Cholangiocarcinoma or bile duct cancer is a rare cancer of the bile ducts that is often fatal. The bile ducts are tubes in which bile is transported from its site of secretion (liver) to its site of storage (gallbladder). Ducts transport bile to your digestive tract from the gallbladder, where it helps in the digestion of fats. In majority of the cases, bile duct cancer occurs in the bile ducts, which are present outside the liver. The cancer may occur in the ducts present in the liver in rare cases.
The symptoms of bile duct cancer do not occur until the condition has progressed. However, early diagnosis facilitates effective treatment. The symptoms usually appear during the course of the disease when the bile duct becomes blocked.
Bile contains a greenish yellow pigment called bilirubin which is produced by the liver. Jaundice occurs when the bile made in the liver cannot leave the liver due to blocked bile ducts. This results in bile backing up and entering into the bloodstream and depositing in various parts of the body. Jaundice causes yellowing of eyes and skin due to presence of excess bile in these parts of the body.
Although, jaundice is most common sign of bile duct cancer; however, jaundice is more frequently caused by hepatitis and gall stones that have blocked the bile duct. But, if you notice symptoms of jaundice, you should immediately consult your doctor.
Itching of the skin
People with bile duct cancer complain of itchy skin which occurs because of excess bilirubin deposited in the skin.
Pale colored and greasy stools
Bilirubin adds brown color to your stools. Hence, if the bilirubin is not released into the intestine, your stools will be lighter in color. If the release of bile and pancreatic juice into the intestines is blocked due to cancer, fat is not absorbed by your body. This results in pale, greasy, bulky stools which also float in the toilet due to the presence of undigested fat. Pale colored stools are one of the common bile duct cancer symptoms.
Dark colored urine
When blood levels of bilirubin become high, it may also enter the urine and make it dark in color.
Pain in the abdomen
Advanced stages of the cancer are characterized by the presence of pain on the right side of the abdomen below the ribs.
Appetite and weight loss
People suffering from bile duct cancer tend to lose their appetite and experience weight loss.
Presence of fever, nausea and vomiting
In some people suffering from bile duct cancer, fever can occur as one of the symptoms. It occurs along with nausea and vomiting when the bile ducts get infected due to blockage leading to cholangitis.
After discussing bile duct cancer symptoms, let’s discuss how it is diagnosed. Your physician will conduct a physical exam and draw your blood samples. The blood samples will be tested for the presence of tumor markers. Elevated levels of these tumor markers indicate the presence of bile duct cancer.
Further, your doctor will recommend diagnostic imaging scans such as ultrasound, CT scan and MRI. These scans provide an image of your bile ducts and the surrounding areas. The presence of tumors and the area where they are present can be easily detected from these images. This is helpful for your surgeon if they decide to perform a biopsy, which is a technique where a small portion of the affected tissue is removed to test for the presence of cancer cells.
Your doctor may also suggest endoscopic retrograde cholangiopancreatography (ERCP). In this technique, your surgeon will pass a tube bearing a camera from your throat into the gut to the region where the bile ducts open and a dye is injected into the bile ducts. The bile ducts are then clearly viewed using X-rays showing any blockages.
In another technique called endoscopic ultrasound, a probe bearing a camera is passed through your gut to take ultrasound images of your bile ducts.
Percutaneous transhepatic cholangiography (PTC) is also a diagnostic test recommended for diagnosing bile duct cancer. In this test, your doctor injects a dye directly into your liver via the skin above the liver, which then travels to the bile ducts and later X-ray images of your bile ducts are taken.
Stages of bile duct cancer
If you have a diagnosis of bile duct cancer, your doctor will determine the stage of your cancer using the TNM system. In this system, the stage of your cancer is represented by the three letters TNM where:
By identifying the stage of your cancer, your doctor can recommend a suitable treatment option for you.
The following are the treatment options available for bile duct cancer:
Surgery to remove the cancer
The doctors perform surgery to remove the maximum amount of cancer possible. In case of small cancers, the part of the affected duct is removed and the remaining ends are then joined together. In cases of advanced cancers nearby pancreas tissue, liver tissue or lymph nodes may also be removed.
In some people suffering from hilar cholangiocarcinoma, liver transplant may be performed. In most cases, a liver transplant is a cure for hilar cholangiocarcinoma but there is a risk of recurrence of the cancer.
Chemotherapy to kill cancer cells
Chemotherapy involves administering drugs that kill the cancer cells. It is usually used before performing a liver transplant. It is also recommended for people with advanced bile duct cancer to slow the progression of the disease and to provide relief from the bile duct cancer symptoms.
Radiation therapy to kill cancer cells
Radiation therapy utilizes high energy particles such as protons and photons (X-rays) to destroy the cancer cells. Radiation therapy can be administered using a machine that directs the radiation at the affected body part. This is called external beam radiation. It can also be administered by placing the radioactive material near the cancer affected site in your body, which is called brachytherapy.
Photodynamic therapy to kill cancer cells
A chemical sensitive to light is first introduced into the body by injecting it through a vein and the chemical accumulates in the cancer cells that are growing faster than other cells. Then laser light is directed towards the cancer affected cells, causing a chemical reaction that destroys the cells. Photodynamic therapy is administered multiple times for optimum benefit. It effectively provides relief from symptoms and slows progression of cancer. However, after treatments you should avoid exposure to the sun.
Biliary drainage to restore normal bile flow
Biliary drainage is performed to restore the normal flow of bile. It is done by a bypass surgery where the bile is rerouted around the cancer affected parts or by use of stents to open a cancer affected bile duct that has collapsed. Biliary drainage provides relief from bile duct cancer.