Bile duct cancer arises from the cells that line the bile ducts, the drainage system for bile that is produced by the liver. Bile ducts collect this bile, draining it into the gallbladder and finally into the small intestine where it aids in the digestion process. Bile duct cancer is also called cholangiocarcinoma.
Bile duct cancer is a rare form of cancer.Bile duct cancers are most commonly found just outside of the liver in the perihilar area and least commonly found within the liver.The incidence of bile duct cancer increases with age. It is a slow-growing cancer that invades local structures and for that reason, the diagnosis is often made late in the disease process when the bile ducts become blocked. This blockade prevents bile drainage from the liver into the gallbladder and intestine.
The initial symptoms of bile duct cancer occur because of inability of bile to drain normally from the liver where it is produced. This causes liver inflammation (hepatitis). Symptoms include yellow coloring of the skin and eyes (jaundice), itching, abdominal pain, bloating, and weight loss. Low-grade fever may be present, and there can be darkening in the color of urine and stool.
Unfortunately, bile duct tumors may not cause any symptoms until they have grown in size and the cancer has spread (metastasized) from beyond its original location. Abdominal pain is often a late symptom and is usually located in the right upper quadrant of the belly and may be associated with a tender, enlarged liver.
When you see your physician you will have a routine examination. Your doctor will ask you questions about your general health and your family history of cancer and liver disease. You will also be asked about your lifestyle and habits, including drinking and smoking.
Your physician may order the following tests
Blood work: Blood tests may include a complete blood count, hematocrit, platelet count, liver function tests, Carcinoembriogenic antigen (CEA) and Carbohydrate antigen 19-9 (CA19-9), which may be elevated in patients with bile duct cancer.
Abdominal ultrasound: This test helps the doctor see the tumor.
CT scan: This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver
MRI and MRCP: This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver.
ERCP:Endoscopic retrograde cholangiopancreatography (ERCP) is a specialized test used to examine the bile duct as it enters the duodenum. ERCP is performed by using a fiberoptic camera at the end of a flexible viewing tube.
Sometimes, an interventional radiologist may obtain a tissue biopsy by threading a needle through the skin into the liver.
Treatment for bile duct cancer may include a combination of the following:
- Surgery to remove the bile duct, and sometimes part of the liver
- Stent placement. A stent is a tube that allows the bile, which is made by the liver, to drain more easily into the intestine if a tumor is blocking the bile duct.
Percutaneous transhepatic biliary drainage (PTBD):
Percutaneous transhepatic biliary drainage (PTBD) is the placement of a drain into bile ducts using needles inserted through the skin. The procedure can be used to treat cholestasis (where the bile cannot flow from the liver to the small intestine), which may be a result of a narrowing or blockage in the bile ducts or of a bile leakage after an operation.
Biliary stenting is performed after biliary drainage if the blockage is malignant (cancerous) to keep the bile duct open and to allow the drain used in PTBD to be removed. This involves putting a stent (a mesh metal tube) into the bile duct, which then functions as a supportive skeleton to prevent the duct from closing.