Bile duct cancer (Cholangiocarcinoma)

Bile Duct Cancer shown on a body map

Facts and figures

Bile duct cancer is very rare; less than 2000 new cases are diagnosed each year in the UK. The incidence in men and women is approximately the same, giving a male to female ratio of 1:1. Age related with approximately 66% arising in those 65+ years.

Causes are unknown but medical conditions such as primary sclerosing cholangitis, ulcerative colitis, choledochal cysts and bile duct stones can increase the risks. Other possible factors include liver cirrhosis, tobacco smoking, obesity, diabetes, hepatitis C infection and HIV. Most of the tumours are adenocarcinomas.

The majority of the tumours develop in bile ducts outside of the liver (extrahepatic) in the perihilar and distal regions with around 20% of them arising in the bile ducts inside the liver (intrahepatic). It is often diagnosed late as symptoms are vague.

Symptoms

  • Nausea and loss of appetite.
  • Abdominal pain.
  • Weight loss.
  • Jaundice.
  • High temperatures and shivering.

Diagnosis

Investigations may include:

  • Physical examination.
  • Blood tests.
  • Ultrasound scan.
  • Ultrasound from inside the body (EUS) –tissue samples may be taken for biopsy.
  • CT scan.
  • MRI scan.
  • Endoscopy – tissue samples may be taken for biopsy.
  • Fine needle aspiration- under CT scan or ultrasound a very fine needle is passed through the skin into the bile duct to enable tissue samples to be collected for biopsy.
  • Percutaneous transhepatic cholangiography (PTC) - tissue samples may be taken for biopsy.
  • PET-CT scan.
  • Laparoscopy- tissue samples may be taken for biopsy.

Treatment

Depends on several factors:

  • Position of the tumour.
  • The stage of the cancer.

Surgery

In early stage, surgery is the main treatment. This involves removing the bile duct and other adjacent structures which is long and complicated surgery. In the less common intrahepatic cancers, part of the liver will also be removed (hepectomy), sometimes a lobe of liver will be removed with the bile duct (lobectomy).

Liver cells can regenerate and function normally again after surgery. Surgery for perihilar and distal cancers is more difficult; perihilar cancers will require removing part of the liver, gall bladder, local lymph nodes and possibly part of the pancreas and small bowel. Distal tumours will involve removing bile ducts, part of the pancreas and part of the small bowel.

The tumours are often advanced at diagnosis and this surgery is not appropriate but insertion of a stent to open the bile duct to allow the bile to drain and relieve the jaundice may be required.

Radiotherapy

Radiotherapy may be prescribed after surgery possibly with chemotherapy to reduce the risk of recurrence. If surgery is not an option, radiotherapy may be used to relieve symptoms and slow the growth of the cancer cells.

Chemotherapy

After surgery, chemotherapy may be used in conjunction with radiotherapy to reduce the risk of recurrence or used to relieve symptoms and slow the growth of cancer cells in inoperable cases.

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