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Bile Duct Cancer

Bringing you comprehensive information about different types of Bile Duct Cancer

Bile Duct Cancer

Bringing you comprehensive information about different types of Bile Duct Cancer

AOI > Cancer Types > Bile Duct Cancer > Treatment

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    What are the different types of treatments for biliary duct cancers?

    The main types of treatment for bile duct cancer include:

    • Surgery
    • Radiation Therapy
    • Chemotherapy
    • Targeted Therapy
    • Immunotherapy
    • Palliative Therapy

    At AOI, the best hospital for biliary duct cancer treatment, our team of doctors and other professionals discuss the treatment plan and care specifically suited for you and your cancer type. Our multidisciplinary team (MDT) includes a surgical oncologist, a radiation oncologist, a medical oncologist, a gastroenterologist and a hepatologist.

    Patients who can’t have surgery to cure their cancer will be suggested other treatment options such as chemotherapy, radiotherapy or a combination of treatments to shrink or slow down the growth of tumor.

    The bile duct cancer treatment depends on:

    •  Size, location and stage of the cancer
    • Whether the cancer is resectable, i.e, removable by surgery
    • Patient’s general health
    • Any treatment patient have already had

    What is the latest treatment for biliary duct cancer?

    In case of stage 1 and stage 2 bile duct cancers, a cure is possible by surgery during which the affected part of the bile duct along with some of the liver or gallbladder is removed.

    Whereas in case of the stage 3 bile duct cancers, the chance of achieving a successful cure depends on how many lymph nodes have been affected. And in case of the stage 4 bile duct cancers, achieving a successful cure is highly unlikely.

    However, modalities like chemotherapy, radiotherapy and surgery can be used to help relieve symptoms.

    Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer.

    What is the common treatment for biliary duct cancer in elderly?

    For elderly people who commonly present with biliary duct cancer, endoscopic intervention in contrast with emergency surgery is often better tolerated, and is associated with significantly less risk and a lower mortality.

    Endoscopic palliation also improves the patient’s quality of life with few complications or post-procedural machinations.

    Bilary Duct Cancer Surgery

    Some patients with bile duct cancer may be good candidates for bile duct cancer surgery. The surgery is often prescribed only after accessing the possible benefits and risks and also how it is likely to affect the quality of life of an individual.

    Depending on the extent of the cancer, during surgery, a surgeon may remove:

    • section of bile duct that contains cancerous cells
    • gallbladder
    • nearby lymph nodes
    • a large part of liver

    After surgery, it is possible to reconstruct what remains of the bile duct so that bile can still flow into the intestine.

    Similarly, it is often possible for the liver to resume normal functions after the surgery because liver has ability to regenerate itself after surgery.

    Success rates of bile duct surgery depend on factors such as whether nearby lymph nodes are free of cancer and whether it was possible to remove all of the cancerous cells during the surgery.

    Surgeries for bile duct cancer include

    Bile Duct Resection: Based on the size of the tumor, some or all of the bile duct may be removed. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes may also be removed to check for any cancer cells.

    Partial Hepatectomy: During this procedure the part of the liver near the bile duct where cancer is present is removed. The part may be a wedge, an entire lobe, or a larger part of the liver along with some surrounding tissue.

    Biliary Bypass: If a tumor is blocking the small intestine and bile is building up in the liver, a biliary bypass may be performed surgically such that gallbladder or bile duct is cut and sewn directly to the small intestine to create a new pathway around the blockage. This procedure is not designed to cure bile duct cancer but it’s helpful only to relieve symptoms.

    Endoscopic Stent Placement: If the bile duct is being blocked by a tumor, a stent may be placed through an Endoscopic Retrograde Cholangiopancreatography (ERCP) or interventional radiology to drain bile that builds up in the area. The procedure does not help to cure bile duct cancer, but it aids in relieving symptoms.

    What is whipple procedure?

    A whipple procedure or pancreaticoduodenectomy is a complex procedure in which the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas are removed.

    Laparoscopy to plan bile duct surgery

    If your surgical team is planning curative surgery, they first may do a laparoscopy which is a type of minor surgery to look for any spread of the cancer that could make curative surgery, not an option.

    Laparoscopy allows the surgeon to look for cancer in areas that did not show up on imaging tests. Laparoscopy also helps to plan the operation in case of resectable cancer.

    What is partial hepatectomy vs hepatic lobectomy?

    For resectable cancers, the type of operation depends on location of the cancer.

