Cholangiocarcinoma (Bile Duct Cancer)

Causes of cholangiocarcinoma

Bile duct cancer occurs when cells in the bile tubes grow out of control. Cells grow out of control when their DNA develops changes (mutations). These DNA changes allow cells to build up and grow into tumors. The cells that line the tubes connecting the liver to the gall bladder or the gall bladder to the small intestine can develop these changes.

Risk factors of cholangiocarcinoma

Scientists have identified some things that may increase the risk of developing bile duct cancer.

• Chronic liver disease — people with liver disease, like hepatitis B or C, for many years have a higher risk of developing cholangiocarcinoma.
• Primary sclerosing cholangitis (PSC) — people with PSC, a disease where bile tubes get inflamed, are more likely to get cholangiocarcinoma.
• Smoking — people who smoke are more likely to get bile duct cancer than those who don’t smoke.
• Age – bile duct cancer is more common in people older than 50.
• Liver fluke infection — liver fluke is a parasite that you can get by eating undercooked fish. It’s a rare cause of cholangiocarcinoma in Southeast Asia.
• Choledochal cyst  — a choledochal cyst, sacs filled with bile, frequently get precancerous changes that can put you at risk for bile duct cancer.
• Alcohol use — people who drink a lot of alcohol are more likely to get bile duct cancer than those who don’t drink.

Symptoms of cholangiocarcinoma

People who have bile duct cancer often do not have symptoms for a very long time. Also, symptoms are often subtle, and people don’t realize they are sick. The most common symptoms are:

• Itchy skin
• Clay-colored stool
• Yellow skin or eyes
• Unexplained weight loss
• Fevers, chills and night sweats
• Abdominal pain and back pain

Diagnosis of cholangiocarcinoma

Bile duct cancer can be hard to diagnose. The tests doctors use to diagnose are:

• Blood tests — your doctor may choose to start with liver function tests to help determine the cause of your symptoms.
• Imaging — imaging tests, like a CT, MRI or MRCP, of the abdomen are useful for identifying cholangiocarcinoma.
• Endoscopic retrograde cholangiopancreatography (ERCP) — a test to examine your bile duct where a camera is put down your throat and into your small intestine and bile tube to examine for signs of cancer.
• Biopsy — a biopsy is a procedure where a doctor removes a small amount of tissue to look at under a microscope, it can sometimes be done at the same time as an ERCP.

Treatment of cholangiocarcinoma

Treatment for bile duct cancer includes:

• Surgery
• Radiation
• Chemotherapy
• Liver transplant — advanced disease may require a complete exchange of your liver with a liver from a donor.
• Photodynamic therapy — in photodynamic therapy, a dye is put into your body and accumulates in cancer cells, a laser light interacts with the dye and can cause the cells to die.
• Biliary drainage/stenting — when a bile duct cancer is causing disruption of normal liver function, biliary drainage or stenting can be done; this does not treat the cancer itself, but can help with the symptoms.

Recovery from cholangiocarcinoma

Recovery from bile duct cancer depends on the type of treatment. Your doctor will likely want you to follow closely in the office during and after treatment.

There is a chance that cholangiocarcinoma can come back even after treatment. Make sure to attend all your follow-up appointments.