It’s a type that forms inside your bile duct. This is a thin tube about 4 to 5 inches long that moves a fluid called bile from your liver and gallbladder to your small intestine. When it gets there, it helps digest fat in the food you eat.
Bile duct cancer, also called cholangiocarcinoma, affects men slightly more than women. It tends to develop in people who are between 50 and 70.
For some people, treatment can destroy the cancer. In others, it may never go away entirely. While this is hard to hear, you can live with it. You may need regular doses of chemotherapy, radiation, or other treatments to keep it in check.
Though it’s a challenge to manage the stress, worry, and concerns about the future that come along with a cancer diagnosis, it’s important to learn about your illness and to gather support from your medical team, family, and friends.
Causes of Bile Duct Cancer
Primary sclerosing cholangitis: This inflammation of the bile duct leads to scarring. The cause isn’t known, but many people with it also have ulcerative colitis, an inflammation of the large intestine.
Bile duct stones: These are similar to gallstones, but much smaller.
Choledochal cysts: These are changes to cells in the linings of bile-filled sacs that connect to the bile duct. They often signal cancer.
Liver fluke infections: This problem is rare in the U.S. It’s more common in Asia and happens when people eat raw or poorly cooked fish that are infected with tiny parasitic worms called liver flukes. They can live in your bile ducts and cause cancer.
Reflux: When digestive juices from your pancreas flow back into the bile ducts, they can’t empty properly.
Some other conditions that can make you more likely to get bile duct cancer include:
Bile Duct Cancer Symptoms
Cancer can grow in any part of the bile duct. There are three types: intrahepatic (inside the liver), perihilar (where the ducts leave the liver), and distal (closer to the intestine). Symptoms may differ according to the location, but they usually include:
Getting a Diagnosis
Your doctor will use several methods to figure out if you have bile duct cancer.
Physical exam . He’ll do a complete medical checkup and ask about your general health, family history of cancer and liver disease, lifestyle, and habits, including drinking alcohol and smoking. He’ll also look for symptoms of bile duct cancer, like jaundice, which can appear as a yellowish tint to your skin and eyes. He’ll check for masses, tenderness, or fluid buildup in your belly.
Blood tests. Some make sure your liver is working like it should. Others look for signs of tumors, called markers, that show up when you have bile duct cancer. Your doctor may also check levels of bilirubin, the substance in your blood that causes jaundice.
Abdominal ultrasound . This imaging test helps your doctor see the tumor.
CT scan or magnetic resonance imaging (MRI). A CT scan is a powerful X-ray that makes detailed pictures inside your body. An MRI uses high-powered magnets to make images of organs and structures inside your body. These show the tumor and pinpoint its size and location in your liver. They also help gauge how healthy the organ is. Your doctor will decide whether you need one or both.
Endoscopy. This tool is sort of like a camera on the end of a cable. It lets your doctor see inside your body without surgery. He can examine your esophagus, stomach, and the beginning of the lower intestine.
Cholangioscopy. These imaging tests check your bile ducts for problems. In ERCP, or endoscopic retrograde cholangiopancreatography, the doctor can look for tumors there. You’ll be lightly sedated. He’ll use an endoscope to inject dye into your bile ducts, then take X-rays.
Laparoscopy . You’ll be asleep when the doctor does this test because it requires an incision in your belly. He’ll insert a thin tube with a light and small video camera. It lets him look at your bile duct, gallbladder, liver, and other organs and tissues. When he knows if -- and how far -- the cancer has spread, he can plan your surgery and treatments. He can also take biopsy samples.
Biopsy. The doctor removes a sample of bile duct cells or tissue and checks them under a microscope to confirm your diagnosis. You may not always get one before surgery. If other tests suggest a bile duct tumor, you may go straight to surgery.
Questions for Your Doctor
- Where is my cancer?
- Has it spread beyond the bile duct?
- What stage is it?
- Do you think you’ll be able to remove it completely through surgery?
- What are my treatment choices? What do you recommend and why?
- How much experience do you have treating this cancer?
- Should I get a second opinion?
- What’s the goal of my treatment plan?
- What are the risks and side effects of the treatment?
- How will treatment affect my daily life?
- What are the chances my cancer will return after treatment?
- If it recurs or if treatment doesn’t work, what else can we do?
- What type of follow-up care will I need?
Bile duct cancer treatment may include a combination of these:
Surgery. There are two types. Curative means the surgeon can get all the cancer out. Palliative means the disease is too widespread to be completely removed, but the operation will relieve symptoms or treat complications. The recovery time can last several weeks.
Radiation. This method uses high-energy rays or particles to kill cancer cells. Your doctor may use it before surgery to shrink the tumor and make the operation easier. After surgery it can kill any cancer cells that remain. If the cancer can’t be surgically removed but hasn’t spread throughout your body, radiation can help keep the disease under control.
Chemotherapy . This treatment is mostly used before surgery to shrink the tumor and raise the chances that the operation will be successful. It may be used afterward to lower odds that the cancer will return. You can take chemo by mouth or an injection into a vein.
Stent placement. A tube called a stent can go into a blocked duct. It allows bile to drain more easily from the liver to your intestine.
Liver transplant. This is a rare treatment option. It may be hard to get a new liver, but it can cure the cancer.
You might benefit from other treatments, too. Ask your doctor about your options.
Taking Care of Yourself
Even during cancer treatment, you can take steps to feel as healthy as possible.
Cut down on alcohol and give up smoking. Fatigue or extreme tiredness -- the kind that doesn’t get better with rest -- can happen when you have cancer. You might be so tired that it’s hard to work out or do other things you want to do. While you do need to get enough rest, following an exercise program that’s tailored to you can help reduce fatigue.
When you find out you have cancer, it’s only normal to think about your future and your own mortality. This can be a distressing time, so seek support everywhere you can. Whether it’s a family member or friend, a counselor, or a religious leader, talk to someone you trust.
What to Expect
The chances of successfully treating this type of cancer depend on its location and how far along it is when you’re diagnosed. The bile duct is deep within your body, so unlike other cancers you won’t see or feel problems in the early stages. There are no good screening tests, so most cases aren’t found until after the tumors are big enough to cause symptoms. Only a small number of bile duct cancers are found early enough to be completely removed by surgery.
People with cancers outside the liver fare better than those whose are inside the organ. But if the cancer has spread to other organs, the outcome is about the same.
For information and support, visit the American Cancer Society at www.cancer.org.