Cholangiocellular carcinoma

What is bile duct cancer?

Bile duct carcinoma (cholangiocarcinoma) represents a mere 0.7% of all malignant formations. Bile duct cancer is a rare type of cancer ailment.

The bile ducts provide a connection between the liver and the duodenum. The bile ducts run partially through the pancreas. The task of the bile ducts is to transport bile fluids into the small intestine, thereby into the stool. For retention between meals, the gallbladder diverts from the bile ducts. The bile fluids are required to take in fats from food and to remove other heavy, water soluble waste from the body.

Since the bile ducts are very close to other organs, such as the liver, pancreas, and duodenum, surgical resection (removal) is usually hardly possible. An especially difficult to treat (surgically remove) tumor sub-type is the so-called “Klatskin-tumor,” which is very close to the liver and is therefore only possible to resection in 20-25% of cases.

What are the symptoms of bile duct cancer?

Typical symptoms of bile duct cancer (cholangiocarcinoma, CCC) is a painless, yellow-tinge of the sclera (the “whites of the eyes”) and of the skin, in addition to the palpable enlargement of the gallbladder, due to a backlog of bile fluids, resulting in the accumulation of yellow blood pigments (bilirubin) throughout the body.

The painlessness is highly suspicious for a cancer illness (the clinically named “Courvoisier’s sign”). Further symptoms, which can result from a gallbladder build-up include light-colored stool, dark urine and itchiness. In addition, most patients suffer from weight loss, loss of appetite, and fatigue. Late signs of a tumor can include vomiting or fluid retention in the abdomen (ascites). Blood test results can lead to unspecific lab results.

How is the diagnose of bile duct cancer confirmed?

In order to confirm the diagnosis, in addition to a physical examination and a thorough check into one’s medical history, various technical tools are available. An ultrasound examination can provide a good overview of the size of the cholestasis and to detect possible liver metastases.

With help of an ERCP (endoscopic retrograde cholangiopancreaticography), the gall passages can be examined internally. This procedure is comparable to a gastroscopy, during which the patient is lightly sedated. Here, tissue biopsies and possible tumor formations can be removed. In computed tomography (CT) and magnetic resonance tomography (MRT) the relationship of the tumor to the surrounding organs can be visualized and help in planning the exact therapy.

What does the treatment of cholangiocarcinoma look like?

The healing of cholangiocarcinoma can only occur with help of a complete surgical removal. The surgical technique used depends on the location of tumor. Depending on the location, it can be necessary to remove sections of the duodenum, the stomach, and the pancreas. This occurs with “partial pancreatoduodenectomy,” referred to as a “Whipple” procedure.

The closer a tumor is to the liver, the more difficult a complete resection becomes. By advanced metastasis or difficult to reach tumor tissue, a palliative resection should be discussed. Through a palliative resection, the complete tumor tissue isn’t removed, but to relieve the symptoms of cholestasis, diversions are made to allow the bile fluids to outlet. This occurs by biliodigestive anastomosis (diversion of the bile ducts into the small intestine). Here, there are various surgical techniques. For concrete questions, you can confidently refer to one of our specialists.

Radiation therapy can help alleviate the illness by reducing tumors that narrow the bile ducts.

What is the survival probability by bile duct cancer?

A 5-year survival rate with tumors located near the liver is approximately 5%, and 25-35% by tumors further from the liver. The life expectancy isn’t typically improved by additional chemotherapy or radiation therapy.