Bile Duct Cancer (Cholangiocarcinoma) Treatment in Delhi, India
Overview
Cholangiocarcinoma is the medical term for bile duct cancer. It starts in the bile ducts, within the liver (intrahepatic cancer), at the point where the bile ducts come out of the liver (perihilar cancer), and outside of the liver (extrahepatic cancer). The most common type is perihilar cancer. It is a relatively rare malignancy.
Associated Anatomy of Bile Duct Cancer
Lymphatic system and bloodstream
Types of Bile Duct Cancer
Bile duct cancer is classified into several types based on the location of cancer in the common bile duct:
Intrahepatic Cholangiocarcinoma
Intrahepatic Cholangiocarcinoma develops in the bile ducts inside the liver and is occasionally wrongly categorized as liver cancer.
Hilar Cholangiocarcinoma
Hilar Cholangiocarcinoma is a condition that develops in the bile ducts, which are located just outside of the liver. Perihilar cholangiocarcinoma is another name for this type of cancer.
Distal Cholangiocarcinoma
Hilar Cholangiocarcinoma occurs in the bile duct region nearest to the duodenem. This form of cholangiocarcinoma is also known as Extrahepatic Cholangiocarcinoma.
Bile Duct Cancer Causes
- Old age
- Ethnicity
- Type 1 and Type 2 Diabetes may be associated with Cholangiocarcinoma
- Hepatitis infection
- Obesity
- Family History
- Excessive alcohol consumption
- Smoking
- Exposure to toxic chemicals.
Bile Duct Cancer Symptoms
Cholangiocarcinoma can present with -
- Jaundice
- Dark coloured urine
- Clay-colored stool
- Abdominal pain
- Fever
- Dry, itchy skin
- Vomiting and nausea
- Non-intensional weight loss.
Stages of Bile Duct Cancer
Staging is the process of determining whether or not cancer cells have progressed within the bile ducts or to other body organs.
When bile duct cancer is detected, it is staged to determine the best treatment plan and assess its fate.
For bile duct cancers, there are three main location:
- Intrahepatic bile duct cancer (occurs within the liver)
- Perihilar bile duct cancer (occurs mainly in the hilum, outside the liver)
- Distal bile duct cancer (appears farther down the bile duct system)
Cancers of the liver, both intrahepatic and extrahepatic, are staged independently. Extrahepatic cancers are classified as perihilar or distal.
Bile Duct Cancer Diagnosis
A detailed physical exam is required to diagnose bile duct cancer. Your physician may also perform the following tests:
Clinical Examinations
Bile duct cancer and other health issues can be detected by physical examination. The abdomen (belly) will be examined for tumors, discomfort or fluid build-up.
Laboratory Tests
Blood testing can detect bilirubin levels. Your doctor may also perform blood tests to determine the level of albumin, liver enzymes, and certain other chemicals in your blood as well as tumor marlers (CA 19.9).
Imaging Scans and MRIs
These use X-rays, magnetic fields, or sound waves to make images of your body. In addition to showing the bile duct, CT scans can also show lymph nodes and other organs where cancer may have spread.
MRI scans, like CT scans, provide detailed images of the body's soft tissues. However, MRI scans use radio waves and powerful magnets. MRI scans can also provide high-resolution images of the bile ducts and other body parts.
Endoscopy
An endoscopic test (ERCP) involves passing a thin, flexible tube with a tiny camera down your throat and into your small intestine. The camera examines the bile ducts' connection to the small intestine. Your doctor may administer this treatment to make the bile ducts appear better on imaging exams. A stent can also be placed.
Percutaneous Radiological Treatment
A more extensive type of imaging scan is percutaneous radiological diagnosis. Percutaneous is a term that refers to something that penetrates the skin. It’s an imaging technique that involves a needle into the affected area and injecting dye in the biliary system. The biliary tree is then seen using X-ray imaging.
Bile Duct Cancer Tests
Before planning treatment, it is critical to determine whether the bile duct carcinoma can be surgically removed. Typically, sequentially perform tests and procedures for detecting, diagnosing, and staging bile duct cancer.
