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’s possible for you to have this surgery your surgeon looks 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
- whether the cancer has spread to other parts of the body
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’s not clear if the cancer has spread into blood vessels and lymph nodes until you have the operation.
The type of operation you have depends on which bile duct the cancer is growing in.
Cancers in the bile ducts in the liver (intrahepatic bile duct cancer)
Your doctor removes part of your liver (hepatectomy). Usually the doctor needs to remove the whole lobe of the liver (lobectomy). The liver has two main lobes.
They might also remove the nearby lymph nodes.
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
They might also remove part of your pancreas and small bowel.
Then they rejoin the remaining bile ducts to your bowel. They might also need to remove and rebuild parts of the major blood vessels which supply the liver.
Cancers in the bile ducts near the pancreas and small bowel (distal bile duct cancer)
Your surgeon removes the bile ducts and nearby lymph nodes. They also remove part of your pancreas and small bowel. They call this a pancreaticoduodenectomy (pronounced pank-ree-at-ic-oh dew-oh-den-ek-tom-ee)
Surgery to relieve symptoms (palliative surgery)
When a cancer is blocking the bile duct it can cause yellowing of your skin (jaundice). To relieve this blockage your doctor usually puts a small tube (stent) into the bile duct.
Very rarely, if it hasn’t been possible to put in a stent, you might have an operation to relieve the jaundice. Doctors call this bypass surgery. This involves cutting the bile duct just above the tumour and rejoining it to the bowel.