Bile duct cancer: An uncommon type of cancer that arises from the bile duct, the tube that connects the liver and the gallbladder to the small intestine.
The part of the bile duct that is outside the liver is called the extrahepatic bile duct. Bile, a fluid made by the liver that breaks down fats during digestion, is stored in the gallbladder. When food is being broken down in the intestines, bile is released from the gallbladder through the bile duct to the first part of the small intestine.
Bile duct cancers, also called cholangiocarcinomas, may arise in many locations in and around the liver. They are rare, affecting only 16,600 people in the United States per year. The only definitive treatment is the complete surgical removal of the tumor, which is not often possible. If the cancer cannot be entirely removed, the principal goals of therapy become the relief of symptoms caused by the accumulation of bile, and relief from pain.
SymptomsIf you have bile duct cancer, you may have some of the following
- mild pain in the upper abdomen (tummy)
- loss of appetite or feeling sick
- your skin and the white of your eyes are yellowed (jaundice)
- dark urine
- pale coloured faeces
- unexplained weight loss
- itchy skin
- diarrhoea (loose stools)
CausesThe causes of bile duct cancer aren't fully understood at present. However, there are certain factors that make bile duct cancer more likely and these are listed below.
- It's slightly more common if you were born with abnormal bile ducts.
- If you have ulcerative colitis your risk is increased.
- Your risk increases if you are a smoker or have been exposed to particular industrial chemicals used in the metal or rubber industry.
- If you have been infected with a parasite called the liver fluke, this increases the risk of bile duct cancer. Infection generally occurs in Eastern Europe, Asia and South America so it's more common in these areas.
- Hepatitis B or C infection may also increase your risk of bile duct cancer.
DiagnosisYour doctor will ask you about your symptoms and will examine you. Your GP may give you a blood test and may refer you to a different doctor, such as a specialist in conditions that affect the gallbladder, for further tests including the following.
- Further blood tests may be taken to check your general health and the levels of bilirubin in your blood.
- An ultrasound scan uses high frequency sound waves to produce an image of the abdomen.
- A CT (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the abdomen.
- An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the body.
- An endoscopic retrograde cholangio-pancreatography (ERCP) is a test using a narrow, flexible, tube-like telescopic camera called an endoscope which is used to check parts of your digestive system. You will have an anaesthetic spray to numb your throat and you may need a sedative.
- Percutaneous transhepatic cholangiography (PTC) is when a needle is passed through the skin to the liver and a dye is injected into the bile duct in the liver. An X-ray is then taken to detect any blockages or cancer. For this you will need a local anaesthetic.
- Some people may need an angiogram, which is when a fine tube is inserted into an artery in your groin and a dye is injected. This will highlight all the blood vessels when an X-ray is taken.
- A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
- Other tests can include an endoscopic ultrasound scan (EUS) which uses an endoscope which has an ultrasound probe to check the pancreas and the surrounding tissues. An ultrasound is used to produce images to detect any cancer. Some people may need a laparotomy, which is a small incision made in your abdomen so your doctor can look directly at the bile duct and surrounding tissues. For this you will need a general anaesthetic.
For more information, see Related topics. The results of the tests will determine your course of treatment.
TreatmentThe treatment for bile duct cancer depends on the type, stage and grade of cancer that you may have. Bile duct cancer is often at an advanced stage when it's diagnosed and it may not be possible to cure the cancer. The following treatments may be used even if a cure isn't possible.
SurgerySurgery may be used to remove the bile ducts and possibly some of the surrounding tissue and organs if they are also affected by the cancer. This is the only way to cure the cancer. The bile duct is in an awkward position and it may not be possible to remove all of the cancer. Bypass surgery, which allows the bile to flow from the liver to the small bowel, may be suggested if it isn't possible to remove the tumour.
Stent insertionA stent (a small hollow tube) may be inserted to help the bile drain properly into the digestive system and prevent jaundice. This can be added during an ERCP or PTC. A catheter (a longer tube which drains to the outside of the body) can also be inserted.
RadiotherapyThis uses radiation to destroy cancer cells but isn't generally suitable for bile duct cancer. It's sometimes given at the same time as chemotherapy. For more information, see Related topics.
ChemotherapyMedicines to attack cancer cells are given to some people with certain types of cancer. Chemotherapy medicines may be given if the cancer can't be completely removed or has spread elsewhere in the body. In some patients it can shrink the tumour for a short time. You may be offered this type of treatment as part of a clinical trial. For more information, see Related topics.
Photodynamic therapyA light sensitive medicine is injected into your body via a vein and is taken up by cancer cells. A laser is then passed over the cells to activate the medicine which then kills the cells.
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