Bile duct cancers are also known as cholangiocarcinomas are a rare but
aggressive type of cancer affecting the bile ducts. The bile ducts are
thin tubes that connect the liver to the small intestine facilitating
the transit of bile from the liver.
The common symptom of bile duct cancer is unexplained
painless progressive jaundice. This usually happens because cancer
blocks the bile duct and hence the bile is not able to come into the
small intestine and as a result spreads into the blood circulation
causing jaundice. Some patients may also develop fever due to do an
infection called cholangitis.
This jaundice may be associated with itching all over the body, deeply
yellow urine, and clay-colored stools.
The first test is usually a liver profile which will reveal a high direct
bilirubin level with the rise and alkaline phosphatase levels. An
ultrasound of the abdomen will show dilated intrahepatic bile duct
radicals with an abrupt cutoff at the level of the tumor.
An MRCP of the abdomen would be the best imaging to diagnose a
cholangiocarcinoma. A tumor marker called CA 19-9 is useful in assessing
the severity of cancer. Often, a CT scan of the abdomen is also
performed in order to closely look at the blood vessels going towards
the liver to map out the involvement and thus plan for the surgery.
If the jaundice is high, your surgeon may advise biliary drainage prior
to surgery. This could be either via the Trans hepatic route called a
PTBD or by the endoscopic route via ERCP.
When jaundice reduces by drainage based on the extent of the tumor and
the involvement of the blood vessels of the liver (hepatic artery
branches and portal vein), your surgeon will plan an appropriate
surgery.
Some bile duct cancers will only require a bile duct resection along with
complete removal of all portal lymph nodes. Many other bile duct cancers
which track along the right or the left bile duct will require more
extensive surgery in the form of right or left hepatectomy with the
removal of the bile duct and the portal nodes. Often the caudate lobe of
the liver also has to be removed. The reconstruction is in the form of a
loop of the intestine is joined to the remnant bile duct called a
hepaticojejunostomy.
Those patients in which bile duct cancers have already spread to other
parts of the liver or distant parts of the body would not be able to
undergo radical surgery. Palliation in these patients would be in the
form of metal stents and chemotherapy or radiation.