Bile duct cancer is rare; about 1,000 people in the UK get it each year. Bile duct cancer most commonly affects people over 65. It’s usually treated with surgery, and more rarely, with chemotherapy, radiotherapy and photodynamic therapy.
 
How cancer develops
About bile duct cancer
Symptoms of bile duct cancer
Causes of bile duct cancer
Diagnosis of bile duct cancer
Treatment of bile duct cancer
Living with bile duct cancer
 

How cancer develops

The information on the video provided does not constitute advice on diagnosis or the treatment for heart disease and such advice should always be sought from a doctor or another suitably qualified health professional.

About bile duct cancer

Bile is a digestive fluid that helps to break down fats. It’s made by the liver and stored in the gallbladder. Bile then passes from the gallbladder into your small bowel to help break down fatty food. The bile ducts are the tubes connecting the liver and gallbladder to the small bowel.
 
Bile duct cancer almost always starts in a type of tissue called glandular tissue and is then known as adenocarcinoma. If the cancer starts in the part of the bile duct inside the liver, it’s known as intra-hepatic bile duct cancer. If it starts in the area of the bile ducts outside the liver, then it’s known as extra-hepatic bile duct cancer.
 
This factsheet is about extra-hepatic bile duct cancer. Intra-hepatic bile duct cancer is treated the same way as liver cancer.
 

Symptoms of bile duct cancer

Symptoms of bile duct cancer may include:
 

  • yellowing of the skin and the white of your eyes (known as jaundice)
  • dark yellow urine
  • pale coloured faeces
  • mild pain in the upper abdomen
  • a high temperature
  • loss of appetite or feeling sick
  • weight loss and tiredness
  • itchy skin

These symptoms aren’t always due to bile duct cancer but if you have them, visit your GP.

Causes of bile duct cancer

Doctors don’t fully understand why bile duct cancer develops. However, certain factors make bile duct cancer more likely.
 

  • Age – it’s most common around age 65.
  • Cholangitis with or without ulcerative colitis  – it causes inflammation in the bile ducts.
  • Choledochal cysts.
  • Chronic gall stones.
  • Exposure to certain chemicals used in the metal or rubber industry.
  • Infection with a parasite called the liver fluke – found in South Asia and Africa.
  • Smoking.

 

Diagnosis of bile duct cancer

Your GP will ask about your symptoms and examine you. You may then be referred to a doctor specialising in cancer (an oncologist).
 
You may have the following tests to confirm diagnosis.
 

  • Blood tests to check your liver function.
  • Endoscopic retrograde cholangio-pancreatography (ERCP) – images of the pancreatic duct and the bile duct are taken using an endoscope (a camera attached to a flexible tube) passed down through your mouth. You will have an anaesthetic spray to numb your throat and you may need a sedative.
  • Percutaneous transhepatic cholangiography (PTC) – a needle is passed through the skin to the liver and a dye is injected into the bile duct and X-ray image is taken. For this procedure you will need a local anaesthetic.
  • Biopsy – a sample of cells or tissue is removed from the bile duct and sent to a laboratory for diagnosis. This is usually done when the ERCP or PTC is performed.
  • Scans – these may include ultrasound, MRI or CT scans. These are done to check the liver, gallbladder and bile ducts to see if the cancer has spread.

 
Other tests to determine how far the cancer has spread may include the following.
 

  • An endoscopic ultrasound scan (EUS) – an endoscope with an ultrasound probe is used to check the pancreas and the surrounding tissues.
  • An angiogram – dye is injected into main artery leading to the liver to check the blood vessels close to the liver, gall bladder and bile ducts.
  • A laparotomy – a small cut is made in your abdomen to look directly at the bile duct and surrounding tissues. For this procedure you will need a general anaesthetic.



 

Treatment of bile duct cancer

Treatment depends on the position and size of the cancer in the bile duct and how far it has spread. Your doctor will discuss your treatment options with you.

Surgery

Surgery may be used to remove the cancer if it hasn’t spread beyond the bile duct. This option isn’t always suitable as the bile duct is in an awkward position and it may not be possible to remove all of the cancer.
If it’s not possible to remove the cancer, your surgeon may suggest bypass surgery to relieve symptoms of jaundice. This allows the bile to flow from the liver to the small bowel.

Stent insertion

A stent insertion may be used to help relieve symptoms of jaundice without having to perform surgery. A stent (a small hollow tube) is fitted into the bile duct to allow bile to drain away. This can be done using ERCP or PTC procedure.

