Bile duct cancer begins when cells in the bile duct become abnormal and grow uncontrollably. These cells form a growth of tissue, called a tumor. The bile duct is a 4-inch to 5-inch tube that connects the liver and gallbladder to the small intestine. The bile duct allows bile, which is made in the liver and stored in the gallbladder, to flow into the small intestine. Bile is a liquid that helps to break down fats found in foods and helps the body get rid of waste material filtered out of the bloodstream by the liver.
The bile duct starts in the liver. Within the liver, smaller tubes, similar to small blood vessels, drain bile from the cells in the liver into larger and larger branches, ending in a tube called the common bile duct. Outside of the liver, the bile duct drains into the small intestine. The gallbladder is a reservoir that holds bile until food reaches the intestines. It is attached by a small duct, called the cystic duct, to the common bile duct about one-third of the way down the bile duct from the liver. The end of the bile duct empties into the small intestine.
Cancer can occur in any part of the bile duct. The part of the bile duct that is outside of the liver is called extrahepatic. It is in this portion where cancer usually begins. A perihilar cancer, also called a Klatskin tumor, begins where many small channels join into the bile duct at the point where it leaves the liver. About two-thirds of all bile duct cancers occur here. Distal bile duct cancer occurs at the opposite end of the duct from perihilar cancer, near where the bile duct empties into the small intestine. About one-fourth of all bile duct cancers are distal bile duct cancer. About 5% to 10% of bile duct cancers are intrahepatic, or inside the liver.
Adenocarcinoma is the most common type of extrahepatic bile duct cancer, and accounts for about 95% of all bile duct cancers. Adenocarcinoma is cancer that begins in the mucus glands lining the inside of the bile duct. Cholangiocarcinoma is another term that may be used to describe this type of cancer.
This section is about primary bile duct cancer, which is cancer that starts in the bile duct. For information about cancer that began in another part of the body and spread to the bile duct, please see Cancer.Net’s guide for that type of cancer.
Statistics
Primary bile duct cancer is a rare disease. In 2008, an estimated 4,700 adults in the United States will be diagnosed with bile duct cancer. The overall incidence of bile duct cancer is increasing, mostly due to rising rates of intrahepatic bile duct cancer. The reason for this increase is not known. It may be due to the use of more accurate tests to diagnose this type of cancer. Previously, intrahepatic bile duct cancer may have been thought to be a different type of cancer. In some parts of the world, a parasite called a liver fluke can infect the bile duct and cause cancer. Liver flukes are very common in Asia and the Middle East, and therefore bile duct cancer is more common in these regions. Also, gallstones and inflammatory conditions of the gastrointestinal (GI) tract, such as ulcerative colitis or an associated condition called sclerosing cholangitis (PSC), an autoimmune disease in which the body’s immune system attacks the bile ducts and causes scarring, increase the risk of bile duct cancer.
About 20% of bile duct cancers are found at an early stage. The five-year relative survival rate (the percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) for people diagnosed with early-stage bile duct cancer is about 30%. The five-year relative survival rate decreases if the cancer spreads before it is diagnosed.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States and may not apply to a single person. It is not possible to tell a person how long he or she will live with bile duct cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
The following factors may raise a person’s risk of developing bile duct cancer:
Previous disease or irritation of the bile duct. Inflammation of the bile duct can be caused by ulcerative colitis or stones similar to gallstones. PSC may also increase the risk. Other diseases, including choledochal cysts (an abnormality in which there is a cystic swelling of the part of the bile duct outside the liver, present at the time of birth), Caroli’s syndrome (an abnormality of the small bile ducts within the liver that increases a person’s risk of infection and stones, like gallstones, forming in the liver; present at the time of birth), and cirrhosis (liver disease) can cause scarring or chronic irritation that can lead to cancer. Infection with liver flukes that invade the bile duct can also increase the risk of bile duct cancer.
Age. Older adults are more likely to develop bile duct cancer.
Certain chemicals. Dioxins, nitrosamines, and polychlorinated biphenyls (PCBs) may potentially cause bile duct cancer. In particular, people who work in rubber plants and automotive industries may be exposed to these chemicals.
Even though some people who have no risk factors develop bile duct cancer, there are ways to reduce your risk.
Avoid exposure to hazardous chemicals. Even though thorium dioxide (a chemical associated with a high risk of developing bile duct cancer) has been banned from use, other hazardous chemicals are still available or present in the environment.
Get a vaccination against hepatitis B, because chronic hepatitis B infection might increase the risk of cirrhosis and bile duct cancer.
Avoid alcohol abuse, which can lead to cirrhosis.
If traveling in parts of the world where liver flukes are common, drink only purified water and foods that have been thoroughly cooked.
