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Extrahepatic Bile Duct Cancer
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of extrahepatic bile duct cancer.
Extrahepatic Bile Duct Cancer
General Information About Extrahepatic Bile Duct Cancer
Extrahepatic bile duct cancer is a rare disease in which malignant
(cancer) cells form in the part of bile duct that is outside the liver.
A network of bile ducts (tubes) connects the liver and the gallbladder to the small intestine . This network begins in the liver where many small ducts collect bile , a fluid made by the liver to break down fats during digestion . The small ducts come together to form the right and left hepatic bile ducts, which lead out of the liver. The two ducts join outside the liver to become the common hepatic duct. The part of the common hepatic duct that is outside the liver is called the extrahepatic bile duct . The extrahepatic bile duct is joined by a duct from the gallbladder (which stores bile) to form the common bile duct . Bile is released from the gallbladder through the common bile duct into the
small intestine when food is being digested.
Having colitis or certain liver diseases can increase the risk of developing
extrahepatic bile duct cancer.
Anything that increases your risk of getting a disease is called a risk factor . Risk factors include having any of the following
disorders :
Possible signs of extrahepatic bile duct cancer include
jaundice and pain.
These and other symptoms may be caused by extrahepatic bile duct
cancer or by other conditions. A doctor should be consulted if any of the
following problems occur:
Tests that examine the bile duct and liver are used to detect
(find) and diagnose extrahepatic bile duct cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Ultrasound : A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram .
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiral or helical CT scan makes
detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- ERCP (endoscopic
retrograde cholangiopancreatography): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope is passed through the mouth, esophagus , and stomach into the first part of the small intestine. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A catheter (a smaller tube) is then inserted through the endoscope into the pancreatic ducts . A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor , a fine tube may be inserted into the duct to unblock it. This tube (or stent ) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer.
- PTC (percutaneous
transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.
- Biopsy : The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The sample may be taken using a fine needle inserted into the duct
during an x-ray or ultrasound. This
is called needle biopsy or
fine-needle aspiration biopsy . The biopsy
is usually done during PTC or ERCP. Tissue may also be removed during
surgery .
- Liver function tests : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by extrahepatic bile duct cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (whether it affects only the bile duct or has spread to
other places in the body).
- Whether the tumor can be completely removed by surgery.
- Whether the tumor is in the upper or lower part of the duct.
- Whether the cancer has just been diagnosed or has recurred (come back).
Treatment options may also depend on the symptoms caused by the tumor. Extrahepatic bile duct cancer is usually found after it has spread and can rarely be removed completely by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life .
Stages of Extrahepatic Bile Duct Cancer
After extrahepatic bile duct cancer has been diagnosed, tests
are done to find out if cancer cells have spread within the bile duct or to
other parts of the body.
The process used to find out if cancer has spread within the extrahepatic bile
duct or to other parts of the body is called staging . The information gathered from the staging
process determines the stage of the
disease. It is important to know the stage in order to plan treatment.
Extrahepatic bile duct cancer is usually staged following a laparotomy . A surgical incision is made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope. The results of the diagnostic imaging tests , laparotomy, and biopsy are viewed together to determine the stage of the cancer.
Sometimes, a laparoscopy will be done before the laparotomy to see if the cancer has spread. If the cancer has spread and cannot be removed by surgery , the surgeon may decide not to do a laparotomy.
The following stages are used for extrahepatic bile duct cancer:
Stage 0 (Carcinoma in Situ)
In stage 0 , cancer is found only in the innermost layer of cells lining the extrahepatic bile duct . Stage 0 cancer is also called carcinoma in situ .
Stage I
Stage I is divided into
stage IA and
stage IB.
Stage II
Stage II is divided into
stage IIA and
stage IIB.
Stage III
In stage III , cancer has spread:
Cancer may have spread to nearby lymph nodes also.
Stage IV
In stage IV , cancer has spread to lymph nodes and/or organs far away from the extrahepatic bile duct .
Extrahepatic bile duct
cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:
Localized (and resectable)
The cancer is in an area where it can be removed completely by surgery.
Unresectable
The cancer cannot be removed completely by surgery . The cancer
may have spread to nearby blood vessels , the liver , the common bile duct , nearby lymph nodes , or other parts of the abdominal cavity .
Recurrent Extrahepatic Bile Duct Cancer
Recurrent extrahepatic bile duct cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in the bile
duct or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with
extrahepatic bile duct cancer.
Different types of treatment are available for patients with
extrahepatic bile duct cancer . Some treatments are standard (the currently used
treatment), and some are being tested in clinical
trials . Before starting treatment, patients may want to think
about taking part in a clinical trial. A treatment clinical trial is a research
study meant to help improve current treatments or obtain information on new
treatments for patients with cancer. When clinical trials show that a new
treatment is better than the standard
treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Two types of standard treatment are used:
Surgery
The following types of surgery are used to treat extrahepatic bile duct
cancer:
- Removal of the bile
duct : If the tumor is small and only in the bile duct, the
entire bile duct may be removed. A new duct is made by connecting the duct
openings in the liver to the intestine . Lymph nodes are removed and viewed
under a microscope to see if they contain cancer.
- Partial hepatectomy : Removal of the part of the liver
where cancer is found. The part removed may be a wedge of tissue , an entire
lobe , or a larger part of the liver, along with some normal tissue around it.
- Whipple
procedure : A surgical procedure in which the head of the pancreas , the gallbladder , part of the
stomach , part of the small
intestine , and the bile duct are removed. Enough of the pancreas is left to
make digestive juices and
insulin .
- Surgical biliary bypass : If the tumor cannot be removed but is
blocking the small intestine and causing bile to build up in the gallbladder, a biliary
bypass may be done. During this operation, the gallbladder
or bile duct will be cut and sewn to the small intestine to create a new pathway around
the blocked area. This procedure helps to relieve jaundice caused by the
build-up of bile.
- Stent placement: If the tumor is blocking the bile duct, a
stent (a thin tube) may be placed in the duct to drain bile that has built up
in the area. The stent may drain to the outside of the body or it may go around
the blocked area and drain the bile into the small intestine. The doctor may
place the stent during surgery or PTC , or with an endoscope .
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from dividing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
New types of treatment are being tested in clinical trials.
These include the following:
Radiation sensitizers
Clinical trials are studying ways to improve the effect of
radiation therapy on tumor cells, including the following:
- Hyperthermia therapy : A treatment in which body tissue is exposed
to high temperatures to damage and kill cancer cells or to make cancer cells
more sensitive to the effects of radiation therapy and certain anticancer
drugs .
- Radiosensitizers : Drugs that make tumor cells more
sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more
tumor cells.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the spinal column , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Treatment Options for Extrahepatic Bile Duct Cancer
Localized Extrahepatic Bile Duct Cancer
Treatment of localized extrahepatic bile duct cancer may include
the following:
Unresectable Extrahepatic Bile Duct Cancer
Treatment of unresectable extrahepatic bile duct cancer may include
the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Recurrent Extrahepatic Bile Duct
Cancer
Treatment of recurrent extrahepatic bile duct cancer
may include the following:
Information about ongoing clinical trials is available from the
NCI Web site.
Changes to This Summary (02/26/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
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PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
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Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
2007-02-26
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