Bile Duct Cancer Definition
Bile Duct Cancer begins in the defective bile duct itself. Bile is the digestive fluid which helps in breaking down fats. It is produced by the liver and accumulated in the gallbladder. Bile goes from the gallbladder directly into the small intestine in order to help in the process of digestion.
This type of cancer is also known as cholangiocarcinoma which is a rare type of cancer that could rapidly affect other areas. The problem usually begins as a glandular tissue referred to as an adenocarcinoma. There are also different kinds of this condition which depends on the exact location where it originated.
The first one is intrahepatic cancer of the bile duct, where it affects the bile ducts inside the liver. The second one starts in the outside region of the liver which is extrahepatic cancer of the bile duct, and the last one is distal extrahepatic cancer of the bile duct located at the ampulla of Vater.
Signs and Symptoms
The symptoms of cancer of the bile duct happen due to the incapability of bile to normally drain in the liver. Hepatitis may then develop which is an inflammation of the liver. In most individuals with this cancer, no clinical symptoms had been experienced unless it develops to later stages.
These symptoms include:
- Itchy skin
- Yellowish color of the skin
- Pain in the upper abdomen
- Color of the stool and urine may also appear darker
Pain felt in the abdomen is usually a late symptom that is commonly located in the upper right section of the belly and sometimes corresponded with an enlarged, tender liver.
Unfortunately for the patient, bile duct tumors might not present any significant signs until they have increased in size and the cancer has scattered in other locations.
Bile Duct Cancer Causes
The exact causes of cancer of the bile duct are still not clear up to now. Nevertheless, there are still factors that could possibly increase the chances of getting the condition.
Predisposing factors include the following:
- Age – A person will become highly vulnerable of developing the cancer due to aging. About two thirds of diagnosed individuals are 65 years old or above.
- Biliary stones – These are almost identical to gallstones. The difference is that they are formed inside the liver, instead of the gallbladder.
- Primary sclerosing cholangitis – A rare type of disease in the liver that leads to a chronic liver inflammation.
- Infection with a liver fluke parasite – This type of infection is only common in Africa and Asia. A person can be influenced with liver flukes by ingesting a half-cooked fish that has been polluted with fluke eggs.
- Bile duct abnormalities – A few people have cysts in the bile duct which are typically present from birth. About 20% of individuals with these cysts develop into cancer if the fluid-filled sacs are not removed.
- Toxin exposures – Some chemical toxins can increase the chance of having cancer involving the bile duct.
Bile Duct Cancer Diagnosis
The diagnosis of cancer of the bile duct is not easy, so there are plenty of tests that might be performed and these are:
- Physical examination is done initially by an attending physician based on presented symptoms
- Patient’s medical history will be reviewed by the physician to assess for risk factors
- Blood tests are done in order to help examine the liver function through liver functions tests or gallbladder tests, possibly followed by a biopsy and pathology since blood tests alone cannot accurately diagnose the condition
- A biopsy may be required to study a small amount of tissue under a microscope
- Imaging tests such as CT (computed tomography) scan, MRI (magnetic resonance imaging), and ultrasound scan could be useful for evaluation of the organs and locating the tumor
- PTC (percutaneous transhepatic cholangiography) test might be needed to highlight the bile ducts
For some instances, the surgeon would rather suggest removing the tumor that is suspected according to the scan results.
Only a few cases of cancer affecting the bile duct can be cured and these are those individuals whose cancerous cells have not yet metastasized. Instead, treatment options are usually used to ease the symptoms.
Surgery can get rid of the cancer problem affecting the bile, but most of the patients are older which means that there is a huge possibility that they could not tolerate it nor recover from it. This only means that surgery depends on the decision of each individual and their situation.
Other options of treating the condition are only meant to maintain the quality of life of an affected person:
- Radiotherapy and Chemotherapy can destroy cancer cells
- Photodynamic therapy is also another option in controlling the symptoms and shrinking the tumor
- Endoscopic retrograde cholangiopancreatography (ERCP) procedure where a stent is done to keep the bile duct open, which is considered beneficial in controlling the symptoms
Like the other cancers, each patient’s treatment is individualized. It is important to discuss the matter between the physician, patient, and family to comprehend the treatment options.
Individuals have a finer prognosis if the tumor is located further away from the liver hilum. The prognosis may also vary on some features of cell type and shape in the tumor. A worse prognosis occurs to those individuals whose tumor has scattered to other locations in the body, has the participation of lymph nodes, and has occupied adjacent tissues.
There is 50% chance of survival within a year, 20% rate at 2 years, 10% chance at 3 years, and no possibility of survival at 5 years if the condition is untreated. The complete removal of the tumor increases the chance of surviving but it usually varies upon the tumor’s location and whether it had spread to other tissues.
1. Bile Duct Cancer (Cholangiocarcinoma) Treatment, Prognosis, Life Expectancy at http://www.medicinenet.com/bile_duct_cancer_cholangiocarcinoma/page3.htm
2. Bile duct cancer (Cholangiocarcinoma) Diagnosis, Treatment & Prevention at http://www.nhs.uk/conditions/cancer-of-the-bile-duct/Pages/Introduction.aspx
4. Abou-Alfa GK, Jarnagin W, Lowery M, et al (2014). Chapter 80: Liver and bile duct cancer. In: Niederhuber JE, Armitage JO, Dorshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa. Elsevier.
5. Bartlett DL, Ramanathan RK, Ben-Josef E (2011). Cancer of the biliary tree. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 9th ed. Philadelphia, Pa: Lippincott Williams & Wilkins: 1019-1047.
6. Bengala C, Bertolini F, Malavasi N, et al (2010). Sorafenib in patients with advanced biliary tract carcinoma: A phase II trial. Br J Cancer. 102: 68-72.