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Bile duct cancer - or cholangiocarcinoma - is the second-most common cause of bile duct obstruction after gallstones. Most bile duct cancers come from cancers that originated in the pancreas.
Bile duct cancers may arise in many locations in and around the liver. Bile duct cancer tends to spread into the liver, along the bile duct surface and through the lymph system to lymph nodes in the region of the liver. Tumors in the bile duct leading from the gall bladder to the common bile duct (cystic duct) can spread to involve the gall bladder. Ultimately, other lymph nodes as well as other organs within the abdomen may become involved.
Incidence; Causes & Development; Risk Factors
Bile duct cancers are quite rare, affecting some 16,600 people in the United States per year at the time of writing.
The cause is unknown.
People with chronic inflammatory processes such as ulcerative colitis or parasitic infections of the bile ducts, or with congenital abnormalities of the bile ducts are at higher risk for developing this cancer. No one cause has been clearly demonstrated.
Signs & Symptoms
The most common symptoms of bile duct cancer include jaundice and itching (the most common signs), abdominal pain, poor appetite, bloating, weight loss, fever, nausea, or an enlarging abdominal mass. Jaundice is caused by the accumulation in the skin of a component of bile (bilirubin) that normally empties into the intestines after traveling through the bile ducts. Pain usually signifies advanced disease.
There are no signs or symptoms unique to bile duct cancer; even if the findings associated with bile duct cancer are present, other explanations - such as gallstones - are far more likely. Symptoms generally develop slowly and are often subtle.
Diagnosis & Tests
In addition to a complete medical history and medical examination, diagnostic procedures for bile duct cancer may include:- Ultrasound - high-frequency sound waves create an image of the internal organs
- Computerized tomography (CT scan) - a computer along with X-rays are used to create cross-sectional images of the body
- Cholangiography - X-ray taken after contrast fluid had been injected
- Biopsy
Treatment & Prevention
Treatment may include surgery or chemotherapy. If the cancer cannot be entirely removed, the principal goals of therapy become the relief of symptoms caused by the accumulation of bile, and relief from pain.
If the tumor is fairly small, it may be treated with radiation without much damage to the surrounding liver. It may also apply to patients with small or microscopic deposits of tumor following surgery.
Prognosis
Studies have not shown that chemotherapy prolongs survival. Even when tumor shrinkage occurs, patients may not be better off as the tumor ultimately regrows and treatment has side-effects.
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Signs, symptoms & indicators of Bile duct Cancer:
Conditions that suggest Bile duct Cancer:
Risk factors for Bile duct Cancer:
Bile duct Cancer suggests the following may be present:
Recommendations and treatments for Bile duct Cancer: | | | | | Surgery/Invasive |  Surgery | The optimal and only definitive treatment is the complete surgical removal of the tumor, which is not often possible. Unfortunately, by the time symptoms develop, the cancer has usually spread throughout the bile ducts and into the liver, meaning that the tumor cannot be entirely removed. |
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KEY | | Weak or unproven link |  | | Strong or generally accepted link |  | | Proven definite or direct link | | | Likely to help |
GLOSSARY
Abdomen (Abdominal)
That part of the body between the chest and the hips that contains the stomach, intestines, liver, bladder, pancreas and other organs.
Bile
A bitter, yellow-green secretion of the liver. Bile is stored in the gallbladder and is released when fat enters the first part of the small intestine (duodenum) in order to aid digestion.
Bilirubin
A waste product of hemoglobin recycling, it is primarily excreted in feces, oxidizing into that familiar brown color (except for beets).
Biopsy
Removal of a sample of tissue from a living being for diagnosis. A pathologist later uses a microscope to look for certain features, such as cancer cells, in the sample. A fine-needle aspiration biopsy involves inserting a thin needle to remove a small amount of tissue, sometimes using CT or ultrasound to guide the needle. A core biopsy involves obtaining a sample of tissue with a thick needle or by inserting a thin, lighted tube (laparoscope) into a small incision in the abdomen. Another biopsy method is to remove tissue during an operation.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Chemotherapy
A treatment of disease by any chemicals. Used most often to refer to the chemical treatments used to combat cancer cells. Chemotherapy is usually given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most anticancer drugs are given by injection into a blood vessel (IV); some are given by mouth. Chemotherapy is a systemic therapy, meaning that the drugs enter the bloodstream and travel throughout the body. Usually, a patient has chemotherapy as an outpatient (at the hospital, at the doctor's office, or at home). However, depending on which drugs are given and the patient's general health, a short hospital stay may be needed.
Chronic (Chronicity)
Usually referring to chronic illness: Illness extending over a long period of time.
Computerised Tomography (CAT Scan, Computed Tomography, Computerized Axial Tomography, CT Scan)
A scanning procedure using X-rays and a computer to detect abnormalities of the body's organs. This technique provides cross-sectional images of body organs, which is much clearer than those provided by conventional X-rays.
