What Are the Treatments for Bile Duct Cancer?

The bile duct is a part of the digestive track. It is small, skinny tube which is between four and five inches long. The bile duct connects the small intestine and liver, and bile (a fluid the body produces to aid in digestion) moves from liver and gallbladder, through the bile duct, to the small intestine. There are three main types of bile duct cancers: intrahepatic, which refers to cancers that develop in small branches of the bile duct which extend into the liver; hilar, which develop in the ducts that exist just outside the liver; and distal bile duct cancers, which develop close to the small intestine.

Treatment

• Treatment for bile duct cancer depends on the staging of the cancer, the location of the tumor extent of the spread, and the patients general health. Treatment options include surgery, radiation, chemotherapy and palliative care (pain/symptom management).

Surgery

• There are two major types of surgery performed for bile duct cancer. The appropriate surgery may be designed either to cure the cancer, or to manage and alleviate symptoms associated with the cancer. The appropriate surgical procedure depends upon whether the cancer has spread. Surgery designed to cure bile duct cancer should be performed when medical tests demonstrate the cancer is small enough and/or localized enough to be entirely removed by surgery. Because bile duct cancer is often not diagnosed until it is relatively advanced, often it is not possible to remove all the cancer with surgery. If it is not possible to remove and cure the cancer, palliative surgery can be performed to minimize symptoms associated with the cancer. The recovery process from bile duct surgery is slow and extensive, so patients should carefully consider whether they want to undergo surgery if the surgery is unlikely to cure the cancer.

Radiation

• Radiation therapy administered after curative surgery is called adjuvant therapy, and is designed to kill any remaining cancer cells. Radiation is often combined with a specific chemotherapy drug, called 5-flourouracil, which helps the radiation to kill cancer cells.

  In some cases, radiation is actually administered during the surgery. This procedure, called intra-operative radiation therapy, is recommended for some patients with bile duct cancer, because the doctor is able to administer the radiation directly to the bile duct by moving healthy organs out of the way. As of 2009, this procedure is experimental and is not available at all cancer treatment centers.

  For certain patients, the radiation is administered prior to the surgery. This is called neoadjuvant therapy, and it is designed to make cancers small enough to be removable by surgery.

Chemotherapy

• Chemotherapy may be used in conjunction with radiation and/or surgery to kill cancer cells, or it may be used to slow the spread of cancer. The chemotherapy agents used in the treatment of bile duct cancer include 5-fluorouracil, capecitabine, cisplatin, doxorubicin, gemcitabine and mitomycin C. These five drugs may be administered in different combinations, depending on the needs of the patient and how effective the drug is at killing the cancer cells.

Palliative Therapy

• Palliative therapy is designed to manage pain, relieve symptoms and improve quality of life. It is not designed to cure cancer, but rather to make advanced cancer more bearable. There are several different types of palliative care available to patients with advanced bile duct cancers. A biliary stent (small tube) may be inserted into a bile duct that is blocked by cancer, in order to reduce the risk of infection or gallbladder inflammation and to ease digestion. A biliary bypass is another procedure wthat aids the body in getting bile to the small intestine. A biliary bypass is a more invasive procedure than the insertion of a biliary stent but may last longer. Finally, a therapy called PDT (photodynamic therapy) is under study in 2009 by the American Cancer Society. PDT involves injecting a light-activated drug intravenously. A light is then attached to a bronchoscope, which is inserted into the throat and down to the bile duct. The light is then turned on and aimed at the drugs, which activate in the bile duct and kill the cancer cells.