Extrahepatic Bile Duct Cancer Treatment (PDQ�)
General Information About Extrahepatic Bile Duct Cancer
Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver.
A network of
Having colitis or certain liver diseases can increase the risk of developing extrahepatic bile duct cancer.
Anything that increases your risk of getting a disease is called a
Primary sclerosing cholangitis.
Chronic ulcerative colitis.
cysts. Infectionwith a Chinese liver fluke parasite.
Possible signs of extrahepatic bile duct cancer include jaundice and pain.
These and other
Jaundice(yellowing of the skin or whites of the eyes).
Pain in the
Tests that examine the bile duct and liver are used to detect (find) and diagnose extrahepatic bile duct cancer.
The following tests and procedures may be used:
Physical examand history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient?s health habits and past illnesses and treatments will also be taken. Ultrasoundexam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissuesor organsand make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-raymachine. A dyemay be injectedinto a veinor swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A spiralor helical CT scan makes detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). ERCP(endoscopic retrograde cholangiopancreatography): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscopeis passed through the mouth, esophagus, and stomachinto the first part of the small intestine. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A catheter(a smaller tube) is then inserted through the endoscope into the pancreatic ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer. PTC(percutaneous transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drainbile into the small intestine or a collection bag outside the body. Biopsy: The removal of cellsor tissues so they can be viewed under a microscope to check for signs of cancer. The sample may be taken using a thin needle inserted into the duct during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy. The biopsy is usually done during PTC or ERCP. Tissue may also be removed during surgery. Liver function tests: A procedure in which a bloodsample is checked to measure the amounts of certain substances released into the bloodby the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by extrahepatic bile duct cancer.
Certain factors affect prognosis (chance of recovery) and treatment options.
stageof the cancer (whether it affects only the bile duct or has spread to other places in the body).
Whether the tumor can be completely removed by surgery.
Whether the tumor is in the upper or lower part of the duct.
Whether the cancer has just been
diagnosedor has recurred(come back).
Treatment options may also depend on the symptoms caused by the tumor. Extrahepatic bile duct cancer is usually found after it has spread and can rarely be removed completely by surgery.
Stages of Extrahepatic Bile Duct Cancer
After extrahepatic bile duct cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bile duct or to other parts of the body.
The process used to find out if
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
tissue. Cancer invadesthe surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veinsand capillariesand travels through the blood to other places in the body.
The following stages are used for extrahepatic bile duct cancer:
Stage 0 (Carcinoma in Situ)
Stage IA: Canceris found in the bile ductonly. Stage IB: Cancerhas spread through the wall of the bile duct.
Stage IIA: Cancerhas spread to the liver, gallbladder, pancreas, and/or to either the right or left branch of the hepatic arteryor to the right or left branch of the portal vein. Stage IIB: Cancerhas spread to nearby lymph nodesand:
is found in the
bile duct; or
has spread through the wall of the bile duct; or
has spread to the liver, gallbladder, pancreas, and/or the right or left branches of the hepatic artery or portal vein.
to the main
portal veinor to both right and left branches of the portal vein; or
hepatic artery; or
to other nearby
organsor tissues, such as the colon, stomach, small intestine, or abdominalwall.
Cancer may have spread to nearby
Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:
Localized (and resectable)
Unresectable, recurrent, or metastatic
Treatment Option Overview
There are different types of treatment for patients with extrahepatic bile duct cancer.
Different types of treatment are available for patients with
Three types of standard treatment are used:
The following types of
Removal of the
bile duct: If the tumoris small and only in the bile duct, the entire bile duct may be removed. A new ductis made by connecting the duct openings in the liverto the intestine. Lymph nodesare removed and viewed under a microscope to see if they contain cancer.
hepatectomy: Removal of the part of the liver where cancer is found. The part removed may be a wedgeof tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it. Whipple procedure: A surgical procedure in which the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juicesand insulin.
biliary bypass: If the tumor cannot be removed but is blocking the small intestine and causing bileto build up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area. This procedure helps to relieve jaundicecaused by the build-up of bile. Stentplacement: If the tumor is blocking the bile duct, a stent (a thin tube) may be placed in the duct to drainbile that has built up in the area. The stent may drain to the outside of the body or it may go around the blocked area and drain the bile into the small intestine. The doctor may place the stent during surgery or PTC, or with an endoscope.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Clinical trials are studying ways to improve the effect of radiation therapy on tumor cells, including the following:
Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs. Radiosensitizers: Drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more tumor cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed.
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options for Extrahepatic Bile Duct Cancer
A link to a list of current
Localized Extrahepatic Bile Duct Cancer
Stentplacement or biliary bypassto relieve blockage of the bile ductmay be done before surgeryto relieve jaundice.
Surgery, with or without
external-beam radiation therapy.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Unresectable, Recurrent, or Metastatic Extrahepatic Bile Duct Cancer
Stentplacement or biliary bypasswith or without internalor external radiation therapy, as palliative treatmentto relieve symptomsand improve the quality of life. Chemotherapy.
A clinical trial of new ways to give palliative
radiation therapy, such as combining it with hyperthermia therapy, radiosensitizers, or chemotherapy.
A clinical trial of new
drugsand drug combinations.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with unresectable extrahepatic bile duct cancer, recurrent extrahepatic bile duct cancer and metastatic extrahepatic bile duct cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Extrahepatic Bile Duct Cancer
For more information from the
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Information For Survivors/Caregivers/Advocates
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Changes to This Summary (08/19/2011)
Changes were made to this summary to match those made to the health professional version.
PDQ is a comprehensive cancer database available on NCI's Web site.
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