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Cholangiocarcinoma, also known as bile duct cancer, is more often found in people 50 years old and above. This type of cancer usually presents symptoms in the later stages, making it difficult to be cured. It is the type of cancer that is found in the bile ducts, which are the thin tubes that carry bile fluid in the digestive system. They are the tubes that connect the liver to the gallbladder as well as the small intestine.
Different types of the disease can be found in different locations in the biliary tract. The different types are named according to the original location of the cancer.
- Intrahepatic cholangiocarcinoma. This type of cancer is found in the bile duct inside the liver, also known as intrahepatic bile duct cancer.
- Extrahepatic cholangiocarcinoma. This type of cancer is found in the bile duct outside the liver and can be categorized further into:
- Hilar cholangiocarcinoma. This type is found outside the liver and is also called perihilar cholangiocarcinoma or Klatskin tumor.
- Distal cholangiocarcinoma. This type is found furthest from the biliary tract, near the small intestine.
Cholangiocarcinoma Signs and Symptoms
The symptoms of the disease are:
- Yellow coloration of the eyes and skin
- Itchy skin
- Light-colored/pale stools
- Fatigue
- Abdominal pain under the right side of the rib
- Unexplained weight loss
- Fever
- Night sweats
- Dark urine
If you have any of these symptoms, it is important to consult your doctor immediately. Early detection and diagnosis of the disease can increase the success rate of your treatment.
Causes of Cholangiocarcinoma
The disease occurs when there is a change of DNA in the bile ducts. The DNA in the cells alters the cell’s behavior. The cell mutation in the biliary tract causes uncontrolled duplication resulting in a mass of cells forming, also known as a tumor. This tumor then begins to invade and destroy the healthy tissues.
Risk factors
There are multiple factors that can increase the risk such as the following:
- Primary sclerosing cholangitis. This occurs when there is a hardening and scarring of the bile ducts.
- Chronic liver disease.
- Congenital bile duct abnormalities.
- A liver parasite. This is most common in South-East Asia and occurs when eating raw fish causes the ingestion of a liver parasite.
- Smoking.
- Diabetes. People who have type 1 or 2 diabetes have an increased risk.
Cholangiocarcinoma Prevention
Quit Smoking. People who smoke have a statistically greater chance of developing cholangiocarcinoma.
Reduce your risk of liver disease. Cholangiocarcinoma is associated with chronic liver disease, so it’s important to do what you can to protect the health of your liver. Only drinking in moderation will help reduce the risk of liver inflammation (cirrhosis). Reducing your food intake will also help maintain a healthy weight and therefore reduce stress on your liver. When you’re working with chemicals, always follow the safety instructions to avoid any contact with your skin, as some common industrial chemicals can cause liver damage
Diagnosis and Treatment of Cholangiocarcinoma
If you are exhibiting symptoms of cholangiocarcinoma, you will undergo one or more of the following tests:
Liver Function tests. Blood tests that measure your liver function level can indicate the cause of your signs and symptoms.
Tumor marker test. A blood test that checks the level of carbohydrate antigen (CA) 19-9 may point to a cause for your symptoms. CA 19-9 is a protein that’s overproduced by bile duct cancer cells.
Examination by an endoscope. Your doctor may examine the bile ducts in your small intestine by inserting a small camera on the end of a thin, flexible tube in a procedure called an endoscopic retrograde cholangiopancreatography (ECRP).
Imaging Tests. There are two imaging tests your doctor can use to look for signs of cholangiocarcinoma. CT and MRI scans are combined with magnetic resonance cholangiopancreatography (MCRP). MCRP is increasingly being used as an alternative to ERCP, as it offers 3D images without the need for dye enhancements.
Biopsy. A biopsy removes a small piece of bile duct tissue. The tissue is then examined under a microscope for indications of bile duct cancer.
Treatment of Cholangiocarcinoma
There are numerous treatments that have been approved for treating bile duct cancer. Your doctor may choose one or more treatments depending on the location, type, and size of your tumor(s). The approved treatments include:
- Surgery
- Liver transplant
- Chemotherapy
- Radiation therapy
- Targeted drug therapy
- Immunotherapy
- Heating cancer cells
- Photodynamic therapy
- Biliary Drainage
Your doctor can explain what each of these treatments entails and how they treat your cancer.
If you’re experiencing any of the symptoms of bile duct cancer, make an appointment at the Life Cancer Center at Vejthani Hospital.
Diagnosis
If Cholangiocarcionoma is suspected, doctor will perform multiple investigations, such as:
- Liver function tests. These are blood tests that show the functioning of the liver.
- Tumor marker tests. These is also blood test that is more specific, Carbohydrate antigen 19-9 (CA 19-9) is a protein that is produced by the bile duct, malignancy or overactivity of the bile duct may show the increase of the marker.
- Endoscopic retrograde cholangiopancreatography (ERCP). A test consisting of a flexible thin tube connected to a tiny camera which will be inserted into a patient’s mouth passing through the throat down to small intestine. It looks around the area near your small intestine where the bile ducts are connected to. In order to have a clearer picture sometimes dye is used for further investigation.
- Imaging. Various types of imaging such as ultrasound, computerized tomography (CT) scans,percutaneous transhepatic cholangiography (PTC) and magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography (MRCP) can be used to diagnose the cancer.
- Biopsy. This is a process of taking a sample of body tissue for examination under a microscope to check for cancer. Specialist doctors can take bile duct tissue samplings during ERCP, PTC or fine-needle aspiration.
If your doctor confirms a diagnosis of cholangiocarcinoma they will use some additional tests in order to determine the staging of the cancer. This will help doctors to predict the prognosis and plan the treatment options.
Treatment
Treatments for bile duct cancer may include:
- Surgery. If possible, surgeon try to remove as much of the cancer as they possibly can. Early stage of cholangiocarcinoma could be done by removing the affected part and rejoining the biliary system together. If the cancer is more advanced, there may also need to remove the nearby liver tissue, pancreas tissue or lymph nodes.
- Liver transplant. This is an option by removing the liver and replacing it with a new one. By performing this surgery it may cure the cancer but there is always a risk of recurrence.
- Chemotherapy.This treatment uses drugs to kill the cancer cells and may be used prior to performing a liver transplant. This option, inject medications into the vein or administering them directly to the cancer cells is for those with advanced cancer in order to destroy the cancer cells.
- Radiation therapy. This treatment uses high power beams such as X-rays and protons or by the placement of radioactive material inside the body nearby the cancerous area in order to kill the cells.
- Targeted drug therapy. This type of treatment uses targeted drugs in order to decrease the rate of duplication caused by the cancer causing the cancer cells to die. In order for the doctor to choose this type of treatment, the doctor need to check for a specific receptors before the treatment.
- Immunotherapy. This type of treatment is used for advanced cholangiocarcinoma when other treatments have failed, by using the body’s own immune system. Some cancer cells have the protein preventing them from the immune cells. Immunotherapy will disable that protein and help the immune cells work better.
- Heating cancer cells. This type of treatment uses needs that are inserted through incisions into the abdomen and are heated with an electric current which causes them to destroy the cancerous cell by radiofrequency.
- Photodynamic therapy. In this treatment a laser light is used to inject light sensitive chemicals into the vein causing the destruction of the fast-growing cancer cells. There is a need for multiple treatment in order to slow down the symptoms and the progress of the cancer growth. It is also necessary to stay away from the sun during and after the treatment.
- Biliary drainage. This treatment is done by performing drainage through a thin tube into the bile duct. It is used to relieve the symptoms of the cancer. Bypass surgery to change the bile flow direction of the biliary system and inserting a stent to hold open the bile duct which is collapse by the cancer could be performed.
Bile duct cancer is very difficult to treat, you may need to ask your doctor for more information and find an experienced doctor for the specific treatment of this condition.
Supportive (palliative) care
Palliative care focuses on slowing down the symptoms and pain caused by the cancer through the use of various treatments. The doctors with nurses and other trained professionals will help to improve the quality of the life for people with cancer and to offer moral support to the family as well.