Non-surgical treatments

  • Radiotherapy – radiation is used to kill cancer cells. It isn’t generally suitable for bile duct cancer. It’s occasionally given at the same time as chemotherapy.
  • Chemotherapy – anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes you may be given tablets. Doctors are still assessing how effective chemotherapy is in bile duct cancer.
  • Photodynamic therapy – a light-sensitive drug is injected into a vein and this travels around the body and is taken up by cells. The drug enters more cancer cells than healthy cells. A laser is then passed over the cells to activate the drug which then kills the cells. It’s not yet clear how effective this treatment is.

 

Living with bile duct cancer

After treatment for cancer, you will have regular check ups with your doctor to see if there is any evidence of the cancer returning. If the cancer has already spread, you will be seen regularly by doctors or specialist nurses for treatments to deal with any symptoms.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There are support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.

How would I know if I have been infected by a liver fluke parasite?
If I have surgery, how long will I need to stay in hospital?
If the bile duct cancer can't be cured, what will happen?

 
How would I know if I have been infected by a liver fluke parasite?

You can only get liver fluke infection if you visit certain countries and eat raw fish while you are there. If you have the infection, you would have symptoms.
 

Explanation

 
The two main types of liver fluke parasite that are linked to bile duct cancer are Clonorchis sinensis and Opisthorchis felineus. They cause inflammation and scarring in the bile duct. This increases your risk of developing bile duct cancer.
 
Liver fluke parasites are common in Asia, North Africa, South America and Eastern Europe and you usually get it from eating raw fish. You are unlikely to get this infection unless you visit these parts of the world and eat raw fish while you are there.
 
Symptoms of an infection may appear several months after getting the parasite. These can include:
 

  • severe abdominal (tummy) pain
  • swollen abdomen
  • a high temperature
  • nausea
  • diarrhoea
  • loss of appetite and indigestion

 
Symptoms of a chronic infection include:
 

  • abdominal pain that comes and goes
  • jaundice
  • anaemia

 
If you’re concerned that you have, or have had liver fluke infection, speak to your doctor.

If I have surgery, how long will I need to stay in hospital?

It depends on far the cancer has spread and which organs it is affecting.
 

Explanation

If the cancer has spread to a number of areas, more complicated surgery may be needed such as Whipple’s surgery. This involves removing the bile duct, part of the stomach, part of the small bowel, the pancreas, the gallbladder and surrounding lymph nodes.

You may need to stay in the intensive care unit for a few days after your operation then continue your stay on a general surgical ward for up to two weeks. Ask your surgeon how long he or she expects you to stay in hospital for your particular treatment.

If the bile duct cancer can’t be cured, what will happen?

You will be given palliative treatment which treats the symptoms you have but may not cure you. This will help you feel better on a day-to-day basis.
 

Explanation

Your doctor might choose treatments such as chemotherapy, radiotherapy and photodynamic therapy to shrink the cancer, or help ease your symptoms if it can’t be cured.
There are two operations that your doctor may suggest to relieve any symptoms of jaundice.

  • Inserting a stent – this is a hollow tube, five to 10 cm long and is as thick as the plastic casing of a ballpoint pen. It opens up the bile duct and prevents bile building up. It’s usually replaced every three to four months.
  • Bypass surgery – this is when the gall bladder or the unaffected part of the bile duct is joined to your small bowel, bypassing the blocked area in your bile duct. It allows the bile to flow from the liver into the small bowel.
  •  

Your doctor will be able to explain how your treatment will help your symptoms.

Further information

 

Sources

  • Khan SA, Davidson BR, Goldin R, et al. Guidelines for the diagnosis and treatment of cholangiocarcinoma: consensus document. Gut 2002; 51:vi1-vi9.
  • About bile duct cancer. Cancer Research UK. www.cancerhelp.org.uk,  accessed 1 February 2010
  • Bile duct cancer (cholangiocarcinoma). Macmillan Cancer Support. www.macmillan.org.uk, accessed 1 February 2010
  • Khan SA, Davidson BR, Taylor Robinson SD. Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma. HPB(Oxford) 2008; 10:(2):77–82
  • Photodynamic therapy for bile duct cancer. National Institute of Health and Clinical Excellence (NICE), 2005. www.nice.org.uk

 

Related topics

  • Abdominal ultrasound
  • Cancer staging and grading
  • Chemotherapy
  • CT scan
  • General anaesthesia
  • Liver cancer
  • Local anaesthesia and sedation
  • MRI scan
  • Radiotherapy

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