Bile Duct Cancer

Symptoms: 

Symptoms of bile duct cancer include:

  • Yellowing of your skin and the whites of your eyes (known as jaundice) – this happens when the tumour blocks the bile duct, which causes bile to build up in your blood and tissues
  • Dark urine
  • Pale-coloured faeces
  • Pain or discomfort in your upper abdomen (tummy)
  • A fever
  • Loss of appetite or feeling sick
  • Weight loss
  • Itchy skin
Tests to diagnose: 

The following tests are done :

  • Blood tests can check how well your liver is working.
  • Scans – these may include ultrasound, MRI or CT scans. These are done to check your liver, gallbladder and bile ducts.
  • An endoscopic retrograde cholangio-pancreatography (ERCP) test will take images of your pancreatic duct and your bile duct. This is done using an endoscope (a camera attached to a flexible tube), which your doctor or health professional will pass down through your mouth. You will have an anaesthetic spray to numb your throat and a sedative to relax you.
  • In a percutaneous transhepatic cholangiography (PTC) test, your doctor will pass a fine needle into the right-hand side of your abdomen (tummy). He or she will inject a dye into your bile duct and take an X-ray image. You will need a local anaesthetic for this procedure as well as antibiotics to prevent an infection.
  • A particular type of MRI scan known as magnetic resonance cholangiopancreatography (MRCP) may be done instead of ERCP. This means you won’t have any tubes down your throat as in other tests, and it’s safer (no radiation from X-rays). But it is not possible to perform a biopsy with MRCP.
  • Biopsy – a biopsy is a small sample of tissue. This will be collected from your bile duct and sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. This is usually done at the same time as an ERCP or PTC.
  • If you're found to have cancer, you may need to have other tests to check if the cancer has spread. The process of finding out the stage of a cancer is called staging. The following tests may be used to diagnose bile duct cancer or to check if the cancer has spread.
  • Contrast enhanced CT scan. You will be given “oral contrast” (a type of dye) to drink to make the CT scan images clearer.
  • Endoscopic ultrasounds scan (EUS). In this test an endoscope with an ultrasound probe will be used to check your pancreas and the surrounding tissues. It means that a clearer ultrasound picture can be taken from inside your body.
  • A magnetic resonance (MR) angiogram. Dye will be injected into the main artery leading to your liver to check if the cancer has spread to the blood vessels close to your liver, gallbladder and bile ducts.
  • Laparoscopy. A small cut will be made in your abdomen and a camera attached to a flexible tube will be used to look at your bile duct and surrounding tissues. During the procedure, the doctor might take samples of tissue (biopsy) to see if they are cancerous. You will need a general anaesthetic – this means you will be asleep during the procedure.
Treatment: 

The main treatment for bile duct cancer is surgery. It’s the only way bile duct cancer can be potentially cured. Other options include procedures to help your symptoms and chemotherapy and radiotherapy. Your treatment will depend on the position and size of the cancer in your bile duct, how far it has spread, and your general health. Your doctor will discuss your treatment options with you.

Surgery

Surgery can remove the cancer if it hasn't spread beyond your bile duct. This option isn't always suitable as the bile duct is in an awkward position and it may not be possible to remove all of the cancer.

There are a number of options for surgery.

  • Removal of your bile ducts. If the cancer hasn’t spread beyond your bile ducts, your surgeon will remove them.
  • Partial removal of your liver. If the cancer has started to spread into your liver, your surgeon will remove the affected part, along with your bile ducts.
  • Whipple's procedure. You might have this if the cancer starts in the bile ducts near your pancreas and small bowel. Your surgeon will remove your bile ducts, part of your stomach, part of your small bowel, part of your pancreas, gall bladder and the surrounding lymph nodes. Lymph nodes are glands that are found throughout your body that are part of your immune system.

Some surgical procedures can’t cure you but can help with some of your symptoms.

Bypass surgery – if it's not possible to remove the cancer, your surgeon may suggest bypass surgery to relieve symptoms of jaundice. He or she will connect the bile duct before the blockage to the part after it. This will allow bile to flow from your liver to your small bowel.
Stent – your doctor may insert a stent (a small hollow tube) to help relieve symptoms of jaundice. He or she will fit the stent into your bile duct to keep it open so that bile can drain into your small bowel as it normally would. Alternatively, this procedure may also drain through a small tube into a collecting bag on the outside of your abdomen. This can be done using an ERCP or PTC procedure.

Non-surgical treatments

Non-surgical treatments will aim to improve your symptoms and your quality of life. They may include the following.

Chemotherapy uses medicines to destroy cancer cells. They are usually injected into a vein but sometimes you may be given chemotherapy as tablets. You may have chemotherapy if surgery isn't possible to treat the cancer or after surgery if the operation couldn’t remove all the cancer. It may also be used if the cancer has come back after treatment. However, doctors are still assessing how effective chemotherapy is in bile duct cancer.
Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. You can have radiotherapy externally from a radiotherapy machine, or internally by placing radioactive material close to the tumour (brachytherapy). Radiotherapy is sometimes used after surgery to destroy any remaining cancer cells. Occasionally, it may also be an option if surgery isn't possible. It can't cure bile duct cancer but it can shrink or slow the growth of the cancer. Chemotherapy and radiotherapy may be given together.

A less common treatment is photodynamic therapy. This uses a light-sensitive medicine and a laser to destroy cancer cells. Your doctor will inject the medicine into a vein. This will get absorbed by cells around your body – the medicine will enter more cancer cells than healthy cells. He or she will then pass a laser over the cells to activate the drug, which will then destroy the cells.

However, there’s some uncertainty and conflicting evidence about how safe and effective this treatment is. More research is being done but results have yet to be published. If you’re interested in it, talk to your doctor about what it involves and whether it’s the right option for you.

You can take part in clinical trials as new treatments constantly become available and need to be assessed. Speak to your doctor for more information about them.

After treatment for cancer, you will have regular check-ups with your doctor to see if there is any evidence that the cancer has returned. If the cancer has already spread, you will regularly see doctors or specialist nurses to have treatment for any symptoms you might have.