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A complete overview on Bile Duct Cancer

What’s Bile Duct Cancer’

The medical name for Bile Duct cancer is Cholangiocarcinoma. It is a form of cancer that affects the bile ducts.

What do you understand by the term ‘bile duct’?

Bile ducts are nothing but series of tubes, which transport digestive juice, known as bile to the gall bladder where the bile juice is usually stored and from the gall bladder, the bile juice is then delivered to your small intestine. The food that you consume consists of carbohydrates, proteins and fats and is broken down glucose and other essential nutrients before absorption. Bile plays a major role in this process of digestion.

Most cases of bile duct cancer, otherwise known as cholangiocarcinoma, occur in those parts of the bile ducts that lie outside your liver. In very few instances, the cancer starts from the ducts present within the liver. Tumors that lie outside your liver are relatively smaller in size while those found inside your liver can be fairly larger.

Image titleCauses of Bile duct Cancer

These are the common reasons attributed to the formation of bile duct cancer. They are:

  1. Chronic inflammation of the bile duct due to diseases like primary sclerosing cholangitis, chronic hepatitis due to hepatitis B and C.
  2. Parasitic infections within your bile duct
  3. Intrahepatic stones – a condition called recurrent pyogenic cholangitis leads to formation of intrahepatic stones, can increase the risk of bile duct cancer
  4. Congenital diseases like Caroli’s disease, a disease characterized by dilatation of small bile ducts within the liver.

Symptoms associated with Bile Duct Cancer

Symptoms associated with bile duct cancer include:

  • Yellowish discoloration of skin, eyes and urine(Jaundice)
  • Pale/ Clay colored stools
  • Generalised Itching sensation, due to the obstruction to flow of bile.
  • Dull aching upper abdomen pain and sometimes back pain as well.
  • Loss of appetite and weight loss
  • Fever/ Chills
  • Fatigue.

Diagnosis of Bile Duct Cancer

A complete history of your symptoms and a thorough physical examination will help your physician in suspecting bile duct cancer. Jaundice will be apparent on examination and an enlarged liver or gallbladder can be felt beneath your rib cage on the right side.

Blood tests.

Blood tests will reveal anemia due to blood loss, and will show abnormalities like elevated Bilirubin – marker of jaundice and increased levels of enzymes related to the liver like SGOT, SGPT and ALP. A marker of bile duct cancer is a protein named CA 19.9 which may be elevated in most cases

Imaging tests

Imaging tests include those of Ultrasound abdomen, CT scan as well as MRI scan. Imaging tests reveal the exact location and extent of the cancer. They will also give an idea about involvement of surrounding structures and the status of the liver as well.

Endoscopic Retrograde Cholangio Pancreatography(ERCP) and Endoscopic Ultrasound 

This is a special endoscopic test done by a gastroenterologist, where a long flexible lighted tube is passed down your throat to reach the gut where your bile ducts open up. To add a better visibility to the zone, he also injects some dye into the ducts. The bile ducts thus show up more clearly on an X-Ray. Any blockages are precisely revealed. A mini ultrasound probe is also passed, to visualize the area clearly. This is known as an Endoscopic Ultrasound scan. During these tests, biopsies or brushings can be taken from the bile duct walls or from surrounding lymph nodes to help make a diagnosis.

Treatment options

  1. An open ended incision or laparoscopic procedure can be deployed to just remove your cancer infected bile ducts, in case the malignant cells have not reached your liver.
  1. If the tumors have reached your bile ducts and your liver- a section of your liver, surgical options to remove the damaged portion of the bile ducts and the liver, are ascertained by your surgeon.
  1. A liver transplant can be a surgical option, if your entire liver is damaged on account of the malignant cells, which started off, with your bile duct, as such.
  1. A Whipple procedure is advocated if the cancer cells have invaded the nearby organs, as well. Whipple procedure involves removal of
  1. Bile ducts
  2. The gall bladder
  3. Sections of the affected areas of your stomach and gut and
  4. Finally the pancreas, as well

Chemotherapy and Radiation beams are also given to patients, following the above stated treatments.

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