Cancer of the bile ducts
cancer of bile ducts adult is a very uncommon cancer and not much known about its cause. The presence of choledochal (bile duct) cysts, primary sclerosing cholangitis (a disease of the bile ducts within the liver), and gallstones leading to chronic bile duct irritation been associated with the increased incidence of bile duct cancer. Bile duct cancer usually is slow-growing cancer and can spread to other parts of the body in the later stages of the disease. Its incidence of about 20 per million population and affects both men and women equally. Usually, it more common in people over 65 years of age. however recently young patients in their 4th decade of life are being diagnosed with bile duct cancer in Pakistan.
DIAGNOSIS OF THE BILE DUCT CANCER:
Clinical evaluation by the doctor to look for the presence of jaundice (yellowness of skin and eyes) or presence of scar marks (due to itching) and presence of any lumps in the tummy.
Blood tests including LFT’s (bilirubin level in your blood will be high due to the blockage of the bile duct).
Hemoglobin (Hb level) can below
Tumor markers. These are substances normally seen in the blood, however, in people with cancer, they may high. In bile duct cancer, the tumor marker associated with it is Ca19.9.
Ultrasound scan
CT scan
MRI (magnetic resonance imaging)
Endoscopic Retrograde Cholangio-Pancreatography (ERCP)
Endoscopic ultrasound (EUS)
You may undergo one or more of the scans in order to help identify the tumor and assess your suitability for the various treatments.
Histology/cytology:
All of the previously mentioned tests may lead the doctor to diagnose bile duct cancer. However, the only definite way to confirm this diagnosis to examine some of the abnormal tissue (cancer cells) under a microscope. Some cells may take during the ERCP procedure (these are called brushings). These cells taken to the laboratory for cytology examination. However, the results of cytology do not always produce a diagnosis and may give a negative result, despite cancer existing. If a larger sample of tissue required we may perform a biopsy. This is when a needle passed through your skin, into the affected area. If your doctor planning to treat your cancer with surgery, you may not undergo a biopsy, as tissue confirmation obtained after the operation, by the laboratory.
Treatment:
Complete surgical removal of cancer the mainstay of bile duct cancer treatment. The aim of the treatment to treat cancer and any symptoms it may cause. Treatment of the bile duct cancer depends on the stage of cancer and may differ from person to person because of:
Location of cancer:
Bile duct cancer can occur anywhere within the bile duct system. There are bile ducts throughout the liver – these are called intra (within) hepatic (liver) bile ducts, some of which may run alongside major vessels that supply blood to or return blood from the liver.
There are also bile ducts that run from the liver to the gall bladder, and then from the gall bladder to the duodenum – these called extra (outside) hepatic ducts.
Size of cancer:
The bile duct cancers can grow to a relatively large size causing any symptoms. Some cancers may too small to identify scanning tests.
The spread of cancer:
CT scans can detect whether cancer has spread to any other part of the body – including the lymph glands. As the lymph system runs throughout the body, cancer that may have spread to the lymph system can increase the risk of further cancer spread (metastases) or increase the risk of cancer recurrence where the main cancer already surgically removed.
Age of the patient:
Age can affect how well your body works, however, when deciding on which treatment is the best. For each individual, and it important to assess each person’s actual health. rather than expected health for someone of that age.
Associated medical problems:
Are you well despite having another illness or does you have other medical problem limiting your lifestyle or life expectancy? Curable or palliative (may alleviate symptoms) therapies may offered to you, depending on the factors mentioned above. The clinical team caring for you will discuss, with you, the different treatments and therapies available. They will assist and support you in making decisions and choices about what is right for you.
TREATMENT OF THE BILE DUCT CANCER:
Surgery: Surgery may as a potentially curable or palliative treatment. At present complete surgical and removal of cancer offers the only possible cure.
Surgery to remove an intra-hepatic bile duct cancer will involve removing part of the liver. A normal working liver can continue to function effectively, even if up to 80% of the liver removed. The part of the liver that would remain after surgery will assessed to ensure that it is function is normal. However, if the liver function compromised, removing even a small part of it may lead to liver failure and/or death.
Surgery to remove an extra-hepatic bile duct cancer may involve removing part or all of any tissue or organ next to it.
As an example, if the cancer is within the gall bladder it may necessary to remove a small part of the liver, as the gall bladder is attached to the undersurface of the liver. If it near the lower part of the bile duct system, then part of the duodenum (small intestine) may need to remove. After surgery, patients are monitored in a dedicated Liver Intensive Care Unit for 24-48 hours. After smooth ICU recovery, you will be moved to award.
Stenting:
The insertion of a plastic or metal tube into the blocked bile duct, in order to keep it open, called stenting. It helps to restore the flow of bile into the intestine and can alleviate jaundice. The stent inserted by a procedure called Endoscopic Retrograde Cholangio-Pancreatogram (ERCP) and it’s done by gastroenterologists/ hepatologists. This is the preferred way of stent placement as it more convenient for the patient. In case of failed ERCP. the other way to insert the stent is called Percutaneous Transhepatic CholangioPancreatogram (PTC) and this procedure done by specialist doctors called interventional radiologists
If the cancer-causing a narrowing of the small intestine (duodenum) this can cause problems with your ability to eat and drink and leads to vomiting after meals. A stent, larger than that used for the bile ducts, can used and inserted into the duodenum to allow you to eat and drink, without nausea and/or vomiting.
Chemotherapy:
The treatment of cancer with drugs is called chemotherapy. This treatment offered as a palliative treatment, where surgery is not possible, or as an add-on to surgical treatment. The aim of the palliative to potentially slow down and/or shrink cancer. As an “add-on” (adjuvant) treatment, it offered to treat any cancer that may remain after surgery. Each dose of chemotherapy (single or combination) called a cycle, and each cycle usually separated by 2-3 weeks of a recovery period. This allows your body to receive the treatment, react/respond, and recover.
More about chemotherapy:
Unfortunately, with bile duct cancer, it very difficult to predict whether it will respond to chemotherapy. However, in some people, even if a response not achieved. they may find it can alleviate their symptoms and may prolong their life expectancy.