Bile Duct Cancer
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The bile ducts are a large network of pipes that originate deep within the substance of the liver, extend outside the liver near the gallbladder and transport bile from the liver cells into the gallbladder and intestines. Bile duct cancer (cholangiocarcinoma) is an abnormal growth within the lining of these ducts.
Since the bile ducts can be located both within and outside the liver substance, bile duct cancer can present as a liver mass if it arises from the small ducts within the liver. Cholangiocarcinoma that arises from within the liver substance may be accompanied by subtle laboratory abnormalities. Symptoms often overlap with other liver-related symptoms such as taste disturbances, nausea, jaundice and/or itching. Jaundice commonly appears with bile duct cancer that involves the portion of the duct system outside the liver.
Depending on where the cancer forms in this network of ducts, and how extensive the cancer is when diagnosed, surgery is usually considered first. It is not always possible depending on many factors that must be assessed by a surgeon with expertise in liver surgery. Surgical treatment varies and may include a liver resection, bile duct resection and rarely, liver transplantation. For this reason, there are several tests used to clarify where the cancer is located. Surgery on bile duct cancer includes removing not only the cancer with a clear margin of normal tissue but also removal of the lymph nodes draining the liver and bile ducts.
Patients with an inflammatory condition of the liver known as primary sclerosing cholangitis (PSC) are at higher risk for developing cholangiocarcinoma. PSC can be associated with an autoimmune inflammatory condition of the colon called ulcerative colitis (UC). For this reason, patients with PSC and UC are targeted for surveillance programs designed to identify early changes within the bile ducts that suggest cholangiocarcinoma. Early stage cholangiocarcinoma can be cured with resection or liver transplant.
One or more of the following tools may aid bile duct cancer diagnosis:
- Clinical examination. Checking for changes in complexion (jaundice)
- Endoscopic ultrasound (EUS), endoscopic retrograde cholangiopancreatography (ERCP), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), spiral computed tomography (CT), positron emission tomography (PET) scan and X-rays. These are advanced imaging technologies used to take pictures of the gastrointestinal tract. EUS combines endoscopy with the imaging capabilities of ultrasound to obtain high-quality images of organs deep inside the body. ECRP, a minimally-invasive imaging procedure, is used to diagnose conditions of the liver, gallbladder, bile ducts and pancreas. MRCP is a sophisticated MRI focused on evaluating changes within the network of bile ducts both inside and outside the liver to better understand the location of the abnormalities and/or extent of disease.
- Fine needle aspiration biopsy. Removing tissue or fluid with a needle for examination under a microscope.
- Genetic counseling. Discussing personal and family medical history of certain gastrointestinal conditions and the possibility of genetic testing.
- Genetic testing. Identifying specific genetic factors that put you at greater risk for developing gastrointestinal cancers.
The Indiana University Health Melvin & Bren Simon Cancer Center team has more than a dozen highly-specialized physicians with instant access to advanced diagnostic technology. This allows patients to receive comprehensive diagnostic services and treatment recommendations in one visit.
Unlike many cancer specialists elsewhere, our multidisciplinary team focuses solely on gastrointestinal cancers. Members include:
- Medical oncologists
- Radiation oncologists
- Surgical oncologists
- Interventional radiologists
These specialists work together to develop a customized treatment plan for you. This treatment plan takes into consideration the location and extent of your cancer, plus your general health and life situation. We also provide a nurse coordinator who can help you understand and adjust to a potentially complex care plan.
Our multidisciplinary team provides a full range of treatment options.
- Surgery. Removing cancer in an operation and, if the tumor is large, removing a small amount of healthy tissue around it.
- Chemotherapy. Destroying cancer cells with drugs.
- Radiation therapy. Using high energy, penetrating waves or particles to destroy cancer cells or keep them from reproducing.
- Immunotherapy. Stimulating your immune system to fight cancer.
- Stent placement. Placing a support device in the gastrointestinal tract to keep it from closing.
- Palliative care. Relieving pain and symptoms to improve your quality of life.
- Liver transplantation. In rare cases, liver transplant may be considered for highly selected patients with cholangiocarcinoma.
Radiation therapy treatments may include:
- Computed tomography (CT) simulation. A radiation planning process using a CT scan to define tumor targets and internal anatomy in three dimensions, allowing the radiation oncologist to precisely target the tumor while saving healthy tissue.
- Four-dimensional CT simulation. A CT simulation that visualizes internal anatomy changes (such as changes in tumor location with the breathing cycle) allowing the radiation oncologist to target the tumor more accurately and further spare healthy tissue.
- Image guided radiation therapy (IGRT). Uses precise radiographic imaging to precisely target tumors while sparing healthy tissue.
- Cone-beam computed tomography (CBCT). An IGRT technique that uses a limited CT scan prior to daily radiation. This technique allows extreme precision in targeting the radiation beams.
- Three-dimensional conformal radiotherapy. Guided by a computer-generated three-dimensional picture of the tumor, allowing the highest possible dose of radiation while sparing healthy tissue as much as possible.
- Intensity modulated radiation therapy (IMRT). Advanced radiation technology that allows precise delivery of radiation to areas near or around radiation-sensitive tissues, using a computerized optimization algorithm.
- Stereotactic body radiation therapy (SBRT). Special equipment delivers precise, high-dose radiation to a tumor without affecting healthy tissue.
- Proton beam radiation. Particle radiation that treats tumors in close proximity to critical, radiation-sensitive tissue.
Clinical research at the IU Health Simon Cancer Center is focused on finding new, more effective treatments for gastrointestinal cancers. This research is essential for ongoing improvements to current treatment options. We are at the forefront of cancer care discoveries. Our patients are among the first to benefit from this expertise, having access to all current treatments plus new clinical trial options.
More information about cancer research can be found on the Indiana University School of Medicine website.
Clinical trials at the IU Health Simon Cancer Center focus primarily on developing new treatments for gastrointestinal cancers. The quantity and extent of these trials is unique in Indiana, demonstrating the leadership of this program in the treatment of gastrointestinal cancers.