Bile ducts are located near the major blood vessels that feed the liver, making the surgical removal of tumors quite challenging. It is essential to seek out a specialized cancer center for such complex surgery. If you or a loved one has been diagnosed with bile duct cancer, or you suspect you may have the disease, contact the specialists here at City of Hope.
Our surgeons are experts in the intricate procedures required to treat bile duct cancer, and our world-class staff can answer your questions, address your concerns and deliver a personalized treatment plan with the most innovative, leading-edge therapies available anywhere.
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If you have been diagnosed with bile duct cancer, suffer from continuing inflammation of the bile ducts or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
Recognized as a leader in bile duct cancer research and treatment, U.S. News & World Report has named City of Hope one of the top cancer hospitals in the country for over a decade. With our specialized therapy protocols and an extensive program of clinical trials, newly diagnosed or relapsed patients can find a treatment regimen that is tailored to their needs and gives them the best chance for survival.
City of Hope is one of a handful of institutes to attain the elite designation of comprehensive cancer center by the National Cancer Institute. Here, we are committed to treating the whole person, body and soul. With an unmatched reputation for coordinated, compassionate care, we bring together a broad array of cancer expertise from multiple disciplines, all under one roof.
At City of Hope, your supportive care continues long after treatment is complete. Our specialists will help you adjust to post-treatment diet and lifestyle changes, and our unique family and survivorship programs will assist your loved ones.
February 23, 2016
Bile is a fluid secreted by the liver to help digest food, and bile ducts are the small tubes in and around the liver that carry this fluid to the small intestine. Cancer of the bile ducts occurs when cells in these tubes become abnormal and grow uncontrollably.
Symptoms of bile duct cancer can go unnoticed until the late stages of the disease, but common symptoms are:
Age: Most cases of bile duct cancer are diagnosed in patients in their 60s and 70s.
Liver and inflammatory bowel diseases: Conditions such as primary sclerosing cholangitis, bile duct stones, choledochal cysts, liver fluke infections, cirrhosis and Hepatitis B and C can all inflame the bile ducts and increase risk. This is also true for ulcerative colitis and Crohn’s disease, both of which are characterized by chronic swelling of the digestive tract.
Ethnicity: In the United States, cancer of the bile ducts is more common in Native Americans and Hispanic-Americans.
Obesity: Being overweight or obese can heighten your risk of bile duct cancer.
Genetics: While a family history of bile duct cancer may increase risk, it remain a rare disease with most cases being found in people with no family history at all.
Alcohol consumption: People who consume alcohol, particularly those who have liver disease due to drinking alcohol, are more likely to get bile duct cancer.
Sources: American Cancer Society and National Cancer Institute
The bile ducts are located deep within the body, making it difficult to detect early tumors during a standard physical. Additionally, there are no reliable screening options for bile duct cancer, so it tends to be diagnosed at later stages when the cancer has grown and spread.
To diagnose bile duct cancer, doctors first assess your personal and family health histories, in addition to your risk factors and symptoms. You must also undergo a physical exam and one or more of the following tests:
To conduct a biopsy, a small piece of the bile duct is removed and analyzed by a pathologist to determine if there is cancer present.
Liver function tests can identify bile duct blockages, as can liver enzyme tests. Liver enzyme tests are also used to recognize inflammation and irritation of the liver.
Additional blood tests may be conducted to detect elevated levels of certain substances known as tumor markers.
Abdominal ultrasound: The initial imaging test a patient undergoes is usually an ultrasound. This type of test uses sound waves to create images of potential bile duct cancer tumors. Abdominal ultrasounds require no radiation and are noninvasive.
A doctor or ultrasound technician simply moves a wand-like instrument over your abdomen to capture the echoes that bounce off your internal organs. Those echoes are converted into images with the help of specialized computer programs.
Endoscopic or laparoscopic ultrasound: These ultrasounds provide more detailed images, as they allow for closer access to the bile duct area. Endoscopic and laparoscopic ultrasounds may be used to assist in removing tissue for a biopsy and determining if cancer has spread. During these procedures, a thin tube fitted with a light at the end is inserted through the mouth and down the throat, or through a small incision in the side of the body.
Endoscopic retrograde cholangiopancreatography (ERCP): During this procedure, an endoscope is inserted down the throat, followed by a smaller scope that dispenses dye into the bile ducts. X-rays can then pick up on the dye and reveal any visible abnormalities. If necessary, doctors can also insert stents to unblock bile ducts during an ERCP.
