Cholangiocarcinoma

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.