Bile Duct Cancer

Cancer is made of changed cells that grow out of control. The changed (abnormal) cells often grow to form a lump or mass called a tumor. Cancer cells can also grow into (invade) nearby areas. And they can spread to other parts of the body. This is called metastasis.

Bile duct cancer is rare. It starts in the cells of the bile ducts. The bile ducts are a network of tiny tubes that connect the liver and the gallbladder to the small intestine. They carry bile, a fluid that helps break down fat in the intestines. Bile is made in the liver, but stored in the gallbladder.

Types of Bile Duct Cancer

There are two main types of bile duct cancer: extrahepatic and intrahepatic

Extrahepatic - "extra" meaning "out" this type happens in the ducts outside of the liver. This is the most common type that includes the following sub-types:

Adenocarcinomas

Adenocarcinomas, also called cholangiocarcinoma's, are the most common type of extrahepatic bile duct cancer, form in the cells of the mucous gland lining the inside of the bile duct. This is the most common type of bile duct cancer making up 95% of cases.

Hilar cholangiocarcinoma

Hilar cholangiocarcinoma, also called Klatskin tumors, is a type of bile duct cancer that happens specifically in the bile ducts flowing out of the liver and into the gallbladder. These are also called the hepatic ducts.

The UC Cancer Center is the only center in the Cincinnati region with a transplant program for hilar cholangiocarcinoma.

Distal

Distal bile duct cancer happens near the small intestine opposite the perihilar ducts, mentioned above as the ducts that carry bile out of the liver an into the gallbladder. This type is less common but  about 25% bile duct cancers start in this distal location.

Intrahepatic - "intra" meaning "in" or "inside", this type happens inside the smaller ducts inside the liver. This type makes up between 5 -10% of bile duct cancer cases. The UC Cancer Center is the only center in the region to offer ablative proton radiotherapy for intrahepatic cholangiocarcinoma.

A risk factor is anything that may increase your chance of having a disease. The exact cause of someone’s cancer may not be known. But risk factors can make it more likely for a person to have cancer. Some risk factors may not be in your control. But others may be things you can change.

The risk factors for bile duct cancer include:

• Infection with hepatitis B or C.

• Obesity.

• Older age.

• Family members with this cancer.

• A disease called primary sclerosing cholangitis.

• Chronic ulcerative colitis.

• Inflammatory bowel disease.

• Crohn’s disease.

• Liver fluke infection.

• Bile duct cysts.

• Cirrhosis.

Talk with your healthcare provider about your risk factors for bile duct cancer and what you can do about them.

There is no sure way to prevent bile duct cancer. Some risk factors can be controlled or treated to help reduce risk.

Are there screening tests for bile duct cancer?

There are currently no regular screening tests for bile duct cancer. Screening tests are done to check for disease in people who don’t have symptoms.

You can have bile duct cancer with no symptoms. Symptoms tend to start when the cancer is big or has spread. Common signs of bile duct cancer include:

• Yellow eyes and skin (jaundice).

• Itchy skin.

• Belly pain.

• Very dark urine.

• Losing weight without trying.

• You don’t feel like eating.

• Fever.

Many of these may be caused by other health problems. But it is important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

The most common way to find bile duct cancer is when symptoms cause a person to see a doctor. The doctor will do a physical exam with a focus on the belly. Blood tests will be done. You will need some imaging tests, such as an ultrasound and CT scan, to look at the inside of your belly. 

Special scopes can be put into your body to get a closer look at the bile ducts. A scope is a long, thin, flexible tube with a camera on the end. Small bits of tissue can be taken out through the scope. This is called a biopsy. The pieces of tissue are checked for cancer cells. It’s the only way to know if a lump or change is cancer. Your results will come back in about 1 week.

After a diagnosis of bile duct cancer, you may have other tests. These help your healthcare providers learn more about the cancer. They can help determine the stage of the cancer. The stage is how much and how far the cancer has spread (metastasized) in your body. It is one of the most important things to know when deciding how to treat the cancer.

Once your cancer is staged, your healthcare provider will talk with you about what the stage means for your treatment. Be sure to ask your healthcare provider to explain the stage of your cancer to you in a way you can understand.

Your treatment choices depend on the type of bile duct cancer you have, test results, and the stage of the cancer. Other things to think about are if the cancer can be removed with surgery and your overall health. The goal of treatment may be to cure you, control the cancer, or help ease problems caused by the cancer. Talk with your healthcare team about your treatment choices, the goals of treatment, and what the risks and side effects may be.

If the bile duct cancer is “resectable” this means that it can be treated with surgical removal. In patients with hilar cholangiocarcinoma, this could involve a liver transplant.

If the bile duct cancer is “unresectable”, it means it is not possible to remove surgically and other treatment options will be pursued such as proton therapy. The UC Cancer Center is the only center in the Cincinnati region to offer proton therapy for unresectable cholangiocarcinoma.

Types of treatment for cancer are either local or systemic. Local treatments remove, destroy, or control cancer cells in one area. Surgery and radiation are local treatments. Systemic treatment is used to destroy or control cancer cells that may have traveled around your body. When taken by pill or injection, chemotherapy is a systemic treatment. Most people with bile duct cancer will be treated with surgery. Some will also need chemo or radiation after surgery. If surgery can’t be done, chemo or radiation may be the main treatment.

You may have just 1 treatment or a combination of treatments. 

Talk with your healthcare providers about your treatment options. Make a list of questions. Think about the benefits and possible side effects of each option. Talk about your concerns with your healthcare provider before making a decision.

Cancer treatment such as chemotherapy and radiation can damage normal cells. This causes side effects such as hair loss, mouth sores, and vomiting. Talk with your healthcare provider about side effects you might have and ways to manage them. There may be things you can do and medicines you can take to help prevent or control side effects.

Surgery for bile duct cancer is very complex. Ask what you can expect to happen and what side effects you may have.

Many people feel worried, depressed, and stressed when dealing with cancer. Getting treatment for cancer can be hard on your mind and body. Keep talking with your healthcare team about any problems or concerns you have. Work together to ease the effect of cancer and its symptoms on your daily life.

Here are tips:

• Talk with your family or friends.

• Ask your healthcare team or social worker for help.

• Speak with a counselor.

• Talk with a spiritual advisor, such as a minister or rabbi.

• Ask your healthcare team about medicines for depression or anxiety.

• Keep socially active.

• Join a cancer support group.

Cancer treatment is also hard on the body. To help yourself stay healthier, try to:

• Eat a healthy diet, with a focus on high-protein foods.

• Drink plenty of water, fruit juices, and other liquids.

• Keep physically active.

• Rest as much as needed.

• Talk with your healthcare team about ways to manage treatment side effects.

• Take your medicines as directed by your team.

Your healthcare provider will talk with you about when to call. You may be told to call if you have any of the below:

• New symptoms or symptoms that get worse.

• Signs of an infection, such as a fever.

• Side effects of treatment that affect your daily function or don’t get better with treatment.

Ask your healthcare provider what signs to watch for, and when to call. Know how to get help after office hours and on weekends and holidays.