Bile Duct Cancer

About Bile Duct Cancer

Cholangiocarcinoma(Bile duct cancer ) is a rare and often fatal cancer that affects the bile ducts. It is slightly  more affects men than women.It begins in the bile ducts, thin tubes that transport digestive fluid, known as bile, from the liver and gallbladder into the small intestine. The exact location of the primary tumor (inside or outside the liver) and the kind of cell involved in the development of this disease determines the type of bile duct cancer.

Bile Duct Cancer Cause and  Risk Factors

Age: people who are 6o year and more likely to develop the cancer.

Obesity: Being obese may increase the risk some cancers, including bile duct cancer.

Smoking and Excessive alcohol consumption:It is also risk factor for developing the bile duct cancer.

Exposure to hazardous chemicals: such as  dioxins, nitrosamines, polychlorinated biphenyls (PCBs), asbestos, radon and radio active substance produce the cancer.

Chronic other disease: Some conditions that cause chronic inflammation and increase the risk of bile duct cancer are bile duct stones, ulcerative colitis (inflammation of the gastrointestinal tract) and primary sclerosing cholangitis (PSC), an autoimmune disease that causes inflammation of the bile duct and scarring.

Liver or bile duct diseases: Cirrhosis of liver, pancreatitis (inflammation of the pancreas), irritable bowel syndrome, choledochal cysts (bile-filled sacs outside the liver with pre-cancerous cells) and Caroli’s syndrome (an inherited condition present at birth that causes dilation or widening of the intrahepatic bile ducts), may increase a person’s bile duct cancer risks.

Other Parasitic infections: A water-borne parasite called liver fluke that is commonly found in Asia and the Middle Eastern countries can infect the bile duct and cause cancer.

Bile Duct Cancer Symptoms

Bile duct cancer symptoms typically do not appear in the early stages of the disease.

Earliest symptoms: jaundice, a yellowing of the skin and eyes. Decreased appetite, weight loss,  light colored stools and dark urine

Other bile duct cancer (cholangiocarcinoma) symptoms may include:

Itching: excess amount of bilirubin circulate in blood and reach to skin resulting patient complain of itching in all over body.

Enlarged abdominal mass:  As the tumor grows and interferes with nearby organs, it can cause a visible mass.

Abdominal pain: in  advanced stages of the disease.

Nausea and/or fever: A side effect of abnormal liver function and infection  (blockage of bile ducts or an increase in bilirubin) which produce the nausea and fever.

Bile Duct Cancer Types

Cancers can occur in any part of the bile duct. The location  and the kind of cell involved which  determine by:

1) Intrahepatic bile duct cancer

This cancer occurs in the bile ducts that are within the liver. It is often misdiagnosed as liver cancer.

2) Extrahepatic bile duct cancer

This can develops in the ducts outside of the liver. Most bile duct cancers are extrahepatic, including:

  • Adenocarcinomas: It is also called cholangiocarcinoma.The most common type of extrahepatic bile duct cancer, form in the cells of the mucous gland lining the inside of the bile duct.
  • Hilar (or perihilar) bile duct cancers:Perihilar bile duct cancer is the most common type of extrahepatic bile duct cancer. It occurs at the junction where the bile ducts exit the liver. It also called Klatskin tumors.
  • Distal bile duct cancer:  disease arises near the small intestine, at the farthest reach of the bile ducts.

Diagnosis of Bile Duct Cancer

Blood and urine test :

in which include Liver function tests (LFTs), tumor markers test will help the diagnosis of bile duct cancer.

Imaging tests:

1) Ultrasound

It is is a non-invasive diagnostic technique used to image inside the body

2) CT Scan

A computed tomography (CT) scan is an imaging test that uses a computer to put a series of x-ray images together to create detailed 3D images of organs, tissues, bones and blood vessels in the body.It provides accurate information about the size, shape and position of any tumors in the bile duct and surrounding area.

3) MRI Scan

MRI help to distinguish that tumors cancerous and non-cancerous.A magnetic resonance imaging (MRI) is an imaging test that uses powerful magnetic forces, radio frequency (RF) waves and a computer to make detailed 3-dimensional pictures of the organs, bones and tissues inside your body

Cholangioscopy: It is helpful foridentify abnormalities in the bile ducts such as a block, narrowing or dilation of the bile duct. Types of cholangiography are

  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transhepatic cholangiography (PTC)
  • Magnetic resonance cholangiopancreatography (MRCP)

Bile Duct Cancer Treatments

Surgery

Bile duct cancers are classified based on whether they can be completely removed . Depending on the size and location of your tumor, the cancer may be removed by surgery.

If your cancer has invaded nearby organs,  your surgeon removes:

  • the bile ducts
  • the gallbladder
  • the pancreas
  • sections of your stomach and gut

Liver Transplant Surgery: Surgery to remove your liver and replace it with one from a donor but there is a risk that the cancer will recur after a liver transplant surgery.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. In general, normal cells grow and die in a controlled way. Cancer cells keep growing without control. It stopping them from spreading, or slowing their growth.

Chemotherapy is often used along with radiation therapy and surgery  in treating cancers. It may be used before surgery to shrink a tumor or after surgery to destroy any cancer cells that remain and to prevent the cancer from coming back. Chemotherapy may also be used to relieve symptoms, improve quality of life and extend life for people with advanced cancer

Chemotherapy drugs kill cancer cells, but they can also damage healthy cells.Some common side effects are fatigue, nausea, vomiting, pain, and hair loss.

Radiation therapy

Radiation therapy also called radiotherapy.Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells and shrink tumors.Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.

Radiation therapy is often used along with chemotherapy.At high doses, radiation therapy kills cancer cells or slows their growth by damaging their DNA. Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and removed by the body.

it often causes side effects. These are different for each person. Some common side effects are fatigue, dry mouth,nausea, vomiting, pain, and hair loss.depending on the patient’s stage and location of the tumor(s). Commonly used radiation therapies for this cancer type are:

  1. External beam radiation therapy (EBRT)
  2. Intensity modulated radiation therapy (IMRT)
  3. Intraoperative radiation therapy (IORT)
  4. Photodynamic therapy
  5. TomoTherapy

Gastroenterology procedures

  1. ERCP (endoscopic retrograde cholangiopancreatography)
  2. Stent placements
  3. Balloon dilation for obstruction
  4. Photodynamic therapy (PDT)

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