Bile duct cancer treatments

Our bile duct cancer program offers a variety of techniques in the areas of surgery, radiation and gastroenterology procedures, as well as novel investigative approaches. A multidisciplinary team of experts in bile duct cancer (also called cholangiocarcinoma) makes treatment recommendations based on each patient’s unique diagnosis.

Surgery

Bile duct cancers are classified based on whether they can be completely removed (resected). Depending on the type, size and location of your tumor, the cancer may be removed by surgery. These surgeries are:

Surgery for resectable cancers: For these cancers, the location determines the surgical procedure to be performed. For intrahepatic bile duct cancers (tumors that form in the smaller duct branches of the liver), a partial hepatectomy (removal of part of the liver) is commonly done. For perihilar (tumors that form where hepatic duct branches leave the liver) and distal (near the small intestine) bile duct cancers, the bile duct and nearby lymph nodes along with a part of the liver, gallbladder, pancreas and/or small intestine are surgically removed, depending on the stage of the disease.

Surgery for unresectable cancers: For patients with unresectable tumors (those that cannot be removed with surgery), a variety of innovative treatment options are available, including radiation therapy and ablative therapy. In some cases, surgery may be an option to help control or reduce symptoms caused by a bile duct tumor:

• A biliary stent or biliary catheter may be inserted into the bile duct to keep it open when the tumor is blocking the bile duct.
• A biliary bypass may allow bile to reach the small intestine and reduce symptoms, such as jaundice or itching, by connecting parts of the bile duct before and after the blockage.

Gastroenterology procedures

Some gastrointestinal (GI) procedures for bile duct cancer include:

ERCP (endoscopic retrograde cholangiopancreatography) allows a view of the bile ducts in order to remove samples for biopsy, relieve an obstruction of the bile duct or place a stent into a narrowed duct to keep it open.

Stent placements, also referred to as endoprostheses, enable the bile to drain to provide symptom relief.

Balloon dilation for obstruction allows the physician to open the biliary ducts and for relieve any obstructions.

Photodynamic therapy (PDT) is an innovative treatment that uses light-activated drugs (or photosensitizing agents) and a light source to kill cancer cells.

Radiation therapy

With advanced radiation therapy delivery systems, radiation oncologists are better able to target difficult-to-reach tumors in the bile duct and direct higher radiation doses at bile duct cancer cells, while reducing exposure to normal, healthy tissue.

A number of radiation therapies may be recommended to treat bile duct cancer, depending on the patient’s stage and location of the tumor(s). Commonly used radiation therapies for this cancer type are:

External beam radiation therapy (EBRT): This painless procedure poses no risk of radioactivity to the patient or those who come in contact with the patient. EBRT also does not carry the standard risks or complications associated with bile duct cancer surgery, such as surgical bleeding, post-operative pain or the risk of stroke, heart attack or blood clot.

Intensity modulated radiation therapy (IMRT): This treatment may be recommended for recurrent tumors in the previously treated area. IMRT allows radiation oncologists to use higher radiation doses than traditional therapies would allow in these areas, while helping to spare more of the surrounding healthy bile duct tissue from harmful doses of radiation.

Intraoperative radiation therapy (IORT): IORT delivers a single, powerful dose of radiation to a tumor site immediately after a bile duct tumor is removed. IORT may help reduce the risk of recurrence, as well as reduce the need for additional radiation treatments.

TomoTherapy^®: This innovative radiation treatment is delivered by a machine that combines a form of intensity modulated radiation therapy (IMRT) with the accuracy of computed tomography (CT) scanning technology. The technology uses built-in CT scanning to confirm the shape and location of a bile duct tumor seconds before treatment begins and targets hard-to-reach bile duct tumors by sculpting small, powerful and precise radiation beams at the tumors from a full 360 degrees. It also may lessen treatment-related side effects by reducing damage to nearby healthy tissue and allow the spine, muscle tissue, lungs and other sensitive organs to avoid radiation exposure.

Photodynamic therapy: Uses light-sensitive drugs to target bile duct tumors. This may be a preferred option for patients with unresectable (tumors that cannot be removed with surgery).

Interventional radiology

In some cases, bile duct cancer may be treated with interventional radiology, a field of medicine that minimally invasive techniques to diagnose and treat cancer. One such procedure is:

Percutaneous transhepatic cholangiography (PTC): This is an outpatient procedure that requires anesthesia. In this procedure, a doctor uses a thin, hollow needle to access the bile duct through a small incision. X-ray images are taken when the needle passes through the bile ducts. This procedure may be used to perform biopsies and place stents in the bile duct. If necessary, a tube may be used to drain bile externally.

Liver transplant

If surgery isn’t an option and the bile duct cancer hasn’t spread, a liver transplant may be recommended. A liver transplant requires the surgeon to remove the liver and replace it with a healthy one from an organ donation program, or from a living person who donated part of his or her liver.

Next topic: What are the facts about bile duct cancer?