    In case of intrahepatic bile duct cancers where a part of bile duct is inside the liver, the surgeon cuts out the affected part of the liver. This procedure of removing part of the liver is called a partial hepatectomy. But sometimes this could also mean that a whole lobe (right or left part) of the liver must be removed, commonly called as hepatic lobectomy. It is a complicated operation that requires an experienced surgical team. The liver will still work normally if only a part of liver is removed because liver has some ability to grow back.

    What is liver transplant and what are the reasons for liver transplant surgery?

    For some people with early stage bile duct cancers, removing the liver and bile ducts and then transplanting a donor liver may be an option. Infact, in some cases it might even cure the cancer. However, the only drawback in this case would be finding a matched donor because sometimes it can take too long.

    Patient can have a living donor (often a close relative) who is willing to give a part of their liver for transplant. This can be successful, but sometimes it carries a risk for the donor. Another option might be to treat the cancer first with chemotherapy and radiation, followed by a liver transplant.

    A liver transplant is a major operation which carries potential risks such as bleeding, infection, complications from anesthesia, etc. Besides, after liver transplant, drugs which have to be taken to help suppress the patient’s immune system to keep it from rejecting the new liver have their own side effects.

    Palliative surgery for bile duct cancer

    Palliative surgery is generally performed when the cancer is too widespread to be removed completely. It is often prescribed to relieve symptoms or treat complications, such as blockage of the bile ducts.

    Palliative surgery cannot cure cancer, but it can sometimes help a person feel better and may even help them live longer.

    In some cases the doctor might think the cancer can be removed (is resectable) based on the diagnostic tests such as imaging tests, laparoscopy, etc., but only after the surgery is started it becomes clear if the cancer is too advanced to be removed completely.

    Possible risks and side effects of bile duct surgery

    The risks and side effects of bile duct surgery depends on how well the liver is functioning, kind of surgery and a person’s overall health before surgery. The surgery carries some amount of risk, including the possibility of bleeding, blood clots, infections, complications from anesthesia, pneumonia, and even death in rare cases.

    Patients may also experience some pain from the incision post surgery, but this can be controlled with pain relieving medicines.

    Other serious problems followed by the surgery includes: bile leakage into the abdomen, infections, and liver failure.

    Radiation Therapy for Bile Duct Cancer

    What is radiation therapy?

    Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation isn’t used to treat bile duct cancer, still, it might be useful in following ways:

    • After surgery to remove the cancer: This is called adjuvant therapy. It’s used to kill cancer cells that are left after the surgery but are too small to be seen during the surgery.
    • Before surgery for cancers that might be able to be taken out: Some doctors may use radiation therapy before surgery to shrink the tumor and make it easier to take it out. This is called neo adjuvant therapy.
    • As part of the main therapy for some advanced cancers: Radiation therapy can also be used as a main therapy for some patients whose cancer has not spread throughout the body, but can’t be removed with surgery. This treatment option may not offer a cure, but it may help patients to live longer.
    • As palliative therapy: Radiation therapy is often used to ease symptoms when a cancer is too advanced to be cured. It can help relieve pain or other symptoms by shrinking tumors that block bile ducts or blood vessels.

    What are the different types of radiation therapy for biliary duct cancers?

    The two main types of radiation therapy performed on bilary duct cancer patients are external beam radiation therapy (EBRT) and brachytherapy.

    EBRT is the most common form of radiation for bile duct cancer.

    What are EBRT side effects?

    Radiotherapy is not a standard treatment for bile duct cancer, but it may help to relieve the symptoms, slow the spread of the cancer and prolong life.

    Two types of radiotherapy are used to treat bile duct cancer:

    • External beam radiotherapy – a machine is used to target radioactive beams at your bile duct
    • Internal radiotherapy (brachytherapy) – a radioactive wire is placed inside your bile duct next to the tumor

    Radiotherapy works by damaging the cancerous cells. However, it can also damage healthy cells and cause side effects.

    Some of the common side effects of radiotherapy include:

    • nausea
    • vomiting
    • fatigue

    Chemotherapy for Bile Duct Cancer

    What is chemotherapy treatment for biliary duct cancers?

    Chemotherapy is treatment with cancer-killing drugs that are usually given into a vein (IV) or taken orally by mouth. As a result these drugs enter the bloodstream and reach all areas of the body. This makes chemotherapy treatment useful for some cancers that have spread to organs beyond the bile duct.

