Bile Duct Cancer
Bile duct cancer, also known as cholangiocarcinoma, occurs when abnormal cells in the bile ducts develop uncontrollably. The ducts are 4 to 5 inch long thin tubes that transport bile from the liver towards the gallbladder and small intestine. Bile, on the other hand, aids in the digestion of fat in foods.
Bile duct cancer is a rare type of cancer that mainly affects persons over the age of 50. It can, however, strike anyone at any age. The available treatment can kill cancer for some people. But in other, the disorder might not disappear completely.
Types of Bile Duct Cancer
Physicians classify bile duct cancer into different categories depending on where cancer develops within the bile ducts;
- Intrahepatic bile duct cancer: This is categorized as a form of liver cancer that develops in the portions of the bile ducts in the liver.
- Hilar bile duct cancer: This is also known as perihilar cholangiocarcinoma. It develops within bile ducts located outside the liver are affected.
- Distal bile duct cancer: This forms in the part of the bile duct closest to the small intestine.
Signs and Symptoms of Bile Duct Cancer
The signs and symptoms of bile duct cancer can differ based on where your tumor is located. However, they may include the following;
- Jaundice: This is the most prevalent symptom that is characterized by yellowing of the skin. Depending on the location of the tumor, this can happen at any time, including the early and late stages.
- You may notice dark urine and pale stools.
- Itching can occur as a result of either jaundice or malignancy.
- You may experience abdominal pain that extends towards the back. As cancer advances, this is more likely to happen.
- Enlargement of the spleen, liver, or gallbladder is another possible but rare adverse effect.
You might also experience more general signs and symptoms, including;
- Chills and fever
- A decrease in appetite
- Unexplainable weight loss
- Fatigue
Causes of Bile Duct Cancer
Bile duct cancer causes remain unknown. However, it can develop when the cells within the bile ducts acquire mutations or changes in their DNA. This is the substance that instructs each chemical action in a person’s body.
Changes in the instructions are caused by DNA mutations. As a result, cells may develop out of control and finally form a tumor, which is a mass of malignant cells. It's unclear what actually causes the intense genetic alterations.
Risk Factors of Bile Duct Cancer
The following factors are likely to elevate your risk of developing bile duct cancer;
- Primary sclerosing cholangitis: The bile ducts can sometimes get hard and develop scars as a result of this condition.
- Chronic liver disease: The risk of bile duct cancer can increase due to scarring of the liver because of the previous history of chronic liver illness.
- A parasitic infection of the liver: Bile duct cancer is linked to liver fluke infection, especially in some parts of Asia. People can contract it by consuming raw or even undercooked seafood.
- Being old: Adults who are 50 years old and above are more likely to develop bile duct cancer.
- Smoking: Usually, smoking is linked to a higher risk of bile duct cancer.
- Bile duct disorders that are present from birth: Bile duct cancer is more common in individuals who were born with a choledochal cyst. This creates dilated and uneven bile ducts in the system.
Bile Duct Cancer Diagnosis
If the doctor suspects that you have bile duct cancer, you will undergo one or more diagnostic tests and procedures. They can include the following;
- Liver function tests
Your doctor can perform blood tests to assess the function of your liver and obtain hints on the underlying cause of your symptoms.
- Test for tumor markers
The level of cancer antigen (CA) 19-9 in the blood can provide extra information to the physician regarding your diagnosis. CA 19-9 refers to the protein that bile duct cancer cells overproduce. However, a high amount of CA 19-9 in the blood does not necessarily indicate the presence of bile duct cancer. Other bile duct disorders, including inflammation and obstruction of the bile duct, can cause this effect.
- Imaging tests
The oncologist can use imaging tests to examine if there are any abnormalities within the internal organs that could indicate bile duct cancer.
