Cholangiocarcinoma (Bile Duct Cancer)

What is a bile duct?

Bile ducts are a collection of thin tubes that transport bile from the liver and gallbladder to the small intestine, where it helps to digest food. There are different types of bile ducts. Intrahepatic bile ducts are a network of tiny tubes (ductules) come together to form small tubes (ducts). They merge into larger ducts before and then into the left and right hepatic ducts within the liver, that transport bile to the extrahepatic ducts.

After leaving the liver, the left and right hepatic ducts join to form the common hepatic duct in a part of the liver called the hilum. The gallbladder is joined to the hepatic duct by a duct called the cystic duct, together called the common bile duct. The common bile duct joins the pancreatic duct after passing through the pancreas, transporting bile to the small intestine.

Cholangiocarcinoma (Bile Duct Cancer), Treatment & Surgery

Cholangiocarcinoma, also known as bile duct cancer, is when healthy cells in the bile ducts stop working correctly, multiply and form a tumour. Cholangiocarcinoma is a rare form of cancer, and typically an accurate diagnosis can be difficult.
Bile duct cancer (cholangiocarcinoma) is grouped into different types depending upon where the cancer occurs:

Extrahepatic bile duct cancer

Cancer that occurs outside of the liver, most commonly within the pancreas near where the bile ducts empty into the intestines.

Perihilar (hilar) bile duct cancer

Cancer that occurs at the hilum of the liver (where the right and left hepatic ducts join together).

Intrahepatic bile duct cancer

Cancer that occurs within the smaller bile duct network within the liver, sometimes confused with cancer that begins in hepatocyte liver cells.

Cholangiocarcinoma Symptoms

Cholangiocarcinoma can cause blockage of bile flowing from the liver to the intestine, causing the bile to backup and accumulate in the bloodstream and body. Some bile duct cancer signs and symptoms can include:

  • Jaundice (eyes and skin turning yellow)
  • Abdominal pain
  • Loss of appetite/weight loss
  • Weakness/fatigue
  • Itchy skin

The risk of bile duct cancer increases with:

  • Inflammatory conditions (such as primary sclerosing cholangitis)
  • Chronic liver disease
  • Bile duct problems present since birth
  • Age (generally occurs in adults aged 50+)
  • Smoking

If you are experiencing any of these symptoms and are concerned, you should make an appointment with your doctor.

Cholangiocarcinoma - diagnosis

If your doctor suspects you may have bile duct cancer following a physical exam and a series of tests, you will likely be referred to a specialist who will perform the some or all of the following diagnostic tests:

  • Ultrasound
  • CT Scan
  • MRI
  • ERCP
  • EUS
  • Laparoscopy
  • Biopsy

Cholangiocarcinoma Treatment

Once diagnosed, your doctor will discuss the best treatment options for your cancer. Cholangiocarcinoma treatment options will depend on where the cancer is within the bile ducts, whether the cancer has spread, while considering your age, fitness and general overall health. Cholangiocarcinoma can be very difficult to treat

If a tumour presents within the distal bile duct within the pancreas (extrahepatic) A/Prof Pilgrim may recommend the Whipple’s procedure. The aim of Whipple’s procedure, also known as a pancreaticoduodenectomy, is to remove all cancerous cells from the pancreas and other nearby structures. The operation removes the head of the pancreas, the duodenum (first part of the small intestine), gallbladder and bile duct. A/Prof Pilgrim will then reconnect the remaining organs to allow your body to digest food normally following surgery.

If a tumour presents within the liver, this may require liver resection surgery. Tumours occurring at the hilum of the liver may require more complex management including a procedure called PVE where some of the blood supply to the liver is deliberately blocked up in the x-ray department to allow the remaining liver to grow (which in turns allows a bigger section of liver to be removed at surgery safely). As the bile ducts are very small and complex, and this form of cancer is rare, treatment is very dependent upon the location and progression of the bile duct cancer.
If you would like to make an appointment to discuss cholangiocarcinoma (bile duct cancer) treatment options please call our practice on (03) 9509 4811 to make an appointment, or you can book an appointment online

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