Treatment

The treatment of cholangiocarcinoma depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. In many cases, a team of doctors will work with the patient to determine the best treatment plan. The main treatment for bile duct cancer is surgery. Radiation therapy and chemotherapy may be used if the cancer cannot be entirely removed with surgery and in cases where the edges of the tissues removed at the operation show cancer cells (also called a positive margin). Both stage III and stage IV cancers cannot be completely removed surgically.

Surgery

Due to the location and sensitivity of the bile duct area, surgery for cholangiocarcinoma can be difficult. If the cancer is near the liver, part of the liver will be removed, along with the bile duct, gallbladder, and sometimes part of the pancreas and small intestine. If the cancer is near the pancreas, the surgeon may need to remove some or all of the pancreas and some small intestine. In order to maintain appropriate flow of bile, the remaining part of the bile duct has to be connected to the small intestine. About 5% to 10% of people do not survive this complicated operation; others (25% to 45%) experience serious complications, such as bleeding, infection, or leaking of bile or pancreatic juices. In some cases, surgeons cannot completely remove the tumor. Therefore, the surgeon bypasses the blocked area by connecting part of the bile duct before the blockage with a part of the small intestine beyond the blockage. The surgeon may insert a stent (a plastic or metal tube) into the bile duct to keep it open.

If the doctors think that the tumor cannot be removed by surgery, a plastic or metal stent can be passed through the blockage either during the ERCP procedure or during a procedure similar to PTC. Although these procedures do not remove the tumor, they relieve its effects and people often experience long periods of time when all of their symptoms disappear and quality of life is much better. For both these procedures, the doctor will try to insert the stent internally, so the person will not be aware of its presence. Sometimes, this is not possible, and a tube will be passed through the liver to redirect the bile externally into a bag that will need regular changing. Some doctors suggest that in these situations people receive long-term antibiotics to guard against infection.

Liver transplantation

Complete removal of the liver and bile ducts followed by transplantation of a donor liver has been used to treat this type of cancer. This is a major procedure. Medical professionals are not in agreement about its usefulness for cholangiocarcinoma.

Radiation therapy

Radiation therapy uses high-energy x-rays to damage cancer cells, and several treatments may be needed. External-beam radiation (radiation given from a machine outside the body) is most often used to treat people with cholangiocarcinoma. Occasionally, internal radiation therapy may be used for cholangiocarcinomas; this involves inserting small radioactive pellets near or in the cancer by way of a tube. Side effects of radiation therapy include skin irritation, nausea, and fatigue. Radiation therapy can be used for treatment or to control symptoms and pain in advanced disease.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be used before surgery to shrink the tumor or when surgery is not an option. In some cases, chemotherapy can shrink the tumor, but it has not yet been proven that this improves the quality of life or prolongs life. Drugs that have been used for cholangiocarcinoma include fluorouracil (5-FU, Adrucil, Efudex), cisplatin (Platinol), doxorubicin (Adriamycin, Rubex), and gemcitabine (Gemzar). Side effects depend on the drug and the dosage. Common side effects include nausea and vomiting, loss of appetite, diarrhea, fatigue, low blood count (which increases the body's susceptibility to infection), bleeding or bruising after minor cuts or injuries, numbness and tingling in the hands or feet, headaches, hair loss, and darkening of the skin and fingernails. Side effects usually go away when treatment is complete.

Efforts to improve chemotherapy by investigating new drugs or new combinations of drugs are being made through clinical trials. This is often how patients with cholangiocarcinoma receive chemotherapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you’ve been prescribed, their purpose, and their potential side effects or interactions with other medications.

*adapted from cancer.net

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cholangiocarcinoma, or bile-duct (bile duct) cancer, arises from the tissues in the bile duct.