Computerized tomography (CT) scans and magnetic resonance imaging (MRI) along with magnetic resonance cholangiopancreatography (MRCP) are techniques that can help during bile duct cancer diagnosis. MRCP is becoming a more popular noninvasive option to endoscopic retrograde cholangiopancreatography (ERCP). It creates 3-dimensional pictures even without the use of a dye to make them clearer.
- Using a tiny camera to assess the bile duct
A narrow tube with a tiny camera is sent down your neck and into your gastrointestinal system to the small intestine during ERCP. The camera enables the doctor to look at the connection between the bile ducts and the small intestine. Alternatively, the physician can as well employ this technique to inject dye into the bile ducts. This provides a better view of the organs on the imaging tests.
- A biopsy
This is a procedure to take out a small tissue sample for further testing and examination using a microscope. When the suspicious site is close to where the bile duct meets the small intestine, the doctor may perform an ERCP to collect a biopsy sample.
If the suspicious spot is located within or close to the liver, the doctor can remove a tissue sample by putting a long needle via the skin and directing it to the affected area. This procedure is known as fine-needle aspiration. To guide the needle to the exact location, the doctor may employ an imaging test, including a CT scan or endoscopic ultrasound.
Bile Duct Cancer Treatment
The treatment for bile duct cancer can include one or a combination of the following;
Surgery
The physicians can recommend removing as much cancer as possible. This entails cutting a portion of the bile duct and reconnecting the cut ends for the minor bile duct tumors. Pancreatic tissue, liver tissue, or lymph nodes nearby can also be removed for the more advanced bile duct tumors.
Radiation therapy
Radiation therapy involves the use of high-energy sources, like x-rays or photons and protons to kill or eliminate cancerous cells. It uses special equipment to send radiation beams to the body (external beam radiation). It could also entail injecting radioactive material into the part close to the cancerous location (brachytherapy).
Chemotherapy
Chemotherapy is a treatment that uses chemicals to destroy cancerous cells. Before undergoing a liver transplant, the doctor can first recommend chemotherapy. It could also be a good alternative for those with advanced cancer while slowing down the condition and alleviate symptoms.
Liver transplantation
For patients with hilar bile duct cancer, surgery to extract the liver and replace it with a healthy one from the donor could be an alternative. Although a liver transplant is a remedy for many people with hilar bile duct cancer, there is a chance that cancer will come back after the transplant.
Photodynamic therapy
Photodynamic therapy involves injecting a light-sensitive chemical into a vein. The substance will accumulate in the rapidly developing cancer cells. The cancer cells will then die as a result of a chemical reaction caused by laser light pointed at them.
Multiple treatments are usually required. Photodynamic therapy can make you feel better and may even stop or reduce the progression of your cancer. Following the treatments, you'll have to stay away from getting exposed to the sun.
Biliary drainage
Bile drainage is a technique that helps restores bile flow. It may include bile duct bypass surgery to divert bile from the tumor or using stents to keep a bile duct that has collapsed due to cancer open. Furthermore, biliary drainage aids in the relief of the associated signs and symptoms.
Bile Duct Cancer Prevention
Preventing bile duct cancer is nearly impossible. However, you can lower your chances of getting the condition if you consider the following measures;
Quit smoking: A higher risk of bile duct cancer has been associated with smoking. Therefore, you should stop smoking as soon as you can if you do smoke. If you had attempted to quit before but weren’t successful, consult your medical provider about the quitting tactics.
Reduce your chances of developing liver disease: Bile duct cancer risk is linked to chronic liver disorder. Certain causes and triggers of liver disease are unavoidable, while others can be avoided. Therefore, it’s essential to do everything you can to protect your liver to reduce the chances of developing bile duct cancer.
Conclusion
Bile duct cancer is a rare yet life-threatening form of cancer that occurs in the bile ducts. It can develop in both children and adults who are at a higher risk.
There are various treatment options to address bile duct cancer. Certain treatment forms are effective for some people, while the disease can sometimes recur in others. In other cases, frequent doses of radiation therapy, chemotherapy, and other forms of treatment are necessary. This helps manage and regulate the condition.