Bile Duct Cancer (Cholangiocarcinoma)

What is bile duct cancer?

Bile duct cancer, also called cholangiocarcinoma, is cancer that originates in the bile ducts. The bile ducts are tubes that connect the liver and gallbladder to the small intestine. Their purpose is to move bile from the liver and gallbladder into the small intestine. The bile then functions to help digest fats and other food. 
 
Bile duct cancers occur due to DNA alterations in the bile duct cells. These cancerous cells begin to rapidly multiply and can form malignant (cancerous) tumors in the bile ducts. Often bile duct cancer originates from the mucus gland cells lining the ducts (adenocarcinoma). 
 
Bile duct cancer is not very common, difficult to treat, and usually affects adults over the age of 50. 
 
 
The types of bile duct cancer are classified based on where they occur:
 
  • Intrahepatic cholangiocarcinoma: This type of bile duct cancer originates in the sections of the bile ducts that are in the liver (intrahepatic). They are sometimes treated like a liver cancer. 
  • Hilar cholangiocarcinoma (perihilar): This type of bile duct cancer originates right outside of the liver at the junction of the left and right hepatic ducts. This junction is called the hilum. Tumors that occur here can also be called Klatskin tumors.
  • Distal cholangiocarcinoma: This type of bile duct cancer originates at the distal part of the bile duct that is close to the small intestine.
 
Risk factors
 
  • Smoking
  • Age (bile duct cancer is more common in adults over age 50)
  • Chronic liver disease such as cirrhosis
  • Liver parasites such as liver fluke infection (liver fluke infection can be associated with eating raw fish)
  • Primary sclerosing cholangitis (inflammation and scarring of the bile ducts)
  • Being born with a bile duct problem such as Caroli syndrome 
  • Family history
  • Alcohol use
  • Exposure to thorotrast 
  • Ethnicity (there are higher rates of bile duct cancer in Hispanic and Native Americans)
  • Bile duct stones
  • Choledochal cysts
  • Hepatitis B
 
 
Diagnosis 
When diagnosing bile duct cancer, a complete medical history and physical exam will be obtained by your doctor. Some tests that may be ordered to diagnose bile duct cancer include:
 
  • Liver function tests: blood tests that check liver enzyme and albumin levels to see how well the liver is functioning. Your blood may also be tested to measure the amount of bilirubin in it. Elevated bilirubin levels can mean problems with the bile ducts, liver, or gallbladder. 
  • Tumor marker tests: a blood test that looks at the level of CA 19-9 in the blood. CA 19-9 is a protein that is made my bile duct cancer cells. However, high levels of CA 19-9 aren’t a definitive diagnosis of bile duct cancer; they can occur in other bile duct disorders as well.
  • Cholangiography: a type of imaging test that looks to see if the bile ducts are blocked, narrowed, or dilated potentially by a tumor.
  • Magnetic resonance cholangiopancreatography (MRCP): This type of cholangiogram is non-invasive and uses an MRI machine to look at the bile ducts. 
  • Endoscopic retrograde cholangiopancreatography (ERCP): This type of cholangiogram involves passing a tube (endoscope) down the person’s throat into the beginning of the small intestine. Then a smaller tube goes through the endoscope into the bile ducts. This allows the physician to take X-rays of the ducts in order to look for any blockages, narrowing, or dilation. During an ERCP, the doctor is also able to take samples of cells/fluid, or place stents to keep the duct open.
  • Percutaneous transhepatic cholangiography (PTC): This type of cholangiogram is used only when an ERCP cannot be done. It involves using a local anesthetic and then placing a hollow needle into the bile duct inside the liver. Contrast dye is injected and X-rays are taken. The doctor is able to take samples of cells/fluid and place stents if needed. 
  • Other imaging tests that may be ordered include a magnetic resonance imaging (MRI) scan, a computerized tomography (CT) scan, or an ultrasound. These tests may be used to look for any tumors, see if the cancer has spread, or to help obtain a biopsy. 
  • Biopsy: tissue samples are obtained from the bile duct and the cells are looked at under a microscope to see if they are cancerous. Biopsies can be obtained during an ERCP or PTC. They can also be obtained using a hollow needle. 
 
 
 
Treatment for bile duct cancer is decided based upon the type, location, stage, and person’s health status. If the doctor decides the cancer can be removed safely, surgery may be recommended. Other possible treatment options for bile duct cancer include:
 
  • Radiation therapy
  • Chemotherapy
  • Palliative therapy
  • Liver transplant
 
 
 
# BILE DUCT CANCER BY THE NUMBERS #
  • Bile duct cancer occurs in 1 in 100,000 people per year in the U.S. (about 8,000 diagnosed each year)
  • Bile duct cancer is slightly more common in males
  • Bile duct cancer is more common in Southeast Asia due to a higher occurrence of liver fluke infection
  • The chance of survival for people with bile duct cancer depends on how soon it is detected, where it is located, and how far it has progressed 
 
about bile duct cancer
 
 

Sources:
  • "Cholangiocarcinoma (bile duct cancer)." Mayo Clinic. Mayo Foundation for Medical Education and Research, 25 Apr. 2017. Web. 2 Aug. 2017.
  • “What is Bile Duct Cancer?” American Cancer Society, 20 Jan. 2016. Web. 2 Aug. 2017.
  • “What Are the Risk Factors for Bile Duct Cancer?” American Cancer Society, 20 Jan. 2016. Web. 2 Aug. 2017.
  • “How is Bile Duct Cancer Diagnosed?” American Cancer Society, 20 Jan. 2016. Web. 2 Aug. 2017.
  • “Treating Bile Duct Cancer.” American Cancer Society, 20 Jan. 2016. Web. 2 Aug. 2017.
  • “What Are the Key Statistics About Bile Duct Cancer?” American Cancer Society, 20 Jan. 2016. Web. 2 Aug. 2017.
  • “Conditions We Treat: Bile Duct Cancer (Cholangiocarcinoma).” John’s Hopkins Medicine, 2017. Web. 2 Aug. 2017. 
  • “Bile Duct Cancer (Cholangiocarcinoma).” John’s Hopkins Medicine, 2017. Web. 2 Aug. 2017. 
  • “Stones, Strictures, and Cancer of the Bile Ducts.” Cleveland Clinic, 2017. Web. 2 Aug. 2017.

 

 

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