Bile Duct Cancer Overview

Liver__gallbladder__bile_duct

What is the bile duct?

Bile duct cancer, also known as cholangiocarcinoma, is a rare cancer that begins in the bile duct. The bile duct is a thin tube that goes from the liver to the small intestine. It is about four to five inches long. The main role of the bile duct is to move bile produced in the liver to the gallbladder and to the small intestine. Once bile is in the small intestine, it helps the body digest fats in the foods we eat. Bile duct cancers may develop in and around the liver. 

What is bile duct cancer?

Bile ducts have different types of tissue which can develop into cancer. Many bile duct tumors begin in glandular tissue found within the bile duct. This tissue type is called adenocarcinoma. Squamous carcinoma and sarcomas are other bile duct tissue types. 

Cancer of the bile duct can start in the bile duct and spread to other areas of the body. Bile duct cancer can spread within the liver, and to the gallbladder and pancreas. It can also spread to lymph nodes and to other nearby organs or tissues, such as the colon, stomach, small intestine, or abdominal wall.

Risk factors

It is unknown what causes bile duct cancer. People who have chronic inflammatory bowel disease or have had a parasitic infection have a greater chance of developing bile duct cancer. People chronically infected with the live fluke parasite, Clonorchis sinensis, which is found in parts of Southeast Asia, may develop bile duct cancer. People can become infected with this parasite by eating raw or pickled freshwater fish from this region of the world. Most people with this infection will not develop cancer. Also, people with chronic ulcerative colitis or sclerosing cholangitis have a higher chance of developing bile duct cancer. Another risk factor that may increase the chances of developing bile duct cancer is having a birth defect (congenital abnormality) of the bile duct. No one cause of this disease has been found.

Symptoms

Bile duct cancers usually develop slowly and the signs and symptoms can be so minor that they are difficult to spot.  Common signs of bile duct cancer are the yellowing of the skin or the whites of the eyes (called jaundice) and itching.  Jaundice occurs as bilirubin (a product of bile) builds up in the skin instead of emptying into the small intestine. Other possible signs and symptoms of bile duct cancer are:

  • Bloating
  • Weight loss
  • Decreased appetite
  • Fever
  • Nausea
  • Enlarging abdominal mass
  • Pain in the abdomen

Treatment options

Treatment of bile duct cancer depends on the size of the tumor and whether cancer cells have spread to other parts of the body. Bile duct cancers are usually grouped by how the cancer may be treated. The two groups are called localized and unresectable disease.

  • Localized bile duct cancer means that the tumor cells are found only at the bile duct and may be completely removed by surgery. 
  • Unresectable bile duct cancer means that the tumor cells have spread to lymph nodes, the liver or other areas of the body.  Since the cancer has spread, it cannot be completely removed by surgery alone.

The best treatment option for bile duct cancer that has not spread outside of the bile duct is surgery. If the patient is too sick to go through surgery, radiation therapy to the cancer site can be a treatment option. Radiation therapy along with chemotherapy may also be considered once the cancer has been surgically removed in an effort to remove any remaining cancer cells. 

Unresectable bile duct cancer

Unfortunately, bile duct cancer is commonly found after it has spread to other areas of the body and all of the tumors cannot be removed by surgery. Tumors that cannot be removed by surgery are called “unresectable.” The standard treatment for unresectable bile duct cancer is chemotherapy, with or without radiation therapy. Patients may want to consider participation on a clinical trial.  A clinical trial is meant to obtain information on new treatments for patients with cancer. Patients with unresectable bile duct cancer may have the option to be treated with chemotherapy with or without radiation therapy on a clinical trial. Chemotherapy and radiation therapy may relieve symptoms and improve the patient's quality of life. It is important to discuss all options with a medical oncologist and together decide which treatment is best for you.

Resources:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0032702/