What is Bile Duct Cancer? Your bile ducts are thin tubes that carry bile from the liver, gallbladder, and pancreas into your small intestine to help digest the fats in food. Bile duct cancer happens when cells in the bile ducts divide without stopping and spread into surrounding tissue. Because bile duct cancer occurs deep in the body, it is difficult to detect and there are no screening tests that can find it before it produces symptoms. The good news is that it is very rare, with only 8,000 people per year diagnosed with the disease.
Detection and Diagnosis: Symptoms of bile cancer can include pain in the belly, nausea and vomiting, fever, weakness and dark urine. But experiencing these symptoms does not mean you have the disease – it is quite rare. If you’re concerned about your risk of bile duct cancer, you want a diagnosis or to know the disease has been ruled out quickly. Central Maine Healthcare’s cancer care team is focused on providing fast, accurate testing, along with compassionate care.
Treatment: Bile duct cancer is usually treated with either surgery or radiation and often with a combination of the two. With surgery, your provider removes as much of the cancer as possible. Sometimes all of it can be removed, curing the cancer. In other cases, the cancer is too advanced, but surgery can be done to remove as much as possible in order to relieve symptoms or treat complications.
The other form of treatment is radiation, which uses high-energy rays or particles to kill cancer cells. This approach allows your provider to try to eliminate cancer that could not be safely removed during surgery. If the cancer can’t be operated on but hasn’t spread to other parts of the body, radiation helps control the disease.
Support: Central Maine Healthcare’s cancer care team includes nurses specially trained for treating cancer patients, nurse navigators who guide patients and their loved ones to a variety of supportive resources, and oncology social workers who help you balance the demands of battling cancer with the rest of your life. Our residential facility, Arbor House, offers patients and families bedrooms, apartments, laundry facilities and a dining room all on the Central Maine Medical Center campus.
Screening for Bile Duct Cancer: Your bile ducts are deep inside your liver and gall bladder so detecting cancer in these areas during a physical exam is very difficult. And so far there are no reliable blood tests or other tests that can help providers discover the disease in its early stages. Usually, bile duct cancer is discovered after tumors have grown large enough to create symptoms. One of the most common is jaundice, a yellowing of the eyes and skin, that’s caused by a blocked duct. Other symptoms of bile duct cancer include:
- Pain in your belly or sides, which can come from fluid buildup
- Nausea and vomiting
- Fever
- Loss of appetite/weight loss
- Weakness
- Itching
- Light-colored stools
- Dark urine
It’s important to note that bile duct cancer is quite rare – only about 8,000 people per year are diagnosed with the disease – so if you’re experiencing any of these symptoms, it’s not likely you have bile duct cancer.
Diagnosis of Bile Duct Cancer: Your provider will use a combination of methods to diagnose your condition, including:
- Physical exam
- Blood tests – blood is drawn from your body with a needle and examined in a lab
- Endoscope ERCP spy glass cholangioscopy
- Ultrasound – a pain-free imaging tool that uses soundwaves
- CT scan – which uses powerful x-rays to make an image of the inside of your abdomen
- MRI – image created by high powered magnets that a radiologist uses to detect tumors
- Endoscopy – endoscope cable with a camera lets your provider see inside your body without surgery or be used to inject dye into bile ducts, which are x-rayed in a test referred to as ERCP (endoscopic retrograde cholangiopancreatography).
- Laparoscopy – once sedated, your provider inserts a thin tube through an incision with a small video camera so they can see if – and how far – the cancer has spread.
Treating Bile Duct Cancer: Bile duct cancer is usually treated with surgery, radiation or some mix of the two. Your cancer care team will develop a treatment plan based on how advanced the cancer is, whether tests indicate it can be surgically removed, how well your liver is functioning, your age and general health condition, and a host of other factors.
Surgery for Bile Duct Cancer: Because bile duct cancer is difficult to detect, it’s usually only discovered after surgery could cure the cancer. If imaging tests or surgeries indicate the cancer has been caught early, a surgeon may be able to remove all the cancer, plus a margin of healthy tissue around it. This is referred to as curative surgery because it usually cures the cancer.
In most other cases, the cancer is too advanced or is in a spot where surgery to completely remove the cancer would be very risky for the patient. In these situations, your provider may consider palliative surgery, which means the procedure is done to relieve symptoms or treat complications, rather than cure the disease. Both curative and palliative surgeries are major operations that can require long recovery times, so you should be sure you’re well informed about the goals of the surgery, its risks and potential side effects.
Palliative endoscopy is often done to unblock a bile duct which can relieve jaundice or itching that is common with bile duct cancer. While it can help the patient feel better, it is not done to eliminate or cure the cancer. In some cases, a surgeon will rely on the best information available – which may come from imaging tests and/or exploratory surgeries like laparoscopy – to plan a curative surgery but realize when the surgery begins that the cancer is too advanced or widespread to be cured. At this point, they may decide to take palliative measures.
Radiation therapy for bile duct cancer isn’t common and providers disagree about how helpful it is. But your provider may decide in your case that its benefits outweigh its costs, which can include side effects like skin redness and blistering, nausea, vomiting, diarrhea and fatigue. There are two main types of radiation therapy for bile duct cancer:
External beam radiation therapy (EBRT) – uses high-energy rays aimed directly at the tumor to kill cancer cells. EBRT is the most commonly used radiation therapy for bile duct cancer
Brachytherapy – is also known as “internal radiation therapy.” A radiologist places small pellets of radioactive material next to or into the tumor. Since the source of the radiation is so close, it affects the cancer without causing much harm to nearby healthy tissue.
RFA Endoscopic Treatment – CMMC offers these treatments at the Cancer Care Center, which has state-of-the-art radiation therapy services, including EBRT and brachytherapy.
Chemotherapy for Bile Duct Cancer: the use of medical drugs to treat cancer. Also known as medical oncology, it involves giving these drugs in the vein (IV) or taking them by mouth. Since they go directly into the bloodstream, they reach all areas of the body. Like radiation therapy, providers may not agree on whether chemotherapy is helpful for bile duct cancer. Still, your provider may decide it is useful for your case. Chemotherapy may be used in one or a combination of several ways to treat bile duct cancer:
- To shrink tumors before surgery to make them smaller and easier to remove
- To lessen the odds that cancer will return after surgery has removed the tumors
- To help people whose cancer can’t be operated on to live longer
- To slow the growth of or reduce the size of tumors that are creating painful symptoms by pressing on nerves.
The Cancer Care Center at Central Maine Medical Center offers our cancer patients who need medical oncologists the services of Hematology-Oncology Associates practice, which is committed to offering the most current, individualized, compassionate and convenient care for cancer patients and their families.