What is cholangiocarcinoma?
Cholangiocarcinoma means cancer of the bile ducts. This can arise from bile ducts inside the liver or outside of the liver. It can also grow large enough to involves surrounding structures including the arteries and veins.
The role of the bile ducts is to collect bile from the liver cells and deliver them to the small intestine. The bile duct cancer within the liver may cause pain but usually does not result in jaundice. A cancer in the duct outside of the liver will cause a blockage and the patient will become jaundiced. They will also experience dark urine, pale stools, and itchy skin.
At the other clinic we have a multidisciplinary team of GI doctors, surgeons, interventional radiologists, and medical oncologists that can investigate the extent of the disease and prescribe an appropriate treatment plan. This may involve relieving the jaundice with the use of stents. The resolution of jaundice allows for a safer operation to remove the disease ducts.
What causes bile duct cancer?
The exact cause of plunger carcinoma is not known and remain a mystery in most patients. There are risk factors that predisposed to bile duct cancer through a common pathway of chronic bile duct irritation. This can be from a choledochal cyst, recurrent infections, and autoimmune diseases. There's also an association with ulcerative colitis in patients that have primaries sclerosing cholangitis (PSC).
What are the treatment options for bile duct cancer?
The location of the cancer determines the treatment options. If the tumor is localized to the liver, then it can be resected without requiring a reconstruction of the bile ducts. This carries a lower risk and a quicker recovery.
If the tumor involves the bile duct confluence, then a bile duct reconstruction will be required. This usually requires a liver resection in addition to the bile duct resection to achieve clear margins.
If the bile duct tumor is lower in the duct, then it will require combined pancreas head and bile duct resection. This is called a pancreaticoduodenectomy (Whipple procedure).
Surgery is the only therapy that can achieve cure; for those patients that are not resectable, the non-surgical options include chemotherapy and radiation.
For patients that have a tumor at the confluence of the bile ducts or have poor liver function such that a operation is not feasible then a liver transplant may be considered. This does require a multidisciplinary team evaluation at a liver transplant center.