Bile Duct Cancer

Cancer that starts in the bile ducts of the body is called bile duct cancer. It is a rare, life-threatening disease. However, if not diagnosed and treated, bile duct cancer can lead to liver damage and may spread to other body organs, eventually leading to death. The cancer of the bile duct is also called cholangiocarcinoma. It can be found anywhere in the bile ducts. Based on where cancer starts in the bile ducts, they are grouped into three types which are:

1. Intrahepatic bile duct cancer: In this, cancer starts inside the liver in the smaller bile ducts branches.
2. Perihilar bile duct cancer: In this, cancer starts at the hilum (where the right and left hepatic ducts together leave the liver).
3. Distal bile duct cancer: In this, cancer starts farther down the bile duct and closer to the small intestine.

Bile duct cancer is a  serious life-threatening disease. The exact cause of bile duct cancer is not known. However, many factors increase the risk of this cancer, such as:

1. Age above 65
2. Liver diseases such as irritable bowel disease, choledochal cysts (Cysts in the bile ducts), Caroli’s syndrome and Non-alcoholic fatty liver disease
3. Parasitic infections such as Liver flukes
4. Stones in the bile ducts
5. Ulcerative colitis
6. Primary sclerosing cholangitis
7. A family history of cancer in the bile ducts
8. Smoking
9. Drinking alcohol
10. Diabetes
11. Being obese
12. Hepatitis B and C virus infection
13. Exposure to harmful chemicals like nitrosamines, dioxins
14. Cirrhosis of liver
15. Chronic infection and inflammation of the bile ducts

The signs and symptoms of bile duct cancer are:

1. Change in the urine and stool colour
2. Bloating
3. Stomach Ache and stomach upset
4. Yellowing of the eyes or skin
5. Night sweats
6. Itching
7. Decreased appetite and Weight loss
8. Abdominal pain
9. Vomiting and nausea
10. High fever with chills
11. Feeling tired or fatigue
12. Feeling sick and unwell

Bile ducts cancer can be diagnosed through the following tests:

1. Physical examination: The doctor will perform the physical examination to check for the signs of bile duct cancer and will check for jaundice and other symptoms. A complete medical history and family history will be considered before starting the treatment.
2. Blood test: The doctor will perform the blood test to check for the concentration of some substances such as bilirubin which increases in case of a problem with the liver, bile duct, and gallbladder.
3. Tumour Markers Test:  Tumour markers are the substances produced by the cancerous cell, such as CA 19-9 and CEA, that can be found in the blood. A high level of these substances indicates the presence of cancer.
4. Ultrasound: High-energy sound waves are implemented to create detailed images of the bile ducts to check for cancer and how far it has spread and grown in size.
5. Computerised Tomography: In this diagnostic technique, x-rays are used to produce cross-sectional images of the body. It helps to find the location of cancer and the stage of cancer.
6. Magnetic Resonance Imaging: In this diagnostic technique, magnetic waves are used, which show detailed images of the soft tissues and ducts in the body. It helps to look at the bile ducts to check for blockage, lumps, or width of the ducts.
7. Percutaneous Transhepatic Cholangiography: A hollow needle is put into the bile duct through the abdomen, and contrast dye is injected through the needle. Once done, several X-rays are taken.
8. ERCP: Endoscopic retrograde cholangiopancreatography is a procedure used to detect liver cancer or other disorders related to the liver, gallbladder, pancreas and bile ducts. It involves the use of an endoscope and x-rays. 
9. MRCP: Magnetic resonance cholangiopancreatography assists doctors in determining the extent of liver cancer. It does not involve ionising radiation and uses a magnetic field and radio waves.
10. Laparoscopy: Laparoscopy can be done for the diagnosis of liver cancer and may also determine the stage of cancer. The surgeon may also collect the sample to confirm the presence of liver cancer.
11. Angiography: In this, contrast dye is injected through a catheter into the artery, and X-rays are taken. It helps to look into the blood vessels surrounding the liver and into the bile ducts along with an abnormal mass of cells (cancer).
12. Biopsy: A small piece of tissue is taken from the bile ducts and examined under the microscope to detect cancer.

Disease Progression

The various stages of bile duct cancer are:

1. Stage 0: Cancer is found in the innermost layer of the bile ducts and has not spread to the other parts and deeper layers of the bile ducts.
2. Stage 1: Cancer extends into the deeper layers of the bile ducts but has not spread to the other distant parts or lymph nodes.
3. Stage 2: In this stage, cancer spreads through the walls of the bile ducts into the nearby liver tissues and fat deposits.
4. Stage 3: It is divided into two categories which are:
   1. Stage 3A: Cancer has spread to the main portal vein, duodenum, hepatic artery, colon, and stomach wall.
   2. Stage 3B: In this stage, cancer has spread into the lymph nodes and to distant sites.
5. Stage 4: This stage is further divided into two categories such as:
   1. Stage 4A: Cancer grows in size and spreads to the main blood vessels and lymph nodes but not to the distant sites.
   2. Stage 4 B: Cancer spreads to distant sites and major organs.

Bile duct cancer can be treated using the following methods:

1. Surgery: Surgery is the treatment choice in the early stage of cancer. The doctor tries to remove cancer as much as possible along with surrounding tissue. For the small bile duct cancer, the parts of the duct carrying cancerous cells are removed, and the cut ends are joined later. 
2. Chemotherapy: These are the drugs used to kill or shrink cancerous cells. The chemotherapy may be administered intravenously or orally. It can be combined with radiation therapy or surgery to slow down the disease and relieve cancer symptoms.
3. Radiation Therapy: A high-powered energy beam of X-ray or proton is used to kill the cancer cells. In this, the doctor will make you lie on the table. Once done, the machine (which ejects high-beam energy)  is moved over you on the affected cancerous cells externally. 
4. Targeted drug therapy:  In targeted drug therapy, the treatment is focused on specific abnormalities present within cancerous cells and blocking them, which causes the cancer cells to die.
5. Immunotherapy: Our body's immune system does not attack the cancer cells because the cancer cells produce proteins similar to normal cells. Immunotherapy works by interfering with this process and helps our immune system to fight against cancer by differentiating cancer cells from normal cells.
6. Electricity-induced heating: In this, electric currents are used to heat and destroy the cancer cells. The doctor inserts the needle into the cancerous cells using the imagining test (like an ultrasound) as a guide. Once done, the needle is then heated using electric currents to kill the cancerous cells.

You should consult your doctor if you have persistent abdominal pain, fatigue, or signs and symptoms of jaundice. The doctor will seek information about your past medical history, symptoms, the intensity of symptoms when you first start experiencing them, and precautions taken so far. The doctor may recommend some tests to check for lumps or anything unusual.

Complications

Some of the risks and complications associated with bile duct treatment are:

1. Leakage of bile
2. Development of fistula
3. Recurrence of cancer
4. Liver failure 
5. Chest infection
6. Infection at the site of operation 
7. Reaction to anaesthesia
8. Bleeding
9. Blood clots and heart problems