    Though chemo drugs can help bile duct cancer patients, so far it’s not clear how useful it is.

    In case of bile duct cancer, chemotherapy treatment might be used in the following ways:

    • After surgery to remove the cancer: Chemo drugs sometimes along with radiation therapy are given after surgery so as to lower the risk that the cancer will come back. This is called adjuvant chemo.
    • Before surgery: Chemotherapy may be prescribed before surgery in case of cancers that can be completely removed. Chemo drugs help in shrinking the tumor which improves the odds that surgery will be successful. This is called neo-adjuvant treatment.
    • As part of the liver transplant process: Chemo may be used to keep bile duct cancer under control until a liver transplant takes place.
    • As part of the main treatment for some advanced cancers: Chemotherpay, sometimes with radiation therapy can be used for advanced cancers that cannot be removed or have spread to other parts of the body. In such a scenario, chemo may not cure these cancers, but it might help people live longer.
    • As palliative therapy: Chemotherpy can shrink tumors or slow their growth which helps to relieve advanced stage patients of severe symptoms.

    Chemotherapy is to be given in cycles, with each period of treatment followed by a rest period to give the body some time to recover. Chemo cycles generally last about 3 to 4 weeks.

    What is hepatic artery infusion (HAI)?

    Giving chemo drugs directly into a vein isn’t always helpful in case of bile duct cancer patients, therefore, doctors sometimes prefer giving the drugs right into the main artery that goes into the liver, called the hepatic artery.

    The hepatic artery also supplies most bile duct tumors, so putting the chemo drug into this artery means more medicine going directly to the tumor.

    HAI often proves to be helpful in people whose cancer couldn’t be removed surgically to live longer.

    What is Trans-Arterial Chemoembolization (TACE)?

    Embolization is a procedure where a substance is put into the blood vessels to stop blood from reaching to a tumor. TACE uses tiny beads of chemo to do this. During the procedure a catheter is used to put the beads into the artery that “feeds” the tumor which then blocks the blood flow and give off the chemo.

    TACE is helpful in treating tumors that can’t be removed surgically or to treat bile duct cancer that comes back post surgery.

    Possible side effects of chemotherapy

    Chemo drugs attack cells that divide quickly which is why they work against cancer cells. As a result other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles which also divide quickly can be affected, thereby leading to side effects.

    The side effects of chemotherapy also depends on the type and dose of drugs given, how they’re given, and the length of treatment.

    Some of the common side effects of chemotherapy include:

    • Hair loss
    • Mouth sores
    • Loss of appetite
    • Nausea and vomiting
    • Diarrhea
    • Nerve damage
    • Increased chance of infections
    • Easy bruising/bleeding
    • Fatigue

    However, most of these side effects are short-term, and they go away after the treatment ends.

    Targeted Therapy for Bile Duct Cancer

    What is targeted therapy treatment for gallbladder & biliary duct cancers?
    Targeted therapy, a promising treatment option for bile duct cancer makes use of medications that target the cancerous cells. These targeted drugs work differently from standard chemotherapy (chemo) drugs and sometimes work only when standard chemo drugs fail to show any result.

    FGFR2 inhibitor: Fibroblast growth factor receptors are proteins on cells that help them grow and divide normally. A small number of people with bile duct cancer within the liver have changes in the genes that make FGFRs, which results in abnormal FGFR proteins. These proteins cause cells to grow abnormally and turn into cancer.

    Pemigatinib (Pemazyre): a FGFR2 inhibitor blocks the abnormal FGFR2 protein in bile duct cancer cells and keeps them from growing and spreading to other parts of the body. It can be used to treat some advanced bile duct cancers that cannot be removed surgically or have spread to the distant areas after the previous chemotherapy treatment. For this drug to work, patient’s cancer must have the abnormal FGFR2 gene. Hence, the cancer will be tested before starting the treatment.

    Possible side effects of a FGFR2 inhibitor
    The most common side effect of pemigatinib is having too much or too little phosphate in the blood, hair loss, diarrhea, constipation, nail problems, fatigue, taste changes, nausea, vomiting, dry mouth or mouth sores, loss of appetite, dry skin, dry eye or other eye problems, and joint, abdominal, or back pain, etc.

    What is photodynamic therapy?
    This is a new technique that can help to control but not cure the symptoms of bile duct cancer. During the procedure, a special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumor.

    What is photodynamic therapy?

    This is a new technique that can help to control but not cure the symptoms of bile duct cancer. During the procedure, a special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumor.