People with bile duct cancer may experience the following symptoms, usually because the tumor is blocking the bile duct. Sometimes, people with bile duct cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Jaundice, which is a yellowing of the skin and the whites of the eyes. When the bile duct is blocked, the liver cannot excrete bile, and the bile backs up into the bloodstream. (The blockage may not be cancer; it can also be caused by a gallstone or scar tissue.) Bile contains bilirubin, which is dark yellow and can cause the skin and whites of the eyes to turn yellow if it is present in the bloodstream. Urine may also become a dark color, and bowel movements may become pale.
Itching, caused by a buildup of bile salts and bilirubin in the body and deposited in the skin
Weight loss
Loss of appetite
Fever
Abdominal pain. Early bile duct cancer usually does not cause pain, but pain may occur if the cancer spreads.
Jaundice is a common symptom, and there can be many causes. Your doctor may need to do several diagnostic tests (see Diagnosis) to find the exact cause. Many diseases associated with jaundice are not serious or life threatening; bile duct cancer is one of the less common causes.
Doctors use many tests to diagnose cancer and determine if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer suspected
Severity of symptoms
Previous test results
In addition to a physical examination, the following tests may be used to diagnose bile duct cancer or distinguish it from other possible causes of jaundice:
Blood chemistry tests. Blood chemistry tests measure the levels of bilirubin and alkaline phosphatase and test other liver functions. High levels of these substances could indicate that the bile duct is not functioning properly.
Tumor marker tests. Sometimes, a tumor sheds certain cells or molecules that can be found in the blood. These substances are called tumor markers (a substance found in higher than normal amounts in the blood, urine, or tissue of people with certain types of cancer). Bile duct cancer may cause high levels of carcinoembryonic antigen (CEA) and CA 19-9 to be present in the blood. However, bile duct cancer may still be present even if there are normal levels of these markers. High levels of these substances can sometimes occur from diseases other than cancer.
Other tests may be performed to provide information about the bile duct. These include:
Biopsy.A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The type of biopsy performed will depend on the location of the tumor. The doctor can obtain tissue samples during a procedure called a percutaneous transhepatic cholangiography (PTC) or another procedure called an endoscopic retrograde cholangiopancreatography (ERCP), or by using a computed tomography (CT or CAT) scan to guide a needle biopsy (see below). Sometimes, surgery is the only way to determine if a person has bile duct cancer. If cancer is found during a surgical biopsy, the surgeon may be able to remove the cancer at that time. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. During an ultrasound, the doctor may be able to see the actual tumor; more often when one of the larger bile ducts is blocked, the small bile ducts behind the obstruction become widened. It is this “dilation of ducts” that can be seen on an ultrasound.
To view the bile duct, the doctor may use an endoscopic (a thin, flexible tube inserted through the mouth) or laparoscopic (inserted through a tiny surgical opening in the side of the body) ultrasound. Both of these procedures allow for a clearer view of the bile duct and can help the doctor perform a biopsy.
CT scan.A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail. CT scans can also be used to guide a needle biopsy, which is the use of a fine needle inserted through the skin into the suspicious area to collect a sample of cells.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI specific for the bile duct is called MRI cholangiopancreatography. A contrast medium may be injected into a patient’s vein to create a clearer picture.
PTC. In this test, a thin needle is inserted into the bile duct in the liver. The doctor injects contrast medium into the needle, which flows into the bile duct. An x-ray is used to show if the bile duct is blocked and locate the site of the blockage. This is important in planning treatment.
ERCP. The doctor inserts a flexible tube down the person’s throat, through the stomach, and into the bile duct. Dye is injected into the tube, which will help outline the bile duct on an x-ray. A tiny brush can also be inserted through the tube to collect cells and tissue fragments for a biopsy. This technique can help to find and take a sample of the tumor and provide information that is important in planning treatment.
Laparoscopy. The doctor views the bile duct, gallbladder, and liver through a lighted tube inserted into a surgical opening in the person’s abdomen. Some laparoscopes can help the doctor to maneuver small instruments through the tube to take a tissue sample.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four). The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments.
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Intrahepatic bile duct cancer is staged using the same system as liver cancer. The staging of both intrahepatic and extrahepatic bile duct cancer is below.
Intrahepatic bile duct cancer staging
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups to help describe the tumor in even more detail. If there is more than one tumor, the lowercase letter "m" (multiple) is added to the "T" category. Specific tumor stage information is listed below:
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of a primary tumor.
T1: The tumor is only a single tumor. It has not spread to adjacent blood vessels.
T2: Either of these conditions:
Any tumor that has spread to adjacent blood vessels.
Multiple tumors, none larger than 5 centimeters (cm).
T3: Either of these conditions:
More than one tumor larger than 5 cm.
