Bile is a fluid made by the liver. It helps in breaking down fats during digestion. Small tubes network called ducts connect the liver, gallbladder, and small intestine. Two small ducts emerging from the liver form left and right hepatic ducts. These ducts join outside the liver and form a common hepatic duct. The cystic duct connects the gallbladder to the common hepatic duct. Bile from the liver passes through these ducts and is stored in the gallbladder. During the process of digestion, the gallbladder releases bile that passes through the cystic duct to the common bile duct and then into the intestine.

What is bile duct cancer?

Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. Bile duct cancer is also called cholangiocarcinoma.

What are the types of bile duct cancer?

Intrahepatic bile duct cancer or intrahepatic cholangiocarcinomas: Cancer develops in the bile ducts within the liver. A low percentage of bile duct cancers are intrahepatic.

Extrahepatic bile duct cancer: This type of cancer develops outside the liver in the bile ducts. Cancer is of two types:  perihilar bile duct cancer and distal bile duct cancer.

Perihilar bile duct cancer: This type of cancer develops in the common hepatic duct region. It is also known as perihilar cholangiocarcinoma or Klatskin tumor.

Distal bile duct cancer or extrahepatic cholangiocarcinoma: This type of cancer develops in the region of the common bile duct.

What are the signs and symptoms of bile duct cancer?

The signs and symptoms of bile duct cancer include the following:

  • Fever
  • Itching
  • Weakness
  • Loss of appetite or weight loss
  • Upset stomach and vomiting
  • Pain in your belly or sides
  • Yellow skin or eyes (jaundice)
  • Dark urine
  • Light-colored stools

What are the risk factors for bile duct cancer?

The risk factors for bile duct cancer include:

  • Chronic ulcerative colitis
  • Blocking of bile ducts by inflammation and scarring due to primary sclerosing cholangitis – a progressive disease.
  • Infection with a Chinese liver fluke (parasite)
  • Cysts in the bile duct cause infection, inflammation, and swollen bile ducts. They block the flow of bile.

How is bile duct cancer diagnosed?

A surgical gastroenterologist will do a physical examination. The doctor will ask the patient about their general health, habits, lifestyle (smoking and drinking habits), and family history of liver disease and cancer. The doctor will also check for lymph nodes, masses, tenderness, and fluid buildup in the abdomen.

For an accurate diagnosis of cancer, a gastroenterologist may recommend the following tests:

  • blood tests
  • An ultrasound scan, endoscopy, and a CT or MRI scan

Percutaneous Transhepatic Cholangiography (PTC)

It is A specialized test in which a surgical gastroenterologist inserts a needle through the skin and into a bile duct. The doctor inserts a dye and then takes an X-ray.

Cholangioscopy

Peroral cholangioscopy is often performed during ERCP. This specialized procedure is used to detect cancers in the bile ducts and collect tissue samples (biopsy)

Biopsy – cell sample collected from the bile ducts during cholangioscopy procedure. The cells are analyzed for abnormal growth and cancer.

Magnetic resonance cholangiopancreatography (MRCP) – A MRI machine takes images of bile ducts.

What is the treatment for bile duct cancer?

Bile duct removal: A surgical gastroenterologist removes the affected part of the bile duct if cancer is present in it. Lymph nodes are also removed.

Whipple procedure: This is a surgical procedure to remove the gallbladder, the head of the pancreas, the bile duct, a part of the stomach, and the small intestine. To kill leftover cancer cells after removing cancer, doctors prescribe chemotherapy or radiation therapy.

Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer.

Radiation therapy is used to treat bile duct cancer – both external and internal types are used. Radiation therapy helps in relieving symptoms and improving the quality of life as palliative therapy.

Other Procedures

To relieve symptoms associated with a blocked bile duct and to improve quality of life, an experienced surgical gastroenterologist performs the following types of surgical procedures: endoscopic stent placement, biliary bypass, and percutaneous transhepatic biliary drainage.

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