Types of treatment for bile duct cancer
This page tells you about the main treatments for bile duct cancer (cholangiocarcinoma). You can find the following information
Choosing the right treatment for you
The type of treatment you need for bile duct cancer (cholangiocarcinoma) depends on the stage of your cancer, where in the bile duct it started, and on your general health. Many people with bile duct cancer have an advanced cancer at diagnosis. Then, the aim of treatment is usually to control the cancer and relieve symptoms rather than cure it.
The main treatments
The main treatment is surgery. You may have other treatments to help to relieve symptoms.
If it is possible to remove your cancer and you are fit enough to cope with a major operation, your surgeon will suggest surgery. If your surgeon can’t remove your cancer, you will have treatments to help to relieve symptoms.
Jaundice is a common symptom of bile duct cancer, and can make you feel very ill. Your doctor can put in a small tube (stent) to relieve jaundice. You have this by endoscopy. If this is not possible your surgeon may suggest surgery to go round a blockage in your bowel and keep your digestive system working.
Radiotherapy and chemotherapy
Radiotherapy uses high energy rays to kill cancer cells. Chemotherapy uses anti cancer (cytotoxic) drugs to damage and kill cancer cells.
You may have radiotherapy on its own. Or if results after surgery showed cancer cells in the tissue around the tumour, you may have radiotherapy with chemotherapy to lower the risk of the cancer coming back. Research is looking into how well radiotherapy and chemotherapy can help to lower the risk of bile duct cancer coming back after surgery.
If you can’t have surgery, you may have radiotherapy or chemotherapy to help slow the growth of your cancer and relieve symptoms.
You can view and print the quick guides for all the pages in the treating bile duct cancer section.
If you cannot have surgery, you may have radiotherapy and chemotherapy to relieve symptoms.
The type of treatment you might have depends on
- Where in the bile duct the cancer started
- The stage of your cancer
- Your general health and level of fitness
The stage of your cancer means how advanced it is and how far it has spread. Bile duct cancer can be difficult to treat. Unfortunately, many of these cancers are diagnosed when they are quite advanced and not curable. As with most types of cancer, the earlier the cancer is diagnosed, the easier it is to get it under control and possibly cure it.
Your general health and fitness are important because an operation to remove bile duct cancer is major surgery. You need to be fit enough to make a good recovery afterwards. Age is one factor in fitness, but obviously this varies a lot between people. Your doctor will not base treatment decisions only on your age.
Doctors use surgery for the following reasons
If you have an early stage cancer, surgery is the main treatment. Any surgery to remove bile duct cancer is a major operation. It is often complicated and needs specialist surgeons. The type of surgery you need depends on the position of the cancer in the bile duct.
Intrahepatic bile duct cancers start in the liver. If surgery is possible, your doctor will remove part of your liver. They call this operation a hepatectomy. Occasionally the doctor needs to remove a lobe of the liver with the bile ducts. Removing a lobe of the liver is called a lobectomy. The liver tissue will grow again and work normally after this operation.
Perihilar bile duct cancers start where the right and left hepatic ducts join, just outside the liver. Surgery for these cancers is more difficult. Your surgeon will remove part of your liver and the bile ducts. And they will need to remove your gallbladder, nearby lymph nodes, and sometimes part of your pancreas and small bowel. Your surgeon then has to rejoin the remaining bile ducts to your bowel. This is a major operation and can have serious complications.
Distal bile duct cancers start in the bile ducts near the pancreas and small bowel. Your surgeon will remove the bile ducts, part of your pancreas, and part of your small bowel. This is called a pancreaticoduodenectomy (pank-ree-at-ic-oh dew-oh-den-ek-tom-ee) or Whipple procedure. This is also a major operation and can have serious complications.
Many people have advanced cancer when they are diagnosed. Then it is not possible to have an operation to remove the cancer. But surgery can relieve symptoms.
The most common symptom of advanced bile duct cancer is jaundice. Jaundice means your skin and the whites of your eyes turn yellow. It happens because your bile duct has blocked and bile can’t drain into the bowel as it normally would.
If you have jaundice your doctor usually puts a small tube, called a stent, into your bile duct. The stent opens up the bile duct and relieves the jaundice by allowing bile to drain. Your doctor usually does this during an endoscopy or by percutaneous transhepatic cholangiography (PTC). PTC is when your doctor puts a small needle put through your skin into the bile ducts.
Rarely, it isn’t possible to put a stent in. Then you may need an operation to bypass the blockage. During the operation, your surgeon cuts the bile duct above the blockage and rejoins the bile duct or gallbladder to the small bowel. If your surgeon feels that you are also at risk of blocking the small bowel at the time of surgery, they may take a part of the small bowel beyond the area that is at risk of blockage, and attach it directly to the stomach. This is then called a double bypass operation.
There is detailed information about surgery in our surgery for bile duct cancer section.
Radiotherapy uses high energy rays to kill cancer cells. You may have radiotherapy on its own. Or you may have it after surgery, with chemotherapy, to try to reduce the chance of the cancer coming back. If your surgeon finds cancer cells in the tissue around the tumour, radiotherapy may lower the risk of the cancer coming back.
If you can’t have surgery, you may have radiotherapy to relieve symptoms and slow the growth of the cancer. The radiotherapy may be external or internal. Internal radiotherapy is also called brachytherapy (brak-ee-ther-ap-ee).
There is detailed information about radiotherapy and its side effects in our section about radiotherapy for bile duct cancer.
Chemotherapy uses anti cancer (cytotoxic) drugs to damage and kill cancer cells. After surgery to remove the cancer, you may have chemotherapy with radiotherapy to help reduce the chance of the cancer coming back. Research is looking into how well this works.
If you cannot have surgery you may have chemotherapy to help control the growth of your cancer and relieve any symptoms.
In this section we have detailed information about chemotherapy for bile duct cancer, the drugs used, and their side effects.
If your cancer has already spread to another part of your body, using surgery to remove the tumour in your bile duct will not cure your cancer. Your doctor may suggest chemotherapy and radiotherapy.
A multidisciplinary team (MDT) will look after you. The team is made up of various health professionals who work together to plan your treatment and care. The team includes
- Surgeons who specialise in liver and bile duct cancers (hepatobiliary surgeon)
- Doctors who specialise in chemotherapy and radiotherapy (oncologists)
- Specialist nurses
- Other health professionals.
The team will talk to you about possible treatments you could have and how they may affect you. It is important to take time to think about these.
If you have advanced cancer, the MDT may include doctors and nurses who specialise in treatments to control symptoms (palliative care specialists).
Some people feel they would like to get an opinion from a second doctor before they decide about their treatment. If you would like a second opinion, you can ask your specialist or your GP to refer you to a doctor specialising in liver and bile duct cancers. It can be better to arrange a second opinion through your specialist because they can send all your notes and test results with you.
Do remember that a second opinion does not necessarily mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.
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