Bile Ducts Cancer
The bile ducts are the tubes connecting the liver and gall bladder to the small intestine (small bowel). Bile is a fluid made by the liver and stored in the gall bladder. Its main function is to break down fats during their digestion in the small bowel. In people who have had their gall bladder removed, bile flows directly into the small intestine. The bile ducts and gall bladder are known as the biliary system.
If the cancer starts in the part of the bile ducts contained within the liver it is known as intra-hepatic. If it starts in the area of the bile ducts outside the liver it is known as extra-hepatic. This information concentrates mainly on extra-hepatic bile duct cancers. Intra-hepatic bile duct cancers may be treated like primary liver cancer.
Causes and risk factors
These are : -
Inflammatory bowel disease People who have a chronic inflammatory bowel condition, known as ulcerative colitis, are at an increased risk of developing this type of cancer.
Abnormal bile ducts People who are born with (congenital) abnormalities of the bile ducts, such as choledochal cysts, are more at risk of developing cholangiocarcinoma.
Infection In Africa and Asia, infection with a parasite known as the liver fluke is thought to cause a large number of bile duct cancers…
Signs and symptoms
If cancer develops in the bile ducts it may block the flow of bile from the liver to the intestine. This causes the bile to flow back into the blood and body tissues, and leads to the skin and whites of the eyes becoming yellow (known as jaundice). The urine also becomes a dark yellow colour and stools (bowel motions) are pale. The skin may become itchy. Mild discomfort in the abdomen, loss of appetite, high temperatures (fevers) and weight loss may also occur…
How it is diagnosed
Usually you begin by seeing your GP, who will examine you. They will refer you to a hospital specialist for any tests that may be necessary and for expert advice and treatment.
At the hospital the doctor will ask you about your general health and any previous medical problems. They will also examine you and take blood samples to check your general health and that your liver is working properly…
Laparotomy
If the doctor cannot make the diagnosis from the above tests, a procedure called a laparotomy may be done under a general anaesthetic. This involves making a cut (incision) into your abdomen so that the surgeon can examine the bile duct and the tissue around it for cancer. Sometimes this examination can be done through a tiny cut using a camera called a laparoscope – this procedure is known as keyhole surgery.
If a cancer is found, but looks as though it has not spread to surrounding tissues, the surgeon may be able to remove the cancer or relieve any blockage that it is causing.
Staging and grading
Stage 1A : – The cancer is contained within the bile duct.
Stage 1B : – The cancer has spread through the wall of the bile duct but has not spread into nearby lymph nodes or other structures.
Stage 2A : – The cancer has spread into the liver, pancreas or gall bladder or to the nearby blood vessels, but not the lymph nodes.
Stage 2B : – The cancer has spread into nearby lymph nodes.
Stage 3 : – The cancer is affecting the main blood vessels that take blood to and from the liver, or it has spread into the small or large bowel, the stomach or the abdominal wall. Lymph nodes in the abdomen may also be affected.
Stage 4 : – The cancer has spread to distant parts of the body such as the lungs
If the cancer comes back after initial treatment, this is known as recurrent cancer.
Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop. Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly and are more likely to spread.
Treatment overview
The type of treatment that you are given will depend on a number of factors, including your general health, the position and size of the cancer in the bile duct and whether the cancer has spread beyond the bile duct…
Benefits and disadvantages of treatment
Treatment can be given for different reasons and the potential benefits will vary for each person. If you have been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether or not to go ahead.
If you feel that you can’t make a decision about treatment when it is first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you don’t have it. You don’t have to give a reason for not wanting to have treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice…
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