Tests and techniques such as the following may be used:
- Physical examination and medical history
- Liver function tests
- Laboratory examinations
- CA 19-9 tumor marker and Carcino Embryonic Antigen (CEA) tests
- Ultrasound abdomen
- CT scan abdomne
- MRI (Magnetic Resonance Imaging)
- MRCP (Magnetic Resonance CholangioPancreatography)
- Whole body PET CT Scan.
Bile Duct Cancer Treatment
The treatment options for bile duct cancer patients are numerous. There are three types of standard treatment:
- Surgery
- Radiotherapy
- Chemotherapy
Clinical trials are being conducted to evaluate innovative treatment methods:
Standard Bile Duct Cancer Treatment Options
Several factors will influence your treatment options, including:
- The type and stage of cancer as well as its location and extent
- Resectability of cancer (removable by surgery)
- Treatment-related side effects
- The overall condition of your health
- The probability of treating diseases, maintaining health or relieving symptoms.
Risk Factors of Bile Duct Cancer
Some individuals are more prone to developing this cancer. These include the following:
- People from Asia, as compared to people from the West
- Men more vulnerable to this disease
- Obese individuals
- Individuals aged more than 60 years
- Tobacco smokers
- Diabetics
- Individuals suffering from viral illnesses such as hepatitis B, hepatitis C, and HIV
- Liver diseases such as cirrhosis, gallbladder cancer, and biliary papillomatosis
- Patients with chronic bile duct irritation. These disorders produce bile duct inflammation and predispose one to cancer. This would include primary sclerosing cholangitis, liver fluke (worm) infection, bile stones, and bile duct abnormalities such as cysts.
- Individuals who have been exposed to certain chemicals and medications, including asbestos, thorotrast, dioxin, methyldopa, isoniazid, and older oral contraceptives etc.
Bile Duct Cancer Prevention
Primary Prevention of Bile Duct Cancer
You can lower your risk of bile duct cancer by following these steps:
- Quit smoking. Cigarette smoking has been associated with a higher risk of bile duct cancer. If you had attempted to quit previously and were unsuccessful, consult your physician about strategies to assist you.
- Decrease your risk of developing liver disease. There is a link between chronic liver illness and an increased risk of bile duct cancer.
- Avoid risky activities that may raise your chance of developing hepatitis C, such as needle sharing.
- Vaccinate against hepatitis B to reduce your risk of infection.
- Limit or avoid alcohol consumption.
- Maintain a healthy body weight. The safety guidelines should be followed when working with chemicals.
Secondary Prevention of Bile Duct Cancer
Additionally, people may be able to minimize their chances of developing bile duct cancer by:
- Vaccinating against the hepatitis B virus (HBV) to avoid infection and the cirrhosis that this virus can cause
- Preventing cirrhosis by taking precautions to reduce blood-borne or sexually transmitted diseases such as HBV and other viruses (such as hepatitis C virus and HIV)
- Treating hepatitis B and C to help avoid cirrhosis
- Avoiding exposure to hazardous compounds such as asbestos, radon, and dioxin.
Epidemiology of Bile Duct Cancer
Geographical epidemiological patterns influence the incidence of bile duct cancer. It is most prevalent in South America, notably the Andean region. Symptomatic gallstone disease is a major risk factor for bile duct cancer in Chile, Bolivia, and Ecuador. Other important risk factors for bile duct cancer include gender, age, ethnicity, and the presence of comorbidities.
Expected Prognosis of Bile Duct Cancer
Prognosis and available treatment options are dependent on:
- Whether cancer has spread to other parts of the biliary system or not
- Cancer's current stage (the liver, lymph nodes, or other organs in the body)
- The extent to which cancer has grown to surround nerves or veins
- Whether surgery can completely eradicate cancer
- Whether the patient has secondary sclerosing cholangitis
- Whenever the CA 19-9 level is higher than usual
- Cancer may have just been discovered or may have recurred.
- Prognosis of distal cholangiocarcinoma is better.
Natural Progression of Bile Duct Cancer
Survival rates indicate the percentage of persons diagnosed with the same stage of cancer who survive for a specified period (typically five years) after diagnosis.
Remember that survival statistics are estimates based on the outcomes of large groups of patients with specific cancer and cannot indicate what will happen to any individual. Consult your doctor for information on how these statistics may relate to you before they are closely associated with your conditions.