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Cholangiocarcinoma

Bile duct cancer

 

Cholangiocarcinoma (CCA) is a rare cancerous (malignant) growth in one of the ducts that carries bile from the liver to the small intestine.

Causes

 

Bile duct cancers are slow-growing. They don't spread (metastasize) quickly. The exact cause of CCA isn't known. However, many of these tumors are already quite advanced by the time they are found.

CCA may start anywhere along the bile ducts. These tumors block off the bile ducts.

Both men and women are affected. Most people are older than 65.

People with the following health problems may have a higher chance of developing CCA:

  • Bile duct (choledochal) cysts
  • Chronic biliary and liver inflammation
  • History of infection with parasitic worms, liver flukes
  • Primary sclerosing cholangitis
  • Ulcerative colitis

 

Symptoms

 

Symptoms of CCA may include any of the following:

  • Fever  and chills
  • Clay-colored stools and dark urine
  • Itching
  • Loss of appetite
  • Pain in the upper right abdomen that may radiate to the back
  • Weight loss
  • Yellowing of the skin ( jaundice )

 

Exams and Tests

 

Your health care provider will perform a physical exam. Tests will be done to check for a tumor or blockage in the bile duct. These may include:

  • Abdominal CT scan
  • Abdominal ultrasound
  • X-ray of the bile ducts ( PTCA )
  • Procedure that uses a viewing scope to look at the bile ducts ( ERCP ), during which  tissue may be taken and looked at under a microscope

Blood tests that may be done include:

  • Liver function tests (especially alkaline phosphatase or bilirubin levels)
  • Complete blood count (CBC)

 

Treatment

 

The goal is to treat the cancer and the blockage it causes. When possible, surgery to remove the tumor is the treatment of choice and may result in a cure. If the tumor is large, the entire liver may need to be removed and a liver transplant will be needed. Often the cancer has already spread locally or to another area of the body by the time it is diagnosed. As a result, surgery to cure the cancer is not possible.

Chemotherapy or radiation may be given after surgery to decrease the risk of the cancer returning. But the benefit of this treatment is not certain.

Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts. This may also relieve jaundice when the tumor cannot be removed. Laser therapy combined with light-activated chemotherapy medicines is another treatment option for blocked bile duct.

 

Support Groups

 

You can ease the stress of illness by joining a support group with members who share common experiences and problems.

Hospice is often a good resource for people with CCA that cannot be cured.

 

Outlook (Prognosis)

 

Completely removing the tumor allows some people to survive with the possibility of complete cure.

If the tumor cannot be completely removed, a cure is generally not possible. With treatment, about one half of affected people live a year, and about one half live longer, but rarely beyond 5 years.

 

Possible Complications

 

Complications of CCA include:

  • Infection
  • Liver failure
  • Spread ( metastasis ) of tumor to other organs

 

When to Contact a Medical Professional

 

Call your provider if you have jaundice or other symptoms of cholangiocarcinoma.

 

 

Open References

References

Blechacz B, Gores GJ. Tumors of the bile ducts, gallbladder, and ampulla. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 69.

National Cancer Institute. PDQ bile duct cancer treatment. Updated December 9, 2015. www.cancer.gov/types/liver/hp/bile-duct-treatment-pdq . Accessed July 8, 2016.

Zani S, Pappas TN. Management of cholangiocarcinoma. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy . 11th ed. Philadelphia, PA: Elsevier Saunders; 2014:414-419.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Bile pathway

    Bile pathway - illustration

    The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

    Bile pathway

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Bile pathway

      Bile pathway - illustration

      The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

      Bile pathway

      illustration

    Tests for Cholangiocarcinoma

     
       

      Review Date: 5/20/2016

      Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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