Bile Duct Tumors - Types, Diagnosis and Treatment

Introduction:

Bile duct tumor is a rare disease in which cancer cells form in the bile ducts. The liver, gallbladder, and small intestine are connected by tubes called ducts. The ducts carry bile fluid from the liver and gallbladder to the small intestine, where the bile digests fat. Bile duct cancer is also called cholangiocarcinoma. Most people who develop cholangiocarcinomas are over 65 years of age. Cholangiocarcinoma occurs more often in men than women.

What Are the Types of Bile Duct Tumors?

• Intrahepatic Bile Duct Cancer: This cancer affects the bile ducts inside the liver. They are also called intrahepatic cholangiocarcinomas. They are not commonly found.

• Extrahepatic Bile Duct Cancer: This cancer affects the bile ducts present outside the liver. The extrahepatic bile duct comprises the hilum and the distal region. Cancer can occur in any of the areas.

• Perihilar Bile Duct Cancer: This cancer is found in the hilum region. This is where the right and left bile ducts exit from the liver and form the common hepatic duct. Perihilar type of cancer is also known as Klatskin tumor or perihilar cholangiocarcinoma.

• Distal Bile Duct Cancer: This cancer is found in the distal region. The distal part contains the common bile duct, which passes through the pancreas and ends in the small intestine. It is also called extrahepatic cholangiocarcinoma.

Bile duct tumors are also subdivided based on the microscopic feature of cancer cells. These include sarcomas, lymphomas, small-cell cancers, and cholangiocarcinomas. Nearly all bile duct tumors are cholangiocarcinomas. Other types of cancer are less common. Cholangiocarcinoma is a type of adenocarcinoma in which cancer starts in the gland cells that line the inside of the ducts.

What Are the Factors Which Increase the Risk for Bile Duct Tumors?

The following factors can increase the risk of cholangiocarcinoma:

• Primary Sclerosing Cholangitis: A condition where the bile ducts get blocked by inflammation and scarring.

• Chronic Liver Disease: This causes scarring of the bile ducts.

• Bile Duct Problems at Birth: The common congenital bile duct problems are listed below:

• A choledochal cyst can result in irregularly dilated bile ducts.

• Bile duct stones.

• Liver fluke infection.

• Cirrhosis.

• Inflammatory bowel diseases such as ulcerative colitis and Crohn's disease.

• Chronic ulcerative colitis.

• Alcohol.

• Diabetes.

• Obesity.

• Viral hepatitis infection.

What Are the Signs and Symptoms of Bile Duct Tumors?

Bile duct tumors usually do not cause any symptoms in their early stages.

Some of the symptoms which occur later include:

• Jaundice (yellowish discoloration of the skin or whites of the eyes).

• Abdominal pain.

• Dark urine.

• Clay-colored stool.

• Fever.

• Itchy skin.

• Nausea and vomiting.

• Weakness.

• Weight loss.

• Stomach upset.

What Are the Diagnostic Methods for Bile Duct Tumors?

• Physical Examination: The doctor will ask about the general health, family history of cancer, liver disease, and habits such as smoking and alcohol. Physical examination to check masses, tenderness, or the presence of fluid is done.

• Blood Tests: Used to find out the levels of bilirubin and to look for tumor markers such as CA 19-9 (cancer antigen 19-9), which is elevated in this tumor.

• Abdominal Ultrasound: This imaging test is done to look for tumors.

• Liver Function Test: To measure liver function.

• Computed Tomography (CT) Scan: It produces detailed pictures of the inside of the body.

• Magnetic Resonance Imaging (MRI): Uses a magnetic field to show internal organs. It can also determine the size and location of the tumor.

• Endoscopy: An endoscope with a camera is inserted and is used to view the esophagus, stomach, and part of the intestine.

• Endoscopic Retrograde Cholangiopancreatography (ERCP): A thin, flexible tube with a camera is passed down the throat into the small intestine. The camera is used to examine the bile ducts. A dye is also injected into the bile ducts to improve imaging results.

• Magnetic Resonance Cholangiopancreatography (MRCP): This procedure uses an MRI machine to make images of the bile ducts. It is a non-invasive alternative to ERCP. This procedure does not need the use of a dye.

• Percutaneous Transhepatic Cholangiography (PTC): A needle is inserted through the skin and into a bile duct in the liver. A dye is injected, and an X-ray of that area is taken.

• Laparoscopy: Anesthesia is given, and the surgeon makes a small cut in the stomach through which a tube with a light and a video camera is inserted to look at the bile duct, gallbladder, liver, and other organs and tissues.

• Biopsy: The doctor takes a sample tissue of bile duct cells for examination under a microscope. This is done during laparoscopy.

What Is the Treatment of Bile Duct Tumors?

• Biliary Drainage: If the bile duct is blocked, the doctor performs a bypass by cutting the bile duct and reattaching the duct on the other side of the blockage. A stent is placed into the duct to keep bile flowing.

• Photodynamic Therapy: An inactive form of a specific medication is injected into the vein, and the drug collects more cancer cells than healthy cells. After a few days, an endoscope is used to aim special light at the tumor, which inactivates the drug and kills the cancer cells.

• Radiation: This therapy uses high-energy rays or particles to kill cancer cells. It can be used before or after the surgery. Before surgery, it is used to shrink the size of a tumor. After surgery, it is used to kill the remaining cancer cells.

• Chemotherapy: This uses drugs to kill cancer cells and is used along with radiation therapy. Chemotherapy drugs are taken by mouth or through intravenous infusion.

• Surgery: A part or the entire bile ducts are removed during surgery. Depending on cancer spread, lymph nodes, liver, pancreas, and small intestine are also removed.

• Liver Transplant: It is a rare treatment that can sometimes cure bile duct cancer.

• Targeted Therapy: This procedure uses drugs or other substances to find and kill cancer kills without harming normal cells.

• Immunotherapy: Uses the patient's immune system to fight cancer.

What Is the Prognosis?

Cancers that develop outside the liver have a better prognosis than those which begin inside the liver. But the outcome is poor if cancer has spread to other body parts.

Conclusion:

Bile duct tumors are a rare disease affecting the bile ducts. Since the bile ducts are deep inside the body, small tumors are not seen or felt during a routine examination and do not show any symptoms in the early stage. Diagnosing and treating promptly can help to control the spread to other organs resulting in a good prognosis.