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Bile Duct Cancer (Cholangiocarcinoma)

What are the types of liver cancer? 

Liver cancer may originate in the liver (primary liver cancer also called hepatocellular carcinoma), the bile ducts (bile duct cancer also called cholangiocarcinoma) or spread to the liver from other sites (liver metastases also called secondaries)

What is Biliary cancer?

Liver cancer happens when normal cells in the bile ducts change into abnormal cells and grow out of control. Biliary cancers are more common in older patients.  

What are the symptoms of bile duct cancer?

Biliary cancers cause symptoms when they block the bile ducts causing yellowing of the skin and eyes (jaundice) or cause an infection in the bile ducts (cholangitis). Patients feel full after eating, or lose weight.  Often patients will only present with abnormal blood tests or have a lump seen at a CT or MRI scan performed for another reason.

Having any or some of these symptoms does not mean you have bile duct cancer. Several other minor conditions can cause these symptoms. However, you should talk to your doctor about these issues if you have any.

What are the tests for Bile duct cancer?

If your doctor suspects you have bile duct cancer, he or she will do one or more of the following tests:

What is bile duct cancer staging?

Cancer staging is a way in which doctors find out if a cancer has spread past the layer of tissue where it began and, if so, how far.

How is Bile duct cancer treated?

The bile ducts connect the liver to the small bowel via the pancreas.  The position of the tumour, high (mainly in the liver) or low (mainly in the pancreas) determines the treatment required.   

  • Curative treatment of bile duct cancers requires surgery to remove part of the liver (liver resection) or remove the pancreas and lower bile ducts (Whipple’s procedure) or both.
  • Non-curative treatments include the placement of metal stents using ERCP or via needle directly into the liver.  The response to chemotherapy and radiotherapy can be variable.
  • Ablation therapy for non-removable tumours – A newer treatment for bile duct cancers that cannot be removed, which is still in an experimental phase, is a Nano knife procedure.  This uses electrical current to kill the cancer cells and leave behind vital blood vessels.  Nanoknife is currently available at small number of hospitals for HPB cancers. The Prince of Wales Public and Private Hospitals offers Nanoknife to public and private patients.

What happens after treatment?

After treatment, you will be checked every so often to see if the cancer comes back. Regular follow up tests usually include exams, blood tests, and imaging tests.

You should also watch for the symptoms listed above. Having those symptoms could mean the cancer has come back. Tell your doctor or nurse if you have any symptoms.

What is the prognosis of Bile duct cancer?

The prognosis of bile duct cancer is highly variable and largely dependent on whether the tumour can be removed and whether it has spread to the surrounding structures and lymph nodes.  Of the people who undergo surgery, up to 40% are still alive at 5 years.