The tumor has spread to the major veins within the liver.
T4: Either of these conditions:
The tumor has spread to the organs near the liver (except the gallbladder).
The tumor has spread through the visceral peritoneum (layer of tissue that lines the abdomen).
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the site of the cancer are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be evaluated.
N0: Cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to the regional lymph nodes.
Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.
MX: The tumor cannot be evaluated.
M0: The cancer has not metastasized.
M1: There is metastasis to another part of the body.
Cancer stage grouping for intrahepatic bile duct cancer
Doctors assign the stage of the cancer by combining the T, N, and M classifications:
Stage I: This is the earliest stage of intrahepatic bile duct cancer. The tumor has not spread to the blood vessels, lymph nodes, or other parts of the body (T1, N0, M0).
Stage II: The tumor has spread to nearby blood vessels, but has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).
Stage IIIA: The cancer has not spread beyond the liver, but the area of the cancer is larger than stage I or II, and it often has invaded nearby blood vessels (T3, N0, M0).
Stage IIIB: The cancer has spread to organs near the liver, but has not spread to nearby lymph nodes or other parts of the body (T4, N0, M0).
Stage IIIC: Any tumor that has spread to the regional lymph nodes, but not to other parts of the body (any T, N1, M0).
Stage IV: Any tumor that has spread to other parts of the body (any T, any N, M1).
Recurrent: Recurrent intrahepatic bile duct cancer is cancer that comes back after treatment.
Extrahepatic bile duct cancer staging
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the stage of extrahepatic bile duct cancer. Some stages are also divided into smaller groups that help describe the tumor in even more detail. If there is more than one tumor, the lowercase letter "m" is added to the "T" category. Specific tumor stage information is listed below:
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of a primary tumor.
Tis: Refers to carcinoma (cancer) in situ. Cancer is only in a single layer of cells lining the bile duct and has not invaded other parts of the bile duct wall.
T1: The tumor is located only in the bile duct.
T2: The tumor has spread beyond the wall of the bile duct.
T3: The tumor has spread to the liver, gallbladder, pancreas, and/or a unilateral branch (a single side) of the veins and/or arteries within the liver.
T4: The tumor has spread bilaterally (both sides) to the veins or arteries within the liver and/or adjacent structures, such as the colon, stomach, duodenum, or abdominal wall.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the site of the cancer are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be evaluated.
N0: Cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to the regional lymph nodes.
Distant metastasis. The “M” in the TNM system indicates whether the cancer has spread to other parts of the body.
MX: The tumor cannot be evaluated.
M0: The cancer has not metastasized.
M1: There is metastasis to another part of the body.
Cancer stage grouping for extrahepatic bile duct cancer
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage 0: This is the earliest stage of extrahepatic bile duct cancer. The cancer is only found in one layer of cells, and has not spread (Tis, N0, M0).
Stage IA: The tumor is confined to the bile duct (T1, N0, M0).
Stage IB: The tumor has spread beyond the wall of the bile duct, but has not spread to the regional lymph nodes or other parts of the body (T2, N0, M0).
Stage IIA: The tumor has invaded adjacent organs, such as the liver, gallbladder, pancreas, and/or unilateral branches of adjacent blood vessels, but has still not spread to the regional lymph nodes or other parts of the body (T3, N0, M0).
Stage IIB: The tumor may or may not have invaded unilateral branches of adjacent blood vessels and/or the tumor has spread to nearby organs, such as the liver, gallbladder, and pancreas. The cancer has spread to nearby lymph nodes, but has not spread to other parts of the body (T1 or T2 or T3, N1, M0).
Stage III: The tumor has spread bilaterally to adjacent blood vessels and/or adjacent structures, and may or may not have spread to the regional lymph nodes, but has not spread to other parts of the body (T4, any N, M0).
Stage IV: Any tumor that has spread to other parts of the body (any T, any N, M1).
Recurrent: Recurrent extrahepatic bile duct cancer is cancer that comes back after treatment.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of bile duct cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan.
This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section.
The main treatment for bile duct cancer is surgery. Radiation therapy and chemotherapy may be used if the cancer cannot be entirely removed with surgery and in cases where the edges of the tissue removed during surgery show cancer cells (also called a positive margin). Both stage III and stage IV cancer cannot be completely removed surgically.
