Bile Duct Cancer
Bile is a special fluid that helps break down and digest fats in food. It contains bile salts, cholesterol, and waste products like bilirubin. The liver produces this fluid and the gallbladder stores it. The bile ducts are long tubes that transport bile and connect either the liver or the gallbladder with the small intestine. The biliary system consists of the bile ducts and the gallbladder. Click on image to enlarge.
Bile duct cancer or cholangiocarcinoma is a malignant tumor occurring in one of the ducts. This cancer, which obstructs the bile ducts, is very rare and happens to men and women who are over 65 years old. In the United States, physicians find approximately 4,000 new cases every year.
Causes and Risk Factors
Below are some causes and risk factors that might raise the risk of the cancer:
- Older age increases the risk of developing the cancer for those who are older than 65 years old.
- Congenital abnormalities of the bile ducts like choledochal cysts can put you at risk of the cancer.
- Ulcerative colitis or chronic inflammatory bowel disease can increase the possibility of developing the cancer.
- The liver fluke, which is a parasite leading to hepatobiliary parasitic infection, is believed to result in the cancer.
Several symptoms of the cancer that might appear include:
- Yellowness of the skin or jaundice. The cancer makes bile flow back into the blood, enabling the white of the eye, the skin, and urine to turn yellowish. In addition, stools become pale.
- High fever
- Weight loss
- Loss of appetite
- Abdominal pain
You might undergo some tests below to diagnose whether or not there is any abnormality in your biliary tract.
Computerized tomography (CT) scan
A CT scan applies painless radiation in which it takes x-rays to produce 3-D images of your organs. You must avoid consuming anything for at least four hours before the scan.
It is suggested that you take clear fluids like water for four to six hours before the scan. Usually a gel is applied onto the abdomen, and then a transducer will glide. The gel can prevent air pockets between the skin and the transducer from forming because it can interfere with the ultrasonic signal. The sound waves result in an image of abdominal organs.
Magnetic resonance imaging (MRI)
An MRI applies magnetic field and pulses of radio wave energy to make images of the abdomen. You lie inside a metal cylinder containing a strong magnet. That is why you must remove all metal belongings from your body. A computer will detect any abnormality inside your abdomen.
Percutaneous transhepatic cholangiography (PTC)
This test is to take an x-ray image of the bile duct. The doctor anesthetizes your abdomen with a local injection. A thin needle is inserted through the skin and through the liver into the bile duct. The contrast medium is then injected into the bile duct to visualize the anatomy of the biliary tract.
It will depend greatly on the size and position of the cancer. Several treatments include:
Surgery might involve removal of the bile ducts, and others are then connected to the small intestine to make the bile flow normally. If jaundice occurs, a surgeon will open the blocked part to let the bile flow from the liver into the intestine.
This treatment can shrink cancerous cells surgery cannot remove. It applies anti-cancer medications to eliminate cancer cells.
Radiotherapy uses high-energy x-rays to shrink and eradicate cancerous cells. A radiotherapy machine can kill them externally in addition to placing radioactive material to kill the cells internally.
Stent placement might relieve jaundice and obstruction in the biliary ducts when the tumor cannot be removed. A four-inch stent keeps bile draining properly.
Center for Pancreatic and Biliary Diseases: University of Southern California: Bile Duct Cancer - https://www.surgery.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/BILIARY%20SYSTEM/cholangiocarcinoma.html
MacMillan.org.uk: Bile Duct Cancer - https://www.macmillan.org.uk/Cancerinformation/Cancertypes/Bileduct/Bileductcancer.aspx
Johns Hopkins Pathology: Gallbladder & Bile Duct Cancer - https://pathology2.jhu.edu/gbbd/intro.cfm
Image courtesy of the National Library of Medicine.