Gallbladder (Gall Bladder)
A small, digestive organ positioned under the liver, which concentrates and stores bile. Problems with the gallbladder often lead to gallbladder attacks, which usually occur after a fatty meal and at night. The following are the most common symptoms: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.
Gallstone (Biliary Calculus, Gall Stone, Gall Stones, Gallbladder Attack, Gallbladder Attacks, Gallstones)
Stone-like objects in either the gallbladder or bile ducts, composed mainly of cholesterol and occasionally mixed with calcium. Most gallstones do not cause problems until they become larger or they begin obstructing bile ducts, at which point gallbladder "attacks" begin to occur. Symptoms usually occur after a fatty meal and at night. The following are the most common ones: steady, severe pain in the middle-upper abdomen or below the ribs on the right; pain in the back between the shoulder blades; pain under the right shoulder; nausea; vomiting; fever; chills; jaundice; abdominal bloating; intolerance of fatty foods; belching or gas; indigestion.
Jaundice
Yellow discoloration of the skin, whites of the eyes and excreta as a result of an excess of the pigment bilirubin in the bloodstream.
Liver (Hepatic)
The largest and one of the most complex organs of the body, the liver is responsible for much of the metabolism of fats, proteins and carbohydrates. It is the site of much of the body's detoxification. It is connected very closely with digestion and the regulation of blood sugar, among many other functions. Found behind the ribs on the right side of the abdomen, it has many important functions such as removing harmful material from the blood, making enzymes and bile that help digest food, and converting food into substances needed for life and growth. Hepatic: Pertaining to the liver.
Lymph
A clear fluid that flows through lymph vessels and is collected from the tissues throughout the body. Its function is to nourish tissue cells and return waste matter to the bloodstream. The lymph system eventually connects with and adds to venous circulation.
Lymph Nodes (Axillary Nodes, Inguinal Nodes, Lymph Gland, Lymph Glands, Lymph Node, Lymphatic)
Small, bean-shaped nodes at various points throughout the body that function to filter the lymph fluid and attempt to destroy the microorganisms and abnormal cells which collect there. The most common locations are the neck (both sides and front), armpit (axillary) and groin (inguinal), but also under the jaw and behind the ears. Swollen or painful lymph nodes generally result from localized or systemic infection, abscess formation, or malignancy. Other causes of enlarged lymph nodes are extremely rare. Physical examination for lymph nodes includes pressing on them to check for size, texture, warmth, tenderness and mobility. Most lymph nodes can not be felt until they become swollen, and then will only be tender when pressed or massaged. A lymph node that is painful even without touching indicates greater swelling. Lymph nodes can usually be distinguished from other growths because they generally feel small, smooth, round or oval-shaped and somewhat mobile when attempts are made to push them sideways. Because less fat covers the lymph nodes in children, they are easier to feel, even when they are not busy filtering germs or making antibodies. Childrens' nodes enlarge faster, get bigger in response to an infection and stay swollen longer than an adult's. Also known (incorrectly) as lymph glands.
Nausea
Symptoms resulting from an inclination to vomit.
Pancreas (Pancreatic)
Opposite the liver and behind the stomach, the pancreas has two main functions - to manufacture various enzymes for digestion, and to release hormones to help control the body's use of carbohydrates. It releases insulin to help each cell absorb glucose to burn as energy. In this way, insulin controls the amount of sugar (glucose) in the blood. Proper pancreatic function is very important: too much, too little, or no insulin production can be life-threatening. Some of the chemicals released by the pancreas are not hormones, but stimulate other glands to make hormones. Once again, balance is necessary. Nutritional requirements for the pancreas are many. Research indicates that chromium vitamins C, E, B-complex, calcium, magnesium and potassium are especially important.
Parasite (Parasites, Parasitic, Parasitical)
An organism living in or on another organism.
Tumor (Tumors, Tumour, Tumours)
An abnormal growth of tissue resulting from uncontrolled, progressive multiplication of cells and serving no physiological function; a neoplasm. Literally, a swelling; in the past the term has been used in reference to any swelling of the body, no matter what the cause. However, the word is now being used almost exclusively to refer to a neoplastic mass, and the more general usage is being discarded.
Ulcerative Colitis (Colitis Ulcerosa)
Ulceration of the colon and rectum, usually long-term and characterized by rectal bleeding or blood in the stool, frequent urgent diarrhea/bowel movements each day, abdominal pain.
Ultrasound
Ultrasound testing uses sound waves projected into the body to produce an image of internal organs, structures, tumors, etc. In this procedure, a gel is applied to the patient's skin, and a small device that emits ultrasonic pulses is slowly passed over the area. The sonic image produced is viewed on a monitor.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: May 11, 2008
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