Bile Duct Cancer
Cancer of the bile ducts is uncommon but like all tumors in and around the gallbladder, pancreas and liver, it is a very serious disease. It is thought to be associated with gallstones in nearly two thirds of patients, but it can also be associated with other benign conditions such as Caroli's disease, ulcerative colitis, and certain cysts of the bile duct. The tumors tend to be adenocarcinomas and are thus similar to other solid tumors of the pancreas and gallbladder.
Clinically, they present much as tumors of the pancreas. In other words, they are associated with the development of painless jaundice. Occasionally, patients can present with fever and chills if the obstructed bile has become infected, although this is unusual.
Bile Duct Cancer – Diagnostic Testing
The diagnosis is made by diagnostic tests such as ultrasound, CT scan, MRI or MRCP, or ERCP.
Computed Tomography (CT) is a radiographic procedure used for diagnosis. X-rays are taken from a series of different angles and assembled to show a cross- sectional view of internal organs.
Magnetic Resonance Imaging (MRI) is a special test that produces very clear, detailed pictures of the organs and structures in the body.
Magnetic Resonance Cholangiopancreatography (MRCP) is a non-invasive test in which contrast is administered intravenously and the bile duct and pancreatic duct are visualized. It is similar to an ERCP, but without the necessity of having an endoscope inserted into the mouth and stomach.
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a way to examine your pancreas, pancreatic duct, common bile duct, and/or sphincter of Oddi. The procedure involves the placement of an endoscope through the mouth to the entry point of the bile duct into the duodenum. A small catheter is then inserted and contrast material is injected. X-rays are taken to delineate any blockage. At the same time, a plastic stent can be inserted to relieve the obstruction and allow the bile to drain into the intestine. Alternatively, X-rays can provide important information about the extent of the disease and the presence or absence of metastases.
Treatment of the tumor depends on where in the bile duct it is located. They can occur in the upper, middle or lower third of the bile duct. Tumors in the upper third, at the point where the left and right bile ducts emerge from the liver and join to form the common hepatic duct, are referred to as Klatskin tumors. Although these lesions can be resected and the bile duct reconstructed, it is rarely a curative procedure. They also have a tendency to be slow growing, however, and survival of several years can occur.
Tumors in the middle third can be resected and reconstructed with a loop of small bowel.
If the tumor is at or near the end of the bile duct at the point where it joins with the pancreatic duct and enters the duodenum, a Whipple procedure (radical pancreaticoduodenectomy) is the best operation.
Tumors that originate in the middle or lower thirds of the bile duct typically have a better overall survival.