The liver creates a digestive juice called bile and stores it in the gall bladder. While eating, the gall bladder forces the bile through a tubegall bladder called the bile duct. Bile duct cancer or cholangiocarcinoma is a unique type of cancer that affects this tube that joins the liver and the gall bladder to the small intestine.
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In the bile duct, the appearance of cancer inside the liver is termed as intrahepatic cholangiocarcinoma and the appearance of cancer outside the liver is termed as extrahepatic cholangiocarcinoma, which is also more common.
Types of treatments
There are three standard treatment methods for bile duct cancer: surgery, radiation therapy, and chemotherapy.
The surgical process destroys the maximum number of cancer cells from the body. The following are the surgical methods available as treatment for bile duct cancer.
- Removing the bile duct: If the cancer cell is small and if it is found only in the bile duct, then removal of the bile duct by surgery can be done. The presence of cancer is identified using a microscope, and the lymph nodes and cancer cells from lymph nodes that are taken out are viewed.
- Whipple procedure: In this surgical method, the gall bladder, head of pancreas, a part of the small intestine, bile duct, and a part of stomach are removed. The function of the pancreas is to produce insulin and adequate digestive juices, hence they are retained.
- Partial hepatectomy: In this kind of treatment, the cancer in a part of the liver is removed. The removed part may be a piece of cancer cell or a part of the big liver; a complete lobe along with some surrounding normal cells can also be removed.
Although the surgeon destroys all the identified cancer cells during operation, a few patients are advised chemotherapy and radiation therapy after the surgery process to remove any remaining cancer cells in the tissues.
Radiation therapy is a type of cancer treatment that uses rays with high energy to remove the cancer cells. To treat bile duct cancer, radiation therapy may be utilized in various ways.
- External beam radiation therapy (EBRT): To destroy the cancer cells completely, this type of radiation therapy utilizes an x-ray machine kept outside the patient’s body. Measurements are taken carefully by the radiation team in order to determine the angles accurately.
- Three-dimensional conformal radiation therapy (3D-CRT): Here, specific computers are made use of to exactly map the tumor locations, so that from various directions the radiation beam can focus on the cancer cells. In this procedure, the damage to normal cells is reduced.
- Intensity-modulated radiation therapy (IMRT): This is an advanced type of 3D therapy. Computer-driven machines are used, which can be moved around to deliver radiation.
- Stereotactic body radiotherapy (SBRT): The SBRT technique utilizes the process of IMRT and 3D-CRT where it delivers the radiation in short time periods.
- Internal radiation therapy (branchytherapy): Internal radiation therapy is an important type of therapy that targets the cancer cells inside the liver and delivers giving high-dose radiation. Sometimes, branchytherapy is performed by placing the pellets over a tube.
In chemotherapy treatment, drugs are utilized to remove the cancer cells. In this treatment anticancer drugs are taken by mouth or induced in the vein. The administering of drugs for cancer that has developed throughout the body is called systemic treatment.
Chemotherapy treatment can be useful to people affected by bile duct cancer, although this treatment method is found to be insufficient for this cancer type. Often, for patients in a very bad health condition, chemotherapy is not recommended.
Hepatic artery infusion (HAI): For the bile duct cancer affected patient, when giving of chemotherapy treatment through the vein is not helpful, the drug is directly injected into the liver through the main artery using a pump placed in the liver. HAI can be used in combination with other drugs.
New types of treatments
Many new types of treatments are under the process of testing and examination in clinics. Some of them are given below.
- Liver transplant: In this method, the liver is completely removed and it is replaced by a donated healthy liver. In patients affected by perihilar bile duct cancers, liver transplant can be performed.
For a few patients, a liver transplant may be a good choice. In the process of cancer research, clinical trials are considered as very essential elements. The motive of these trials is to find new treatments for cancer that are effective and safe, or better that the normally followed treatment methods.
Cancer affected patients can participate in clinical trials while undergoing cancer treatment; this may be before, after, or during the period of their treatment procedures.
Reviewed by Afsaneh Khetrapal BSc (Hons)