Bile duct cancer is a rare type of cancer that begins in the bile duct, a thin tube of about four to five inches long that goes from the liver to the small intestine. The bile duct is responsible for transporting bile from the liver and gallbladder to the small intestines. The most common type of bile duct cancer, hilar bile duct cancer, begins where the hepatic ducts, those found in the upper part of the small intestine which carry bile to the liver, come together. Other types of bile duct cancer include intrahepatic bile duct cancer, which begins in the duct branches inside the liver and distal bile duct cancers, which start near the small intestine. Although the exact cause of bile duct cancer is unknown, those who are at risk are people with chronic inflammatory bowel diseases, abnormal bile ducts and a parasitic infection caused by liver flutes.
Stages and Grades
According to the "Detailed Guide: Bile Duct Cancer" on Cancer.org, there are a number of different stages that people with bile duct cancer can be diagnosed with, depending on the size of their cancer and whether it has spread to other parts of their bodies. The type and shape of the cancer helps doctors to make treatment decisions. Stage 1A describes when the cancer can only be found in the bile duct; stage 1B, when it has spread to the wall of the bile duct but is not present in nearby lymph nodes; stage 2A, when it can be found in the liver, pancreas, gallbladder and blood vessels but not nearby lymph nodes; stage 3, when it spreads to blood vessels that carry blood to the liver, the small or large bowel, the abdominal wall, stomach and/or lymph nodes in the abdomen and stage 4, when it can be found in parts of the body that are far away from the bile duct, such as the lungs. Cancer is also graded, when it is examined under the microscope, based on how similar the cancerous cells look to other cells and how quick they are growing. They are considered low-grade if they look like other types of cells in the body, have slow growth patterns and thus are less likely to spread quickly. High-grade tumors are those that look abnormal and are likely to grow and spread more quickly.
One of the most common symptoms of bile duct cancer is jaundice. This is when there is a yellowing in the skin and in the whites of the eyes. When the liver is not able to get rid of bile, there is an excess of a chemical called bilirubin in the bloodstream and body's tissues. If the bile ducts are blocked, bilirubin is often not able to travel to the small intestine. Jaundice can also be caused by a stone from the gallbladder that blocks the bile duct, so it may be indicative of other health problems.
It is possible to treat jaundice without surgery through two possible procedures, according to the Mayo Clinic's overview of bile duct cancer. One involves inserting a tube called a stent into a blocked bile duct. The stent will help to clear away bile that is blocking the bile duct. A doctor may use a dilator, an inflatable balloon, to stretched a narrowed bile duct so that a stent can be inserted. Stents usually need to be replaced in the body every three to four months, or jaundice can return. Another procedure involves a wire with a stent being inserted through a blocked bile duct. During this procedure, a doctor may leave a device called a catheter inside the bile duct. One part of the catheter will be inside the bile duct and another will be connected to a bag that will collect excess bile. Catheters are usually kept in the body for a few days before being removed. Afterwards, doctors will put patients on antibiotics to make sure that they do not get infections.
Some other common symptoms of bile duct cancer are itchy skin, a loss of appetite, a high temperature and weight loss. Some people may also experience an uncomfortable feeling in their abdomen and/or discoloring in their urine and or stool. This means that they may experience urine that is dark yellow and a pale stool. Some of these symptoms could also be indicative of other conditions, which is why it is important to see a doctor if you experience them for a few weeks or if they worsen.
According to the Mayo's Clinic overview of bile duct cancer, for those with symptoms of bile duct cancer, there are a number of tests to determine where they have the disease. This includes ultrasound scans, computerized tomography or CT scans, magnetic resonance imaging or an MRI, a endoscopic retrograde cholangiopancreatography, a percutaneous transhepatic cholangiography, an angiography, a biopsy, an endoscopic ultrasound scan or a laparotomy. In ultrasound scans, sound waves are used to take pictures of the bile duct and surrounding organs. During CT scans, a series of x-rays are done, taking three dimensional pictures of the body. With an MRI, magnetic fields are used, instead of x-rays, to take three dimensional pictures of the body. Endoscopic retrograde cholangiopancreatography is used to take a more detailed x-ray of the pancreatic duct and bile duct. It can also be used to get rid materials blocking the bile duct. Percutaneous transhepatic cholangiography is another procedure that can provide x-ray pictures of the bile duct. An angiography is a test that is done to show whether blood vessels close to the liver have been affected by a tumor. A biopsy is done after other tests, if the doctor suspects that a person has bile duct cancer. A doctor will take a sample of cells or tissue and look at it under a microscope. An endoscopic ultrasound scan is used to take a picture of the pancreas and structures around it. If a doctor are not able to make a diagnosis based on other tests, he or she will use a laparotomy. This type of examination involves a physician cutting open the abdomen to look at the bile duct and surrounding tissue.
According to the "Detailed Guide: Bile Cancer" on Cancer.org, for people with bile duct cancer, the most common type of treatment is surgery. There are a number of surgeries that can be performed, based on the stage of the cancer. If the cancer has not spread beyond the bile duct, it may be possible to remove the tumor. It may also be necessary to remove the bile duct if the cancer is localized and to join the remaining ducts to the small bowel, so that bile will flow through the body once more. A procedure called partial liver resection may be done, where the part of the liver that is affected is removed. Other procedures may also be performed to remove tissue and lymph nodes that the cancer has reached. Some doctors may recommend a liver transplant if the cancer has only spread to the liver but cannot be removed by other treatments. If the cancer has spread to the small bowel, liver, pancreas, gall bladder and lymph nodes, people may need to get all of these structures surgically removed. When removing bodily organs is not possible, doctors may perform bypass surgery, which helps to stop any blockages and allow bile to flow to the small intestine. During this procedure, the gall bladder is connected to part of the small bowel.
Other treatments that may be used to treat bile duct cancer are radiation therapy, chemotherapy and photodynamic therapy. Radiation therapy and chemotherapy are treatment options that are given to patients with different types of cancers. During radiation therapy, high energy x-rays are used to kill off cancer cells and shrink tumors. In radiation therapy for bile duct cancer, radioactive sources are put inside the bile duct for a short period of time. Chemotherapy uses drugs to kill rapidly dividing cancer cells. Chemotherapy and radiation therapy have been found to be most effective when they are used together. One issue has been that chemotherapy has been found to only slow the progression of bile duct cancer, and the treatment is only effective for a period of weeks or months. Photodynamic therapy uses a chemical that is light sensitive, which is injected into patients, according to the Mayo Clinic overview of bile duct cancer. After the chemical has made its way into the canceous cells, a device called an endoscope is inserted into the bile duct with a laser attached in order to kill off the cancerous cells.
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