    Follow-up care

    If you have completed your treatment for biliary duct cancer, your doctors would still want to observe your condition. Therefore, its important that you attend all your follow-up appointments.

    During these visits, your specialist will examine you and may check lab tests or x-rays and scans to look for signs of cancer or treatment side-effects.

    Almost any cancer treatment can have side effects. Some may last for a few weeks to a couple of months and a few can last for the rest of your life. Inform your doctor about any changes or problems you notice and about any questions or concerns you have.

    There’s no follow-up schedule for bile duct cancer but many doctors recommend blood and/or imaging tests about every six months for at least the first couple of years after treatment.

    If the cancer does come back (recur), further treatment will depend on location of the cancer, what treatments you’ve had before, and your overall health.

    How long does it take to recover from bile duct surgery?
    Most patients stay in hospital for around a week after the surgery and take about a month or two months to return to normal activities. Recovery basically depends on a couple of factors including patient’s general health profile, stage of cancer and also the treatment of choice.

    How complicated is bile duct removal surgery?
    Surgery for bile duct cancers is complicated, therefore, it requires a great skill and precision. Usually, part of the liver is also removed, along with the bile duct, gallbladder, nearby lymph nodes, and sometimes part of the pancreas and small intestine too.

    What are bile duct surgery complications?
    Surgery for bile duct cancer is a major operation that might mean removing parts of other organs. This can have a major effect on a person’s recovery and health after the surgery. Serious problems soon after the surgery can include bile leakage into the abdomen, infections, and liver failure.

    What are common foods to avoid bile duct cancer?
    Taking the nutritious diet and supplements including omega-3 fatty acids, specific oral nutrition supplements, vegetables and fruits, folate, insoluble fiber and Vitamin C, etc., may help reduce the risk of cholangiocarcinoma/bile duct cancer. It may even improve cancer related problems in cholangiocarcinoma patients. However, consuming alcohol or smoking, having a family history of cancer, obesity or consuming high nitrate foods, preserved vegetables and salted meats may increase the risk of bile duct cancer/cholangiocarcinoma and therefore, it should be avoided. Additionally, taking Vitamin D3 as part of the diet along with chemotherapy drugs may increase the treatment induced toxicity in cholangiocarcinoma patients. Hence, one should avoid these foods and supplements to reduce the risk and improve treatment outcomes in bile duct cancer/cholangiocarcinoma.
    It is important that patients should discuss it with their doctor or nutritionist and personalize nutrition based on their specific cancer type and ongoing treatments so as to gain maximum benefits.

    Living as a Bile Duct Cancer Survivor

    What is biliary duct cancer follow-up care?

    For some people with bile duct cancer, even though the treatment may lead to complete removal or destruction of the cancer, the end of treatment may add stress. While patients may be relieved that their treatment is finished, still the worry about cancer coming back may cause anxiety. Also, the patients may still have to go for their regular doctor visits and get regular tests done. This is important part of follow-up care.

    Moreover, for some people the cancer might never go away completely as they may get regular treatment with chemotherapy or other modalities for the rest of their life. Learning to live with cancer that doesn’t go away can be difficult and very stressful.

    Can I lower my risk of bile duct cancer progressing or coming back?

    If you have or ever had a bile duct cancer, adopting a healthy lifestyle and doing things such as exercising, eating a certain type of diet, or taking nutritional supplements might lower your risk of the cancer coming back.

    As mentioned, adopting healthy behavior such as not smoking or consuming alcohol, eating well and maintaining healthy weight might help, but there’s no research that validates the fact.

    What to do if the cancer comes back?

    If the cancer comes back at some point, you will have to undergo a series of diagnostic tests to check the spread of cancer and also, will have to go through the treatment.

    The treatment options will depend on where the cancer is located, what treatments you’ve had before, and your overall health condition.

    Precautions

    Can bile duct cancer be prevented?

    There’s no known way to prevent bile duct cancers as many known risk factors for bile duct cancer, such as age, ethnicity, and bile duct abnormalities, are beyond our control. But certainly there are ways that might help to lower the risk.

    Different ways to reduce the risk of bile duct cancer includes:

    • Maintain a healthy weight
    • Get vaccinated against the hepatitis B virus (HBV) to prevent infection
    • Take precautions to avoid sexually transmitted infections
    • Treat hepatitis infections (such as B and C) to prevent cirrhosis
    • Avoid or limit consumption of alcohol
    • Quit smoking
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