What is advanced bile duct cancer?

Advanced bile duct cancer is cancer that has spread outside the bile ducts into lymph nodes or organs near the bile duct. Or that has spread to another part of the body such as the lungs. This is called secondary or metastatic bile duct cancer.

Unfortunately, most people with bile duct cancer already have advanced cancer when they are diagnosed. This is because bile duct cancer usually doesn’t cause symptoms early on. And when it does cause symptoms, they can be vague and difficult to spot.

Advanced cancer can be divided into either:

• locally advanced bile duct cancer
• bile duct cancer that has spread elsewhere in the body, such as the lungs

Locally advanced bile duct cancer

Locally advanced bile duct cancer means that the cancer has spread into lymph nodes or organs near the bile duct. Bile duct cancers tend to spread locally along the bile duct.

A locally advanced bile duct cancer might have grown into the:

• liver
• small bowel
• pancreas
• nearby major blood vessels

This can mean that surgery is not an option. Doctors call this unresectable cancer.

The tests you had to stage your cancer shows whether surgery might be possible or not. Surgery for bile duct cancer is a major operation. Your surgeon makes sure that you are fit enough to have the operation.

Bile duct cancer that has spread elsewhere

Doctors call cancer that has spread to another part of the body secondary or metastatic cancer. It means that the cancer has spread through the bloodstream or lymphatic system to organs further away.

The most common places for bile duct cancer to spread are the:

• lungs
• bones
• lining of the abdomen (peritoneum)
• brain

Treatment options for advanced bile duct cancer

It can be difficult to decide which treatment to have or whether to have treatment at all when you have advanced cancer.

Having treatment can affect your quality of life. It’s important to understand what the aim of treatment is and what the side effects are. It's also important to think about other factors such as the time that you’ll spend in hospital or travelling to the hospital.

Your doctor and specialist nurse will be able to talk this through with you and answer any questions you have. You might find it helpful to talk things over with a close relative or friend. Or there may be a counsellor at the hospital you can talk to.

Types of treatment

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

You might be able to have surgery if you have locally advanced bile duct cancer. Your doctor will explain what type of surgery you need. You can’t usually have surgery to try to cure your cancer, if you have advanced bile duct cancer. But you can have other treatments to shrink or slow down its growth. This helps to control any symptoms you might have and help you feel better.

The best treatment for you depends on:

• where the cancer has spread to
• the size and number of any secondary cancers
• your general health
• any treatment you have already had
• your symptoms
• your wishes

Your doctor might suggest one or more of the following treatments.  ​​​​

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.

You may have one chemotherapy drug or a combination of drugs to treat advanced bile duct cancer. A common combination of chemotherapy drugs is gemcitabine and cisplatin. 

Radiotherapy

Radiotherapy uses high energy x-rays to treat cancer cells. You may have radiotherapy to an area of secondary cancer in your body such as the bone. This can help to control the pain.

Targeted cancer drugs

Your doctor might suggest a targeted cancer drug called pemigatinib. Pemigatinib is a type of targeted cancer drug called a cancer growth blocker. 

Immunotherapy

You might have gemcitabine and cisplatin chemotherapy with an immunotherapy drug called durvalumab (Imfinzi). Immunotherapy uses the immune system to attack cancer cells.

Medicines to control symptoms of advanced bile duct cancer

Bile duct cancer can block the bile ducts which causes yellowing of the skin and white of the eyes (jaundice). Your doctor usually puts in a small tube called a stent to relieve the blockage. You can also have other medicines to help relieve symptoms, such as painkillers and anti sickness medicines.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Coping with advanced bile duct cancer

Finding out that you have advanced bile duct cancer, or that your cancer has come back, can be devastating. You may feel shocked and confused, and find it difficult to take in anything that is being said to you. There is support available to help you cope with emotional, practical and physical issues when you have advanced cancer.