Types of operation
The surgery you have depends on the stage of your cancer and where it is growing in the bile ducts.
The tests you had to diagnose your cancer help your surgeon to decide which operation you need. Your surgeon might suggest:
- surgery to remove the cancer completely
- surgery to relieve symptoms (palliative surgery)
Removing bile duct cancer completely
Surgery to remove bile duct cancer is a major operation. Only surgeons with specialist knowledge and experience should do this type of operation. To check whether it is possible for you to have this surgery your surgeon will look at the stage of your cancer. This includes:
- the position of the cancer in the bile ducts
- whether the cancer has grown into tissues around the bile ducts
- whether there are cancer cells in the nearby lymph nodes
- whether the cancer has grown into any of the blood vessels nearby
The tests that you had to diagnose and stage your cancer will answer most of these questions. Scans can show the size and position of the cancer, and whether it has spread to other parts of the body. Sometimes it is not possible to tell if the cancer has spread into blood vessels and lymph nodes until you have the operation.
The type of operation depends on which bile ducts the cancer is growing in.
Cancers in the bile ducts near the pancreas and small bowel (distal bile duct cancer)
They might also remove part of your pancreas and small bowel. Then they will have to rejoin the remaining bile ducts to your bowel. And they might need to remove and rebuild parts of the major blood vessels which supply the liver.
Cancers in the bile ducts in the liver (intrahepatic bile duct cancer)
Your doctor will remove part of your liver (hepatectomy). Usually the doctor needs to remove the whole lobe of the liver (lobectomy). The liver has two main lobes.
Cancers growing where the right and left hepatic ducts join together, just outside the liver, (perihilar bile duct cancer)
Your surgeon will remove:
- part of your liver and the bile ducts
- your gallbladder
- lymph nodes close to the bile ducts
Your surgeon will remove the bile ducts, part of your pancreas and part of your small bowel. They call this a pancreaticoduodenectomy (pank-ree-at-ic-oh dew-oh-den-ek-tom-ee)
Surgery to relieve symptoms (palliative)
When a cancer is blocking the bile duct it usually causes yellowing of your skin (jaundice). To relieve this blockage your doctor usually puts a small tube (stent) into the bile duct. They put the stent in during an endoscopy.
Rarely, it is not possible to insert a stent. You might then have surgery to relieve the jaundice and symptoms, such as itching. Doctors call this bypass surgery. Bypass surgery involves cutting the bile duct just above the tumour and rejoining it to the bowel.