Bile duct cancer (cholangiocarcinoma)

Q 1 What is bile duct cancer? 

Bile ducts are small tubes found in the liver that connect the liver and small intestine. They allow fluid called bile to flow from the liver, through the pancreas, to the gut, where it helps with digestion. Cancer can affect any part of these ducts.

Q 2 What causes bile duct cancer? 

  • Primary sclerosing cholangitis. This disease is usually associated with inflammatory bowel disease such as ulcerative colitis. 
  • Chronic liver disease. 
  •  Bile duct problems present in childhood such as the choledochal cyst, which causes dilated and irregular bile ducts.
  • A liver parasite infection, which can occur from eating raw or undercooked fish.
  • Older age
  • Smoking 

Q3 what are the symptoms of bile duct cancer? 

  • Most of the patients present with obstructive jaundice ( Yellowing of your skin, itching all over the body, White-colored stools ) 
  • Fatigue
  • Abdominal pain
  • Unintended weight loss

A word of caution 

All of these symptoms can also be caused by conditions that are not cancer. Kindly consult your doctor first. 

Q 4 How is it diagnosed? 

  • Scans, such as an ultrasound scanCT scan or MRI scan
  • Blood tests – to assess the state of liver, kidneys and bone marrow
  • Blood tumor markers such as CA 19.9 & CEA 
  • Chest X-ray – to check if cancer has spread to the lungs or not. 
  • Sometimes a PET scan – To know the distant spread of disease 
  • Sometimes a biopsy may be required for confirmation of diagnosis. 

Q 5 How bile duct cancer is treated?

     Bile duct cancer is often curable if it’s diagnosed at an early stage

     When deciding treatment options for a particular patient, the doctor will consider the following factors and will decide the individual treatment plan:

  • The size of the cancer
  • The stage of the cancer
  • The location of the cancer
  • Your overall health and ability to recover from surgery, radiation therapy or chemotherapy
  • Your personal preferences

Following are the general guidelines but treatment may vary from patient to patient:  

  • If cancer is in early-stage then surgery is done to remove the affected area, but this is only suitable for a small number of people because in majority disease is too far advanced, or the patient is already too ill for surgery. 
  • Options for advanced disease (Unresectable, Recurrent, or Metastatic) include:
  • Taking biopsy either from laparoscopy or ERCP* or PTC 
  • Inserting a hollow tube (stent) into the bile duct to stop it becoming blocked – this can help relieve symptoms such as jaundice
  • Chemotherapy – Given to slow cancer progression and relieve symptoms. 
  • Radiotherapy – to relieve symptoms and improve the quality of life.

*Endoscopic retrograde cholangiopancreatography (ERCP)

  • A procedure used to x-ray the bile ducts that carry bile from the liver to the small intestine.
  • An endoscope is passed through the mouth and stomach and into the small intestine. The dye is injected through the endoscope into the bile ducts and an x-ray is taken. 
  • A sample of tissue is removed and send for confirmation of cancer. 
  • If the bile duct is blocked because of cancer, a thin tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open.