Bile duct cancer

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 25, 2016
StartDiseasesBile duct cancer

Bile duct cancer is rare and usually goes untreated in most cases. Another name for bile duct cancer is cholangiocarcinoma. Excessive consumption of alcohol is the most preventable risk factor, but other risk factors include hepatitis, ethnicity and old age.

Contents

Definition & Facts

Bile is a digestive fluid that helps break down fatty foods in the body. The bile duct is closely related to the liver, small intestine and gall bladder. The gall bladder is the pouch beneath the liver that is responsible for producing bile. The bile duct itself is a tube that connects the small intestine with the gall bladder and liver.

Every year in the United States, between two and three thousand new cases of bile duct cancer are reported. If detected early, the five-year survival rate is thirty percent. If it spreads to distant parts of the body, the five-year survival rate drops down to just two percent.

Symptoms & Complaints

Bile duct cancer often doesn't show symptoms during the early stages unless the bile duct itself is blocked. That blockage leads to a host of medical issues and complaints. One of the main symptoms of bile duct cancer is itchy skin, which is caused by excess bilirubin in the skin. Another primary symptom is jaundice, or yellowing of the skin and/or eyes. People suffering from a bile duct blockage may also experience dark urine from excessive bilirubin, abdominal pain and unusual weight loss without dieting.

A common complaint for people who have bile duct cancer is an irregular looking, greasy stool. This is caused by a lack of bilirubin in the intestine which gives the stool its distinctive brown color. If the bilirubin isn't reaching the intestine due to a blockage and fats aren't being properly digested, the stool is very pale. Yet these symptoms are often overlooked or dismissed as symptoms of something else entirely such as gallstones or even influenza.

Causes

When the mucus cells that line the walls of the glands and ducts of the gall bladder begin to grow abnormally, cancerous cells start to form. They're called adenocarcinomas. Medical researchers believe that the abnormal growth of these cells has less to do with inherited traits and more to do with genetic mutations acquired in a person's lifetime.

People who suffer from gall stones are at high risk for developing bile duct cancer. People over the age of 65 are at high risk as well as people who suffer from a rare chronic liver disease called primary sclerosing cholangitis or PSC.

Researchers have also linked bile duct cancer to infections from liver fluke parasites. These parasites are more prevalent in the Middle East and parts of Asia. Certain diseases such as ulcerative colitis, cholangitis, and cirrhosis also can cause bile duct cancer. All of these maladies irritate the bile duct and accelerate the growth of adenocarcinomas.

Diagnosis & Tests

When doctors diagnose bile duct cancer, they focus on the specific area affected. If the tumor is intrahepatic that means that it's located inside the liver itself. This occurs in only five to ten percent of cases. Most people suffering from bile duct cancer have tumors that are extrahepatic which means that they are growing outside the liver. Doctors find a great deal of extrahepatic tumors at the area where the left and right bile ducts meet.

There are a number of tests that can be performed to locate and properly diagnose this form of rare cancer. By measuring the amount of bilirubin in the chemistry of the patient's blood, doctors can determine if these levels are abnormally high. The most definitive test is a biopsy. A small sample of tissue is removed from the body through a procedure called endoscopic retrograde cholangiopancreatography or ERCP.

Doctors can also use imaging technology to locate tumors in and around the bile duct. Ultrasound uses sound waves to illuminate a blockage and determine if the ducts are abnormally dilated. Ultrasound can also aid a doctor in completing a successful biopsy. CT scans give doctors a three-dimensional view of the internal organs and help determine the size of the tumor. MRIs can also give doctors a clearer view of the bile duct system.

Treatment & Therapy

Because most forms of bile duct cancer can not be cured, treatment options are primarily centered around alleviating symptoms. However, treatment and therapy options are determined by the progressive stage of the cancer itself and whether or not it has spread to other parts of the body. If therapy begins during stage one and stage two, a gastroenterologist or liver surgeon may be able to remove parts of the affected area surgically.

Some patients need to have parts of their bile duct, gall bladder, small intestine or liver removed. The recovery could take up to a month and parts of the bile duct system may be able to be reconstructed in later surgeries. If only a few lymph nodes are affected in a stage three patient, then the spread of cancerous cells may also be slowed by removing those lymph nodes.

For stage four patients, a surgical cure is usually not possible. In order to relieve the symptoms, a multidisciplinary team might try a number of techniques such as radiotherapy, chemotherapy, and stenting. In Thailand and Korea, where this form of cancer is more prevalent, researchers have explored a wide variety of alternative treatments such as medicinal marijuana, yoga, and guided meditation to speed along the recovery or ease the pain of cholangiocarcinoma patients.

Prevention & Prophylaxis

There isn't much a person can do to prevent bile duct cancer, though there are a few ways to limit the risk factors. The best prophylaxis measures include eliminating smoking altogether and reducing alcohol consumption. Those are the greatest preventable causes of bile duct cancer.

The other preventative measures involve avoiding exposure to the hepatitis B virus and hepatitis C viruses. The liver fluke parasite is also to be avoided, primarily for people living in southeast Asia. The best way to avoid contact is to refrain from eating raw, uncooked fish.