirms the condition, other imaging tests can be used to determine the stage of cancer, which will help direct treatment.
TREATMENT
Treatment option will depend on the location of your cancer, and your overall health.
Treatment options:
- This may include removing a part of the bile duct, or in advanced cases, removing nearby liver tissues, lymph nodes, or pancreas tissues.
- For people with hilar cholangiocarcinoma, surgery to remove the liver and replace it with the one from a donor may be the best option.
- Photodynamic therapy to help shrink the tumor and control symptoms
- Radiation therapy that uses powerful, energy beams such as X-rays to kill the cancer cell
- Chemotherapy that involves using medication injected intravenously or taken orally to kill the cancer cell.
- Biliary drainage to restore the flow of bile and help with symptoms.