Surgery
Due to the location and sensitivity of the bile duct area, surgery for bile duct cancer can be difficult. If the cancer is near the liver, the surgeon will remove part of the liver (called a partial hepatectomy), along with the bile duct, gallbladder, and sometimes part of the pancreas and small intestine. If the cancer is near the pancreas, the surgeon may need to remove part or all of the pancreas and part of the small intestine. To maintain the appropriate flow of bile, the remaining part of the bile duct is connected to the small intestine. About 5% to 10% of people do not survive this complicated operation; others (25% to 45%) have serious complications, such as bleeding, infection, or leaking of bile or pancreatic juices. In some cases, surgeons cannot completely remove the tumor. Therefore, the surgeon bypasses the blocked area by connecting part of the bile duct before the blockage with a part of the small intestine beyond the blockage. During this procedure, the surgeon may insert a stent (a plastic or metal tube) into the bile duct to keep it open.
Interventional radiology
If the doctors think that the tumor cannot be removed by surgery, a plastic or metal stent can be passed through the blockage either during the ERCP procedure or during a procedure similar to PTC (see Diagnosis). Although these procedures do not remove the tumor, they can relieve the side effects and people often experience long periods of time when all of their symptoms disappear and quality of life is much better. For both of these procedures, the doctor may insert the stent internally, so the person is not aware of its presence. Sometimes, this is not possible, and a tube will be passed through the liver to redirect the bile externally (outside the body) into a bag that will need regular changing. Some doctors suggest that in these situations people receive long-term antibiotics to guard against infection.
Liver transplantation
Complete removal of the liver and bile ducts followed by transplantation of a donor liver has been used to treat this type of cancer. However, bile duct cancer tends to recur very rapidly after transplantation, and this means that this procedure is very rarely used.
Radiation therapy
Radiation therapy uses high-energy x-rays or other particles to kill cancer cells. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. Occasionally, internal radiation therapy may be used for bile duct cancer. Radiation therapy can be used for treatment or to control the symptoms and pain of advanced disease. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy may be used before surgery to shrink the tumor or when surgery is not an option. In some cases, chemotherapy can shrink the tumor, but it has not yet been proven that this improves a patient’s quality of life or increases survival. Drugs that have been used for bile duct cancer include fluorouracil (5-FU, Adrucil), cisplatin (Platinol), doxorubicin (Adriamycin, Rubex), and gemcitabine (Gemzar). Efforts to improve chemotherapy by investigating new drugs or new combinations of drugs are being made through clinical trials. This is often how patients with bile duct cancer receive chemotherapy.
The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases.
Doctors and scientists are always looking for better ways to treat patients with bile duct cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating bile duct cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bile duct cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health.
Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with the doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’s section on Managing Side Effects, based on ASCO’s curriculum.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient.
For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.
After treatment for bile duct cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. People treated for bile duct cancer may be under medical supervision for several years because there is always a risk that the tumor will recur after treatment or that the person will develop another tumor after apparently successful surgery. Researchers are studying approaches to prevent both recurrence and the development of secondary or “new” tumors, but to date, there is no standard preventive treatment.
If the tumor was not removed by surgery and a stent or surgical bypass was used to relieve jaundice, the most important aspect of follow-up care is early recognition if and when the stent or bypass procedure is no longer effective in removing the blockage. If jaundice becomes worse (a deeper yellow), if a person becomes jaundiced again after the stent has originally cleared the blockage, or if a fever has developed along with sweating, shaking, or abdominal pain, a doctor should be consulted immediately, as the stent may need changing or repositioning.
A possible long-term side effect of treatment for bile duct cancer is the development of strictures after any surgery to the biliary system (bile ducts and gallbladder). These are slowly forming scars that are not cancerous, but may lead to a narrowing of the bile ducts and a recurrence of symptoms similar to those of the original bile duct cancer.
People treated for bile duct cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research for bile duct cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Photodynamic therapy (PDT). After the doctor administers an inactive form of a drug, he or she uses a special light that is directed at the area of the tumor in the bile duct through an endoscope in a procedure similar to ERCP (see Diagnosis). This causes a chemical change in the drug, activating it to kill the tumor cells in the area where the light is directed. PDT is currently used to relieve pain and symptoms, not to cure bile duct cancer. Doctors are also investigating whether PDT can reduce the risk of a stent becoming blocked by reducing the ability of the tumor to grow into it.
Genetics. Scientists are also researching the genetic progression of bile duct cancer, which is the process of how one genetic change turns into many genetic changes that cause a cell to become cancerous.
Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function.
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of bile duct cancer do I have? Where is it located?
Can you explain my pathology report to me?
What is the stage of my cancer? What does this mean?
What are my treatment options?
What clinical trials are open to me?
What treatment do you recommend? Why?
What are the possible side effects of this treatment, both in the short term and the long term?
How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
What is my prognosis?
What are the chances that the cancer will recur?
How can I keep myself as healthy as possible during treatment?
What are the signs that may indicate that my cancer has returned?
What are the signs that may indicate that my stent has become blocked?
What follow-up tests will I need, and how often will I need them?
What support services are available to me? To my family?
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