What is Bile Duct Cancer? What are the symptoms?

Cancer begins when cells in the body begin to grow out of control. Cells in almost any part of the body can turn into cancer and then spread to other parts of the body. Bile tract cancer, also known as cholangiocarcinoma, begins in the bile duct. Bile tract cancer is a rare, aggressive type of cancer. It usually affects adults in their 70s and has spread beyond the bile ducts by the time healthcare providers diagnose it. Treatment usually involves a combination of surgery, chemotherapy, or radiation therapy. Clinical trials to improve outcomes in cholangiocarcinoma are ongoing.

What is Bile Duct Cancer?

Cholangiocarcinoma is a type of cancer that forms in the thin tubes (bile ducts) that carry digestive fluid bile. Bile ducts connect your liver to your gallbladder and small intestine. Although it can occur at any age, it is mostly seen in people over the age of 50. Cholangiocarcinoma is divided into different types, depending on where the cancer occurs in the bile ducts. Types of bile duct cancer can be transferred as follows:

• Intrahepatic cholangiocarcinoma: Occurs in parts of the bile ducts in the liver and is sometimes classified as a type of liver cancer.
• Hilar cholangiocarcinoma: Occurs in the bile ducts just outside the liver. This type is also called perihilar cholangiocarcinoma.
• Distal cholangiocarcinoma: Occurs in the part of the bile duct closest to the small intestine. This type is also called extrahepatic cholangiocarcinoma.

Bile duct cancers can also be divided into types based on what the cancer cells look like under a microscope. Nearly all bile duct cancers are cholangiocarcinomas. These cancers are a type of adenocarcinoma, a cancer that begins in gland cells. Cholangiocarcinomas begin in the gland cells lining the inside of the ducts. Other types of bile duct cancer are much less common. These include sarcomas, lymphomas and small cell cancers. In addition, not all bile duct tumors are cancer. For example, bile duct hamartomas and bile duct adenomas are types of benign (non-cancerous) tumors.

What are the Symptoms of Bile Duct Cancer?

Symptoms of bile duct cancer usually do not begin until the cancer is advanced and blocks the bile duct. Symptoms of bile duct cancer are:

• Yellowing of your skin and the whites of your eyes (jaundice)
• Intensely itchy skin
• White colored stool
• burnout
• feeling tired
• Abdominal pain on the right side, just below the ribs
• Loss of appetite or losing weight without trying
• High fever
• night sweats
• dark urine
• Stomach ache

Cholangiocarcinoma is usually not painful in the early stages. But a large tumor can cause pain concentrated on the right side of the abdomen, below the ribs. In some people, the pain may shift to other parts of the abdomen or back.

What Causes Bile Duct Cancer?

Causes of bile duct cancer is not known exactly. But health conditions that cause chronic (long-term) inflammation in the bile ducts may also play a role. The ongoing damage from inflammation can cause changes in cell DNA. DNA contains instructions that tell cells how to behave. Damaged DNA can cause problems with the growth and division of cells, forming tissue-damaging tumors. These changes are probably not hereditary (not passed on from biological parents to their children). Instead, they likely occur throughout a person’s life. You may be more likely to get bile duct cancer if you:

• over 65 years old
• Abnormal bile ducts, long-term swelling of the intestine (ulcerative colitis) or bile ducts, a parasite in the liver (liver fluke), certain medical conditions such as bile duct stones and liver cirrhosis

How Is Bile Duct Cancer Diagnosed?

If cholangiocarcinoma is suspected, some diagnostic methods are available. Diagnosis of bile duct cancer The methods used for can be explained as follows:

• Liver function tests: Blood tests to measure liver function can give the doctor clues about what is causing signs and symptoms.
• Tumor marker test: Checking the level of carbohydrate antigen (CA) 19-9 in the blood may give the doctor additional clues regarding the diagnosis. CA 19-9 is a protein overproduced by bile duct cancer cells.
  However, a high level of CA 19-9 in the blood does not mean that there is bile duct cancer. This result may also occur in other bile duct diseases, such as bile duct inflammation and obstruction.
• A test to examine the bile duct with a small camera: During endoscopic retrograde cholangiopancreatography (ERCP), a thin, flexible tube equipped with a tiny camera is passed down the throat and through the digestive tract into the small intestine. The camera is used to examine the area where the bile ducts connect to the small intestine.
• Imaging tests. Imaging tests can help the doctor see internal organs and look for signs of cholangiocarcinoma. Techniques used to diagnose bile duct cancer include magnetic resonance imaging (MRI) along with ultrasound, computed tomography (CT) scans, and magnetic resonance cholangiopancreatography (MRCP). MRCP is increasingly used as a noninvasive alternative to ERCP. It provides 3D images without the need for paint to enhance the images.
• Performing a procedure to remove a tissue sample for testing: Biopsy is the process of taking a small sample of tissue to be examined under a microscope. If the suspicious area is very close to where the bile duct meets the small intestine, the doctor may take a biopsy sample during ERCP. If the suspicious area is in or near the liver, the doctor may take a tissue sample by inserting a long needle into the affected area of ​​skin (fine needle aspiration). He or she may use an imaging test, such as an endoscopic ultrasound or CT scan, to guide the needle to the precise area.
  This test may affect how the doctor collects the biopsy sample and what treatment options he or she offers next. For example, if bile duct cancer is biopsied by fine needle aspiration, it is not suitable for liver transplantation.

If the doctor confirms the diagnosis of cholangiocarcinoma, he or she will try to determine the spread (stage) of the cancer. Often this includes additional imaging tests. The stage of the cancer helps determine treatment options.

How Is Bile Duct Cancer Treated?

Bile duct cancer can often be treated. Bile duct cancer treatment The methods used for are as follows:

• Operation: In some cases, surgeons try to remove as much of the cancer as possible. For very small bile duct cancers, this involves removing part of the bile duct and joining the cut ends together. In more advanced bile duct cancers, nearby liver tissue, pancreatic tissue, or lymph nodes may also be removed.
• Liver transplant: Liver transplant may be an option in some cases for people with hilar cholangiocarcinoma.
• Chemotherapy: Medicines are used to kill cancer cells. Chemotherapy may be used before liver transplantation. For people with cholangiocarcinoma, it may help slow the disease and relieve symptoms.
• Radiation therapy: Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells.
• Targeted drug therapy: Targeted drug therapies focus on specific abnormalities present in cancer cells. Targeted drug treatments can block these abnormalities, causing cancer cells to die.
• Immunotherapy: Immunotherapy uses your immune system to fight cancer. Cancer cells produce proteins that help them hide from immune system cells. Immunotherapy works by interfering with this process. Immunotherapy may be an option for advanced cancer when other treatments have not helped.
• Heating cancer cells: Radiofrequency ablation uses electric current to heat and destroy cancer cells. Using an imaging test such as an ultrasound as a guide, the doctor inserts one or more thin needles into small incisions in your abdomen. When the needles reach the cancer, they are heated with electric current and destroy the cancer cells.
• Photodynamic therapy: In photodynamic therapy, a light-sensitive chemical is injected into a vein and accumulates in rapidly growing cancer cells. Laser light directed at the cancer causes a chemical reaction in the cancer cells, killing them.
• Biliary drainage: Biliary drainage is a procedure to restore bile flow. It may involve inserting a thin tube into the bile duct to drain bile. Other strategies include bypass surgery, which redirects bile around the cancer, and stents to keep open the bile duct that has collapsed due to cancer.

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