What is Bile Duct Cancer?

Cancer begins when abnormal cells grow together and form masses called tumors. Sometimes, cancer affects the bile ducts, the thin tubes that connect the liver to the small intestine. Cancer can affect the part of the bile duct outside of the liver (extrahepatic bile duct) or, more rarely, the bile duct inside the liver (intrahepatic bile duct).

Baptist Health is known for advanced, superior care for patients with cancer and the diagnosis, treatment and management of bile duct cancer. You will appreciate timely appointments and a professional, friendly atmosphere where we take time to listen to your concerns. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

Signs and Symptoms

Bile duct cancer symptoms can include:

• Abdominal pain 
• Clay-colored stools
• Dark urine
• Fever
• Itchy skin
• Jaundice
• Malaise, fatigue, and night sweats
• Tumor obstruction of bile drainage
• Weight loss    

Diagnosis

A healthcare provider will perform a physical examination and order tests to diagnose the symptoms. To diagnose bile duct cancer, we use advanced diagnostic procedures and technology to effectively inform treatment and carefully monitor the condition. Diagnostic procedures can include:

Biopsy: A sample is removed from the bile duct tissue or tumor for laboratory testing. Testing can tell the physician whether the tissue is cancerous and, if so, what type of cancer is present. Testing will also reveal the cancer’s grade and its potential to become aggressive. This can be performed using a needle or through a surgical procedure.

Blood test: Blood tests are used to determined organ function, check for infection or anemia, and to determine potential causes of the symptoms. Blood tests can also check for an increased level of proteins that can indicate cancer.

Cholangiography: In this test, dye is injected into the bile duct, to help produced detailed X-ray images.

Computed tomography (CT) scan: A series of detailed pictures of the liver and bile ducts, taken from different angles, are created by a computer linked to an X-ray machine. A special multiphasic, contrast-enhanced, multi-detector CT scan is used to evaluate the bile duct.

Endoscopic retrograde cholo pancreatography (ERCP): In this procedure, an endoscope is used to inject dye into the bile duct for visualization. This procedure may allow for placement of a stent to relieve obstruction of the bile duct.

Intraductal ultrasound: This exam uses a thin tube with a small ultrasound probe, which produces soundwaves to take pictures of the bile ducts and the surrounding area to look for a tumor.

Magnetic resonance imaging (MRI): A large magnet, radio waves and a computer are used to produce pictures of the bile duct and to measure a tumor’s size.

Molecular testing of the tumor: This type of test of a tumor sample identifies specific genes, proteins and other factors unique to the tumor. Results of these tests will help decide whether your treatment options should include a treatment called targeted therapy.

Causes

Most cases of bile duct cancer result from a mutation in the cell DNA, and researches aren’t sure of the cause. 

Risk Factors

Risk factors that can contribute to liver cancer include:

Diseases: Some diseases linked to bile duct cancer include Hepatitis B virus (HBV, hepatitis C virus (HCV), liver cirrhosis, elevated blood glucose, metabolic syndrome, primary sclerosing cholangitis, cholelithiasis, cholecystitis and hepatolithiasis.

Chemical exposure: People in the auto, rubber, chemical and wood-finishing businesses may be exposed to chemicals that can cause bile duct cancer.

Congenital disorders: Some congenital disorders are linked to bile duct cancer, including Caroli's syndrome, congenital hepatic fibrosis and choledochal cysts.

Genetic disorders: Some congenital disorders are linked to bile duct cancer, including Lynch syndrome and biliary papillomatosis.

Prevention 

While some risk factors like heredity cannot be controlled, there are ways you can help to prevent liver cancer:

Avoid and treat hepatitis infections: Avoiding hepatitis infection through safe sex practice and not sharing needles can help prevent the infection that increases risk of liver cancer. People with hepatitis should be treated and follow doctor recommendations.

Control your diet: Normalize weight, avoid obesity and control diabetes.

Manage associated conditions: Be sure to follow up with your gastroenterologist if you are being treated for primary sclerosing cholangitis.

Prognosis

The earlier bile duct cancer is diagnosed, the better the outcome. If curative treatment is not possible, there are multiple treatment measures that can relieve symptoms and improve the quality of life.

Treatment and Recovery

Liver cancer treatment depends on how large the tumor is, general health and whether cirrhosis of the liver is present. Sometimes, multiple types of treatments are necessary, including:

Surgery

For early-stage tumors, surgery can be performed to remove the tumor. When the removal of the tumor is not possible, a bypass of the bile duct obstruction is performed.

Radiation

Radiation therapy focuses high-energy radiation in small doses directly to the tumor to kill cancer cells.

Chemotherapy

Chemotherapy uses special drugs designed to kill cancer cells. Chemotherapy is injected into the blood supply of intraductal cancers to control the growth of tumors.

Complications

If surgery has been performed, complications may include infection, bleeding, blood clots and malnutrition. If the cancer is advanced, complications can include nausea, vomiting, weight loss and physical decline.