A National Cancer Institute-designated Comprehensive Cancer Center

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Bile Duct Cancer

Bile Duct Cancer
Highly experienced at diagnosing and treating bile duct cancer, City of Hope brings an aggressive, multidisciplinary approach to caring for people with the disease, offering them and their loved ones the most positive outcomes possible.

Through our clinical trials program – one of the most extensive in the nation – bile duct cancer patients can often access promising new anticancer drugs and technologies not available elsewhere.
 
Cancer of the bile duct is rare and often occurs in people over the age of 65. In the United States, there are between 2,000 and 3,000 cases of bile duct cancer diagnosed each year.
 
About Bile Duct Cancer
 
Bile Duct Cancers are indolent tumors and often grow slowly and spread gradually. The bile ducts are in close proximity to some of the main blood vessels going into the liver. These include the hepatic arteries and the portal vein. If these structures are involved it becomes difficult to clear the tumor and therefore deemed locally advanced.

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver.

A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine. This network begins in the liver where many small ducts collect bile, a fluid made by the liver to break down fats during digestion. The small ducts come together to form the right and left hepatic bile ducts, which lead out of the liver. The two ducts join outside the liver to become the common hepatic duct. The part of the common hepatic duct that is outside the liver is called the extrahepatic bile duct. The extrahepatic bile duct is joined by a duct from the gallbladder (which stores bile) to form the common bile duct. Bile is released from the gallbladder through the common bile duct into the small intestine when food is being digested.

Recurrent Extrahepatic Bile Duct Cancer

Recurrent extrahepatic bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile duct or in other parts of the body.
 
Bile Duct Cancer Symptoms

Possible symptoms of bile duct cancer are:
 
  •     jaundice
  •     clay-colored stools
  •     itching
  •     fever
  •     chills and rigors
  •     loss of appetite
  •     weight loss or abdominal and back pain as a consequence of the obstruction of these bile ducts.
 
 

How We Diagnose Bile Duct Cancer

Diagnostic tests are needed to determine whether symptoms are, in fact, bile duct cancer. If cancer is found, additional tests may be used to assess the stage of the disease; specifically, how advanced the cancer is, and whether it has spread outside the bile duct.

City of Hope diagnostic and staging tests include:
 
A biopsy — taking a small sample of tissue for examination under a microscope — may also be required to confirm a diagnosis of cancer, and to determine the cancer’s stage.
 
Physical exam and history
 
Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound is used to diagnose gallbladder cancer.
 
Blood chemistry studies: A procedure in which a blood sample is analyzed to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
 
Computerized Axial Tomography (CT or CAT) scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
 
Magnetic Resonance Imaging (MRI): MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
 
Positron Emission Tomography (PET) scan: This scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. Prior to the scan, a small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more frequently than normal cells, they take up more glucose than normal cells and appear brighter in the scan.
 
Endoscopic Retrograde Cholangiopancreatography (ERCP): A thin, flexible tube is guided down the throat, through the stomach, and into the small intestine. The doctor can see through the tube and inject dye into the drainage tube (duct) of the pancreas so that the area can be seen more clearly on an X-ray.
 
Percutaneous Transhepatic Cholangiography (PTC): This is another test that can help find cancer of the extrahepatic bile duct. A thin needle is inserted into the liver through the right side of the patient. Dye is injected through the needle into the bile duct in the liver so that blockages can be seen on X-rays.
 

Bile Duct Cancer Treatment Approaches

At City of Hope, our goal is to ensure treatment for bile duct cancer is not only effective, but also comprehensive and compassionate. Our skilled team of specialists design customized treatment programs using the latest technologies and capabilities available.

Bile duct cancer is often in an advanced stage when it is diagnosed, requiring rapid intervention by a group of specialists experienced in treating the disease. The multidisciplinary team at City of Hope includes medical experts from the departments of surgery, medical oncology and radiation oncology.
 
Experience of the surgeon is a key factor and City of Hope offers several surgical options for removing the tumor. These include:
 
  • Radical Excision of the Bile Duct Tumor: If the tumor is small and only in the bile duct, the entire bile duct may be removed. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes are removed and viewed under a microscope to see if they contain cancer.
 
  • Whipple Operation: A surgical procedure in which the head of the pancreas, the gallbladder, part of the small intestine, the bile duct and occasionally part of the stomach are removed. Enough of the pancreas is left to produce digestive juices and insulin.
 
  • Bile Duct Excision with concomitant Liver Resection
 
  • Bypasses and Stenting: If the tumor is blocking the bile duct, a stent (a thin tube) may be placed in the duct to drain bile that has built up in the area. The stent may drain to the outside of the body or it may go around the blocked area and drain the bile into the small intestine. The doctor may place the stent during surgery or percutaneous transhepatic cholangiography, or with an endoscope.
 
 
Chemotherapy
Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat primary and metastatic bile duct cancer. City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.
 
As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.
 
Radiation
Radiation therapy uses energy beams to kill cancer cells. Specialists in the Department of Radiation Oncology have developed highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing unnecessary exposure of healthy tissues.
 
  • Radiation implants (brachytherapy)
  • Intraoperative radiation
  • Intensity-modulated radiation therapy
     

Resources

City of Hope is committed to the philosophy of healing the whole person throughout treatment and recovery from cancer.

All of our bile duct cancer patients have access to the Sheri & Les Biller Patient and Family Resource Center which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
 
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
888-909-NCCN(6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

 

 
 

Bile Duct Cancer Team

Support this Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

 
 
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Physicians in the United States and throughout the world are welcome to refer patients to City of Hope.

There are a number of options you can choose from to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
Your insurance company/medical group will tell you if you need any authorizations. You can also find out what, if any, co-payments and deductibles will be your responsibility.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
City of Hope is one of only 41 Comprehensive Cancer Centers in the country, the highest designation awarded by the National Cancer Institute to institutions that lead the way in cancer research, treatment, prevention and professional education.
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