Bile Duct Cancer (Cholangiocarcinoma)

Bile Duct Cancer (Cholangiocarcinoma)

The bile duct is a tube that connects the liver and gallbladder to the small intestine, measuring about 10 to 13 cm in length. Bile is a fluid produced by the liver and stored in the gallbladder that helps in the digestion of fats from food. It also aids in removing waste from the liver via the bloodstream.

Types of Bile Duct Cancer:

1. Extrahepatic Cholangiocarcinoma: This type occurs in the bile duct located outside the liver. It is the most common form of bile duct cancer.
2. Hilar Cholangiocarcinoma: Found where the right and left bile ducts join.
3. Intrahepatic Cholangiocarcinoma: Accounts for 5%-10% of bile duct cancers and is found inside the liver.

Statistics:

While exact statistics for bile duct cancer in India are unavailable, approximately 8,000 people are diagnosed with this cancer annually in the United States.

Risk Factors:

Risk factors for bile duct cancer include:

• Primary Sclerosing Cholangitis (PSC): A rare inflammation of the bile duct.
• Choledochal Cyst: A congenital abnormality where fluid accumulates in the bile duct outside the liver.
• Caroli Syndrome: An inherited condition causing bile duct irregularities inside the liver, leading to infection and stones.
• Cirrhosis: Chronic liver disease caused by hepatitis infections or alcohol use.
• Liver Flukes: A parasite infection in the bile ducts.
• Age: Increased risk with age.
• Exposure to Chemicals: Workers handling dioxins, nitrosamines, and polychlorinated biphenyls (PCBs) in industries like rubber and automobiles face higher risk.

Symptoms:

• Jaundice: The bile duct becomes blocked, preventing bile from being excreted, causing jaundice, where the skin and eyes turn yellow.
• Itching: A common symptom due to increased bilirubin in the bloodstream.
• Unexplained weight loss.
• Loss of appetite.
• Fever.
• Abdominal pain.

Diagnosis:

• Blood Tests: To measure bilirubin, alkaline phosphatase, and liver function.
• Tumor Markers: Blood tests for CEA and CA 19-9 levels.
• Biopsy: A sample of suspected tissue is removed for microscopic examination.
• Ultrasound, CT Scan, MRI: Imaging tests to locate and assess tumors.
• Percutaneous Transhepatic Cholangiography (PTC): A test using a needle to inject dye into the bile duct, followed by X-ray imaging to detect blockages.

Bile Duct Cancer Staging:

The standard TNM staging used in other cancers is not applied here. Instead, the cancer is categorized as:

• Local: Cancer is confined to the bile duct and can be removed via surgery.
• Locally Advanced: Cancer has spread around the bile duct but not to other organs.
• Metastatic: Cancer has spread to distant organs, making surgery unfeasible.
• Recurrent: Cancer that has returned after treatment.

Treatment:

1. Surgery: Tumors and some surrounding healthy tissue are surgically removed. Due to the bile duct’s location, surgery can be complicated.
• Bile Duct Removal: If cancer is localized, the bile duct and nearby lymph nodes are removed.
• Partial Hepatectomy: If cancer is near the liver, part of the liver is also removed.
• Whipple Procedure: In advanced cases, the pancreas, small intestine, bile duct, and part of the stomach are removed.
• Liver Transplantation: Complete removal of the liver and bile duct followed by a liver transplant.
2. Radiation Therapy: High-energy radiation is used to kill cancer cells.
3. Chemotherapy: Anti-cancer drugs like Cisplatin, Gemcitabine, Capecitabine, and others are used to kill cancer cells. Chemotherapy can be administered before surgery to shrink tumors or when surgery is not possible.
4. Targeted Therapy: This treatment targets specific genes, proteins, or tissue environments involved in cancer growth. Drugs like Pemigatinib and Infigratinib are used.
5. Immunotherapy: The body’s immune system is stimulated to attack cancer cells. Drugs like Durvalumab, Pembrolizumab, and Nivolumab are used.

Follow-Up:

After completing cancer treatment, regular follow-up tests are necessary to monitor for recurrence and manage side effects. Regular physical exams, blood tests, and imaging tests are recommended as part of the follow-up routine.

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