Bile Duct Cancer

Bile Duct Cancer Overview

Since the bile ducts can exist both within and outside the liver, bile duct cancer can present as a liver mass if it arises from the small ducts within your liver. In such cases, you may have subtle laboratory test abnormalities.

Your symptoms often overlap with other liver-related symptoms such as:

• Taste disturbances
• Nausea
• Jaundice
• Itching

Jaundice commonly appears with bile duct cancer that involves the portion of the duct system outside your liver.

Diagnosis

We'll use several tests to clarify where your cancer originated since your treatment depends on its location. This may include a clinical exam, where your physician will check for changes in complexion (jaundice). They may also use one or more of the following tools:

Advanced Imaging

IU Health uses several imaging technologies to diagnose bile duct cancer. These include:

• Endoscopic ultrasound (EUS): This is a combination of endoscopy and the imaging capabilities of ultrasound to obtain high-quality images of organs deep inside the body.
• Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is a minimally-invasive endoscopic and imaging procedure. With ERCP, we can diagnose conditions of the liver, gallbladder, bile ducts and pancreas.
• Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP): MRCP is a sophisticated MRI focused on evaluating changes within the network of bile ducts inside and outside the liver to understand the abnormalities' location better and/or extent of disease.
• Spiral Computed Tomography (CT)
• Positron emission tomography (PET) scan
• X-rays

Fine needle aspiration biopsy

We remove tissue or fluid with a needle for examination under a microscope.

Genetic Counseling & Testing

We'll discuss with you personal and family medical history of certain gastrointestinal conditions and the possibility of genetic testing. With genetic testing, we identify specific genetic factors that put you at greater risk for developing gastrointestinal cancers.

Treatment

Your multidisciplinary team of physicians at IU Health will include:

• Medical oncologists
• Radiation oncologists
• Surgical oncologists
• Interventional radiologists
• Gastroenterologists
• Radiologists
• Pathologists

These specialists work together to develop a customized treatment plan for you. This treatment plan considers the location and extent of your cancer, plus your general health and life situation. Your doctors will also provide a nurse coordinator to help you understand and adjust to a potentially complex care plan.

An inflammatory condition of the liver known as primary sclerosing cholangitis (PSC) puts you at a higher risk of developing bile duct cancer. PSC can be associated with an autoimmune inflammatory colon condition called ulcerative colitis (UC).

For this reason, PSC and UC patients participate in surveillance programs designed to identify early changes within the bile ducts that suggest bile duct cancer. Your doctors can cure early-stage bile duct cancer with resection or liver transplant.

Your multidisciplinary team provides a full range of treatment options including:

• Surgery. Depending on where the cancer forms in this network of ducts, and how extensive, your physicians usually consider surgery first. While not always possible, surgical treatment varies and may include a liver resection, bile duct resection and rarely, liver transplantation. 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.
• Chemotherapy. Destroying cancer cells with drugs.
• Radiation therapy. Using high energy, penetrating waves or particles destroys cancer cells or keeps 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, a liver transplant may be considered for highly selected patients with bile duct cancer.

Radiation therapy treatments may include:

• Computed tomography (CT) simulation. A radiation planning process using a CT scan defines 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.

Research

Clinical research at the IU Health Simon Cancer Center focuses on finding new, more effective treatments for gastrointestinal cancers. This research creates ongoing improvements to current treatment options. At the forefront of cancer care discoveries, IU Health researchers have access to all current treatments plus new clinical trial options.

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 makes us unique in the state of Indiana, demonstrating the leadership of this program in the treatment of gastrointestinal cancers.

Resources

The following external websites provide further information about bile duct cancer diagnosis, treatment and research:

• American Cancer Society: This website provides resources for emotional support, the latest cancer information, transportation to chemo, accommodations when treatment is far away.
• Medline Plus: The National Institutes of Health's website for patients produced by the National Library of Medicine. It provides information about diseases, conditions, and wellness issues.