Biliary Tract Cancer (Cholangiocarcinoma) - Treatments, Symptoms, Causes

Biliary Tract Cancer (Cholangiocarcinoma) - Treatments, Symptoms, Causes

The bile ducts are thin channels that run from the liver to the small intestine. These channels allow fluid known as bile to move from the liver and gallbladder to the small intestine.

Bile accumulating in liver cells begins in the liver as many small canaliculi. These small ducts come together to form small ducts. Later, these small ducts merge with the larger ducts and the right and left hepatic ducts. All these channels formed inside the liver are called intrahepatic (intra-liver) bile ducts.

The left and right hepatic ducts come out of the liver and connect to the area called the hilum to form the common liver duct. The lower gallbladder (a small organ that stores bile) joins with this common hepatic duct by a small duct (cystic duct). The common bile duct passes through part of the pancreas before it joins with the pancreatic tract and empties into the first part of the small intestine (duodenum) at the bubble of vater.

Bile duct cancer (cholangiocarcinoma) is a malignant epithelial cell that occurs in various parts of the bile ducts. According to the location of the cancer; It is classified into 3 different types as intrahepatic (intra-liver), perihilar and distal (distant) bile duct cancer (cholangiocarcinoma).

Biliary duct cancer (cholangiocarcinoma) together with other rare subtypes are known as subtle adenocarcinomas. The first treatment option for this type of cancer is surgery. However, when planning the surgical intervention, it is necessary to consider the involvement of the vascular structure and lymph nodes. The desmoplastic nature of biliary tract cancer (cholangiocarcinoma) and the fact that it has more than one genetic structure are factors that affect resistance to treatment.

Causes of bile duct cancer – what are the risk factors?

Anything that changes the chance of getting the disease is a risk factor for us. For this reason, it is possible to reduce the risk factors that have an effect on cancer by paying attention to our lifestyle, habits, and all the environmental factors we are exposed to.

Some risk factors, such as smoking and using alcohol, are habits we acquire in life and can be changed. There are also some risk factors, such as a person's age and family history, that cannot be changed. On the other hand, just because you are at risk does not mean you will get cancer. Or it can be said that it is possible to have cancer without any risk factors.

For this reason, it is important to know the causative risk factors in biliary tract cancer. In this way, you can reduce the risk by making small changes in your life. If you have some risk factors related to bile duct cancer, you should not neglect your routine check-ups at frequent intervals. Thus, you can have the opportunity of early diagnosis and effective treatment in cancer.

What are the symptoms of bile duct cancer?

Extrahepatic (non-liver) bile duct cancers usually show symptoms when the tumor blocks the biliary drainage system. It is possible to observe a different development if the cancer is only in the intrahepatic bile ducts.

  • Abnormal liver functions determined as a result of the test,
  • change in urine or stool color,
  • jaundice,
  • stomach ache,
  • nausea and vomiting,
  • itching,
  • weight loss and
  • Fever is a common symptom of biliary tract cancers.

Occasionally, asymptomatic disease may occur by chance as a result of imaging or a liver blood test. When cancer develops outside of the liver, the symptoms of the disease may vary depending on the location of the tumor. While jaundice is seen in extrahepatic biliary tract (except liver) cancer, more pain is observed in patients with tumors in the bile ducts inside the liver instead of jaundice.

Biliary tract cancer - how is cholangiocarcinoma treated?

The treatment of bile duct cancer varies according to the size of the cancer, the region where it is located, and the degree of spread. The treatment applied in the advanced stage of cancer is aimed at improving the quality of life by easing the symptoms associated with the disease.

The main treatment in the early stage is surgery.
However, post-operative preventive treatments (adjuvant radiotherapy and/or chemotherapy), depending on the disease and the patient's condition,

  • Palliative treatments (to improve quality and duration of life),
  • targeted therapies and
  • Arterial treatments can be applied.

Chemotherapy is drug therapy to kill cancer cells. There is not yet satisfactory evidence that adjuvant chemotherapy alone contributes to survival in patients with biliary tract cancer whose cancer has been completely or partially removed by surgery. However, chemotherapy is still a treatment method used to shrink the tumor and slow the development of the disease in some advanced cases. In addition, the risk of recurrence of cancer is reduced by the chemotherapy method applied after surgery.

The most active chemotherapy drugs administered are 5-FU, gemcitabine, cisplatin and oxaliplatin. Gemcitabine-cisplatin combination was observed to be more beneficial than gemcitabine alone.