Extrahepatic Bile Duct Cancer
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Description
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What is extrahepatic bile duct cancer?
Extrahepatic bile duct cancer, a rare cancer, is a disease in which cancer
(malignant) cells are found in the tissues of the extrahepatic bile duct. The
bile duct is a tube that connects the liver and the gallbladder to the small
intestine. The part of the bile duct that is outside the liver is called the
extrahepatic bile duct. A fluid called bile, which is made by the liver and
breaks down fats during digestion, is stored in the gallbladder. When food is
being broken down in the intestines, bile is released from the gallbladder
through the bile duct to the first part of the small intestine.
A doctor should be seen if there are any of the following symptoms:
- Yellowing
of the skin (jaundice)
- Pain in the abdomen
- Fever
- Itching
If there are symptoms, a doctor will perform an examination and order tests to
see if there is cancer. A patient may have an ultrasound, a test that uses
sound waves to find tumors. A patient may also have a CT (computed
tomographic) scan, which is a special type of x-ray that uses a computer to
make a picture of the inside of the abdomen. Another special scan called
magnetic resonance imaging (MRI), which uses magnetic waves to make a picture
of the inside of the abdomen, may be done as well.
A doctor may perform a test called an ERCP (endoscopic retrograde
cholangiopancreatography). During this test, a flexible tube is put down the
throat, through the stomach, and into the small intestine. The doctor can see
through the tube and inject dye into the drainage tube (duct) of the pancreas
so that the area can be seen more clearly on an x-ray.
PTC (percutaneous transhepatic cholangiography) is another test that can help
find cancer of the extrahepatic bile duct. During this test, a thin needle is
put into the liver through the right side of the patient. Dye is injected
through the needle into the bile duct in the liver so that blockages can be
seen on x-rays.
If tissue that is not normal is found, the doctor may remove a small amount of
fluid or tissue from the bile duct and look at it under the microscope to see
if there are any cancer cells. This procedure is called a biopsy and is
usually done during the PTC or ERCP.
Because it is sometimes hard to tell whether a patient has cancer or another
disease, surgery may be needed to see if there is cancer of the bile duct. If
this is the case, the doctor will cut into the abdomen and look at the bile
duct and the tissues around it for cancer. If there is cancer and if it looks
like it has not spread to other tissues, the doctor may remove the cancer or
relieve blockages caused by the tumor.
The chance of recovery (prognosis) and choice of treatment depends on the
location of the cancer in the bile duct, the stage of the cancer (whether it is
only in the bile duct or has spread to other places), and the patient’s general
health.
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Stage Explanation
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Stages of extrahepatic bile duct cancer
Once extrahepatic bile duct cancer is found (diagnosed), more tests will be
done to find out if cancer cells have spread to other parts of the body. This
is called staging. To plan treatment, a doctor needs to know the stage of the
cancer. The following stages are used for extrahepatic bile duct cancer:
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Localized
The cancer is only in the area where it began and can be removed in an
operation.
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Unresectable
All of the cancer cannot be removed in an operation. The cancer may have
spread to nearby organs and lymph nodes or to other parts of the body. (Lymph
nodes are small bean-shaped structures that are found throughout the body.
They produce and store infection-fighting cells.)
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Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may come back in the bile duct or in another part of the
body.
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Treatment Option Overview
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How extrahepatic bile duct cancer is treated
There are treatments for all patients with extrahepatic bile duct cancer. Two
kinds of treatment are used:
- Surgery (taking out the cancer or taking steps to relieve symptoms caused
by the cancer)
- Radiation therapy (using high-dose x-rays to kill cancer cells)
Other treatments for extrahepatic bile duct cancer are being studied in
clinical trials. These include:
- Chemotherapy (using drugs to kill cancer cells)
- Biological therapy (using the body’s immune system to fight cancer)
Surgery is a common treatment of extrahepatic bile duct cancer. If the cancer
is small and is only in the bile duct, a doctor may remove the whole bile duct
and make a new duct by connecting the duct openings in the liver to the
intestine. The doctor will also remove lymph nodes and look at them under the
microscope to see if they contain cancer. If the cancer has spread outside the
bile duct, a surgeon may remove the bile duct and the tissues around it.
If the cancer has spread and it cannot be removed, the doctor may do surgery to
relieve symptoms. If the cancer is blocking the small intestine and bile
builds up in the gallbladder, the doctor may do surgery to go around (bypass)
all or part of the small intestine. During this operation, the doctor will cut
the gallbladder or bile duct and sew it to the small intestine. This is called
biliary bypass. Surgery or x-ray procedures may also be done to put in a tube
(catheter) to drain bile that has built up in the area. During these
procedures, the doctor may make the catheter drain through a tube to the
outside of the body or the catheter may go around the blocked area and drain
the bile to the small intestine. In addition, if the cancer is blocking the
flow of food from the stomach, the stomach may be sewn directly to the small
intestine so the patient can continue to eat normally.
Radiation therapy is the use of high-energy x-rays to kill cancer cells and
shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from putting materials that produce radiation
(radioisotopes) through thin plastic tubes into the area where the cancer cells
are found (internal radiation therapy).
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be
taken by pill, or it may be put into the body by inserting a needle into a vein
or muscle. Chemotherapy is called a systemic treatment because the drug enters
the bloodstream, travels through the body, and can kill cancer cells outside
the bile duct.
Biological therapy tries to get the body to fight cancer. It uses materials
made by the body or made in a laboratory to boost, direct, or restore the
body’s natural defenses against disease. Biological therapy is sometimes
called biological response modifier (BRM) therapy or immunotherapy. This
treatment is currently only being given in clinical trials.
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Treatment by stage
Treatment depends on the stage of the disease, and the patient’s age and
overall health.
Standard treatment may be considered because of its effectiveness in patients
in past studies, or participation in a clinical trial may be considered. Not
all patients are cured with standard therapy and some standard treatments may
have more side effects than are desired. For these reasons, clinical trials
are designed to find better ways to treat cancer patients and are based on the
most up-to-date information. Clinical trials are ongoing in some parts of the
country for patients with extrahepatic bile duct cancer. To learn more about
clinical trials, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
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Localized Extrahepatic Bile Duct Cancer
Treatment may be one of the following:
- Surgery to remove the cancer.
- Surgery to remove the cancer followed by external-beam radiation therapy.
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Unresectable Extrahepatic Bile Duct Cancer
Treatment may be one of the following:
- Surgery or other procedures to bypass blockage in the bile duct.
- Surgery or other procedures to bypass blockage in the bile duct followed
by external-beam radiation therapy or internal radiation therapy.
- Clinical trials of radiation therapy with drugs to make the cancer cells
more sensitive to radiation (radiosensitizers).
- Clinical trials of chemotherapy or biological therapy.
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Recurrent Extrahepatic Bile Duct Cancer
Treatment depends on many factors, including where the cancer came back and
what treatment the patient received before. Clinical trials are testing new
treatments.
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Changes to This Summary (06/03/2003)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Editorial changes were made to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