Magnetic resonance cholangiopancreatography: Similar to a MRI, this test takes thorough pictures of the bile ducts. Unlike the ERCP, it is noninvasive and does not use radiation.
Percutaneous transhepatic cholangiography: Useful in detecting bile duct cancer located inside the liver, this is a more invasive but more accurate procedure. For this test, doctors use a needle to inject dye into the bile ducts. X-rays can then detect any existing problems or blockages. PTC may show the exact location and size of bile duct cancer tumors, and determine if they can be removed surgically.
Accurate staging is crucial for developing the best possible cancer treatment plan. To begin, the type of bile duct cancer is classified based on its location.
Intrahepatic bile duct cancer starts inside the liver, perihilar (or hilar) bile duct cancer start just outside the liver and distal bile duct cancer starts near the small intestine.
Next, doctors determine the cancer’s severity by evaluating the size of the primary tumor and whether it has grown through the wall of the bile duct, if the cancer has reached nearby lymph nodes and if it has spread to other parts the body.
Every patient is different, with different needs. City of Hope treats you as a valued individual. Our entire team works together to bring you precise, state-of-the-art surgical, radiation, drug and other therapy options that will deliver the best outcome for you. We support you every step of the way, both during treatment and long after, helping you and your loved ones manage your recovery.
Highlights of City of Hope's bile duct cancer treatment program include:
Often performed in conjunction with chemotherapy and/or radiation therapy, surgery is a common treatment for bile duct cancer. When possible, City of Hope surgeons will take minimally invasive approaches to remove bile duct cancer such as laparoscopic surgery (using miniaturized operation instruments inserted through a thin tube) and robotically assisted surgery (using a specially designed robot equipped with miniature surgical tools and advanced imaging systems, giving the surgeon superior visualization and greater control at the tumor site.
Bile duct cancer is often treated with systemic chemotherapy (anti-cancer medicines that kill all fast-growing cells in the body), given orally or by injection into the vein.
A new development in bile duct cancer treatment is hepatic arterial infusion. This delivery method uses a tiny pump implanted under the skin in the lower abdomen to supply cancer-killing drugs directly into the main blood vessel entering the liver and surrounding organs, including the bile duct. This direct method of chemotherapy delivery can be more effective against bile duct cancer.
Radiation treatments use high-energy waves such as X-rays, gamma rays and charged particles to treat bile duct cancer. At City of Hope, we use precise radiation delivery techniques. Using advanced imaging techniques, our radiation team can accurately locate and target a bile duct tumor for treatment, ensuring maximum impact against cancer cells while minimizing exposure to surrounding normal tissues. These techniques include respiratory gating and four-dimensional computed tomography, both of which account for organ and tumor movements during breathing.
In addition to standard chemotherapy regimens, City of Hope patients have the opportunity to enroll in clinical trials testing new drugs (or new drug combinations) that may be more effective against bile duct cancer.
City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat cancer, coupled with our enduring belief in providing unparalleled compassionate care. If you have been diagnosed with bile duct cancer or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.
Through our clinical trials program — one of the most extensive in the nation — bile duct cancer patients can often access promising new anti-cancer drugs and technologies not available elsewhere.
Some of our current research projects include:
Trametinib (Mekinist®) is a targeted therapy drug that can stop tumor development by removing enzymes necessary for bile duct cancer cells to grow, and City of Hope is part of a Phase II trial to see if this drug is more effective than combination therapy for patients with advanced or recurrent bile duct cancer. This trial will also evaluate the side effects differences between these two regimens to see which less toxic and easier to tolerate.
In many cases, combining chemotherapy and radiation (chemoradiation) can be more effective than either therapy alone, but it can also lead to more severe side effects as well. In a Phase I clinical trial, City of Hope researchers are seeing if combining the cancer drug gemcitabine (Gemzar®) with radiation therapy is well tolerated in bile duct cancer patients and if so, determine the optimal dose for cancer-fighting effectiveness.
Overexpression of the HER2 protein in some bile duct cancers can be exploited for imaging purposes, since they will take in more trastuzumab (Herceptin) than normal tissues. Using this knowledge, researchers are investigating whether linking trastuzumab to imaging agent 64Cu-DOTA results in better visualization of tumors in a positron emission tomography (PET) scan.
When you come to City of Hope, you automatically gain access to an unparalleled array of support services to help you and your family cope with each challenge in your bile cancer diagnosis and treatment. We can help with all of these concerns, and more: