Cholangiocarcinoma

Overview

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.