Bile Duct Cancer Surgery

Types of bile duct cancer are:

Intrahepatic bile duct cancer develops in the bile ducts inside the liver. Also called intrahepatic cholangiocarcinomas, it is an uncommon type of cancer.

• Extrahepatic bile duct cancer

This cancer forms in the bile ducts that are outside the liver. The extrahepatic bile duct consists of the hilum region and the distal bile duct region. Extrahepatic bile duct cancer can be formed in either of these regions.

• Hilar bile duct cancer

This cancer is also called perihilar cholangiocarcinoma or Klatskin tumor. It is found in the hilum region, in the bile ducts outside the liver.

• Distal bile duct cancer

The distal region consists of a bile duct that passes through the pancreas and ends in the small intestine. This cancer found in the part of the bile duct near the small intestine is also called extrahepatic cholangiocarcinoma.

• Jaundice
• Fever
• Itching
• Nausea and vomiting
• Weight loss (unknown reason)
• Pain in the abdomen (right side, below the ribs)
• Fatigue
• Dark urine

Consult the doctor in case of frequent fatigue, jaundice, or extreme abdominal pain. The doctor may refer to a gastroenterologist (specialist in digestive diseases), early diagnosis can improve the chances of recovery.

Bile duct cancer develops when there are changes in DNA in cells in the bile duct. These changes then cause the cells to multiply fast or run out of control forming a tumor (a mass of cells). This tumor invades and destroys healthy body tissue.

Colitis and other liver diseases can increase the risk of bile duct cancer. The risk factors for bile duct cancer include:

• Age (higher risk to people aged above 50)
• Cysts in the bile ducts
• Primary sclerosing cholangitis (scarring and hardening of the bile ducts)
• Liver disease
• Diabetes (people with type 1 or type 2 diabetes are at higher risk)
• Heredity (few DNA changes passed from parents to children)
• Obesity
• Smoking and alcohol intake
• Parasite infection

The doctor can conduct different test procedures to obtain the tissue sample to diagnose the type of bile duct cancer. Different tests are conducted to diagnose how far cancer has spread.

Following are the test and procedures conducted to detect and diagnose the stage and spread of bile duct cancer:

• Healthy history

  The doctor may ask about past illnesses and current health, to identify the underlying cause of cancer.

• Physical exam

  A physical exam is conducted to check general signs of health problems such as lumps, or anything unusual.

• Laboratory test

  Laboratory tests include tissue, urine, and blood tests. These tests help to diagnose and monitor the disease.

• Liver function test

  A liver function test is a blood test to measure the number of few substances released into the blood by the liver. An unusual amount of substance can indicate liver disease that might be caused by bile duct cancer

• Imaging tests

  Imaging tests such as CT scans, MRI, are conducted to have a closer look inside the body to identify the spread of disease. These tests allow the doctor to have a closer look at the organs and look for the symptoms of bile duct cancer.

• Ultrasound

  Ultrasound is a procedure in which waves are sent to internal tissues or organs, which form a picture of a body called a sonogram. Ultrasound is used to have a closer look at the abdomen to identify the stage and type of cancer.

• Biopsy

  The surgical procedure is to remove cells and tissues, for examination under a microscope to check for the sign of bile duct cancer.

• Endoscopy

  Endoscopy uses a thin, flexible tube with a tiny camera at one end. It is inserted into the throat through the digestive tract into the small intestine. This test gives a closer look at the stomach, pancreas, and bile ducts.

The following are the types of treatment used to treat bile duct cancer:

• Bile Duct Cancer Surgery

  Types of surgery used to treat bile duct cancer are as follows:

• Removal of the bile duct

  A surgical procedure to remove a small part of the bile duct if the bile duct cancer is in its early stage and the tumor is small. Surgery is used to remove lymph nodes from the bile duct and its tissue is viewed under a microscope to see cancer.

• Partial hepatectomy

  A surgical procedure is used to remove a part of the liver where cancer is found. The affected part is removed along with some surrounding tissue to prevent the spread of cancer.

• Whipple procedure

  A surgical procedure is used to remove the gallbladder, the head of the pancreas, part of the small intestine, part of the stomach, and part of the bile duct. The affected part is removed, keeping the remaining part intact for the digestive process.

• Liver transplant

  A surgical process to remove the infected liver and replace it with the donated liver. Perihilar bile duct cancer can be treated with a liver transplant. But after a liver transplant, there is a higher risk of recurring cancer.

• Radiation therapy

  Radiation therapy is a treatment that uses high-energy waves or radiation to kill cancer cells. The two types of radiation therapy are:

• External radiation therapy

  This method uses a machine to send radiation waves inside the body towards the infected part.

• Internal radiation therapy

  This method uses needles, wires, or catheters to send radioactive substances directly into the infected cancerous part.

• Chemotherapy

  Chemotherapy uses drugs and chemicals to kill and stop the growth of cancer cells. Chemotherapy treatment is the process of injecting drugs into a vein or muscle to enter the bloodstream and reach the cancer cells in the body. Chemotherapy is used for people with advanced bile duct cancer, to slow the cell and relieve the symptoms.

• Targeted drug therapy

  Targeted therapy focuses on the abnormality inside the cancer cells. The drugs identify and attack certain types of cancer cells with abnormalities, causing the cancer cells to die. After the completion of the surgery, often radiation therapy or chemotherapy is given to kill the remaining cancerous cells. This also helps prevent the spread of cancer and it's come back in the future.

To reduce the risk of bile duct cancer, one can:

• Quit smoking

  Smoking is directly linked to an increased risk of bile duct cancer.

• Healthy diet

  Obesity is one of the causes of bile duct cancer. Change the eating pattern by including healthy and nutritious fruits and vegetables. Monitor the calories intake.

• Limit alcohol consumption

  Limit alcohol consumption. Excessive alcohol intake increases the risk of cancer. Cut down on alcohol, and adapt to a healthy lifestyle.

The prognosis depends on the stage of cancer and how vast it has spread to other body parts and patients' health conditions. Extrahepatic bile duct cancer has a better chance of recovery.

Most often bile duct cancer is not recognized in its early stages making recovery difficult. Early detection and faster treatment can increase the chance of recovery, and prevent its spread to other body parts. Complete removal of the tumor increases the survival rate.