Cholangiocarcinoma

It is cancer of the biliary ducts. It occurs when a malign tumor, or cancer, begins to grow within the ducts that carry bile from the liver to the small intestine. Tumors of the primary biliary ducts affect 1 out of 100,000 people each year in the United States. More than 95% of these tumors are considered cholangiocarcinoma (epithelial adenocarcinoma); it is more frequently found in men and generally affects individuals older than 50.

What are the symptoms?

Symptoms depend on the location of the tumor or tumors. They may include:

• Jaundice (yellow coloring of the skin and the white of the eye)
• Pale feces
• Itchiness throughout the body
• Fever
• Weight loss
• Progressive weakness

How is it diagnosed?

Diagnostic exams for the precise diagnosis include:

Laboratory tests

Blood tests examine liver function and search for markers that may be indicative of a tumor. Tests include:

• Liver function tests
• CEA and CA19-9, markers associated with gastrointestinal tumors
• Alpha-fetoprotein (AFP) marker

Imaging methods

These methods allow the visualization of detailed images of interior organs.

Abdominal ultrasound

Generally the first test performed when cholangiocarcinoma is suspected. Sound waves are utilized to create an image of the liver and biliary ducts. This test may show dilation or tightening of the ducts around the site of the tumor.

CT scan

A high-resolution x ray that an detect minute masses associated with cancer of the biliary ducts.

MRI

Slightly superior in than CT scan for the visualization of cholangicarcinoma. This test uses magnetic waves to create a detailed image of the biliary tree.

Positron Emission Tomography (PET) scan

A form of nuclear imaging. The patient is administered a small dosage of radioactive sugar that, once in the body, concentrates around tumor lesions in order to detect any abnormalities within the biliary duct.

Endoscopic Retrograde Cholangopancreatography (ERCP)

This method uses a flexible scope for the visualization of the gastrointestinal tract from within. In the case or ERCP, a side-viewing endoscope is used to visualize the entrance to the biliary duct and inject a ratio-opaque contrast for examination of the duct via x rays. A biopsy sample of biliary tissue may be obtained during the procedure for further examination under the microscope.

Cholangiography

Uses a cholangioscope, a special kind of endoscope that may be inserted into the biliary duct. It is utilized to directly visualize and obtain tissue of the tumor. It is possible to perform it simultaneously with ERCP.

Endoscopic Ultrasound (EUS)

This procedure combines an endoscopy with ultrasound to obtain images of the gastrointestinal tract. EUS is useful for the detection of abnormalities within the biliary duct

What is the treatment for cholangiocarcinoma?

Destruction of the tumor tissue is the best opportunity to cure cancer of biliary ducts. The treatment depends on the size and location of the tumors. Treatment options include:

• Surgery
• Endoscopic therapy
• Radiologic therapy
• Liver transplant
• Other approaches for treatment

Surgery

The surgical extraction of tumors is the only option that has potential for full cure. The surgical approaches have become more aggressive against tumors, yielding better outcomes. Surgery of the biliary duct implies the resection of a large area of the liver. The exact nature of the procedure depends on the tumor’s location and the progress of disease.

The survival rates are higher when surgery takes place in a specialized institution that involves a multi-disciplinary team composed, ideally, by a surgeon, and oncologist, an endoscopist, interventional radiologist, and support staff.

Endoscopic treatment

If the patient is not a good candidate for surgery, it is possible to proceed with endoscopic dilation of the biliary ducts.

During an endoscopic biliary dilation, a physician uses and endoscope to access the biliary ducts and stretches or dilates the ducts with the use of an expandable ballon. Metal or plastic stents can be placed to maintain the latency of the ducts and allow flow of bile toward the small intestine.

Radiologic therapy

A specialized radiologist can perform a procedure called palliative percutaneous transheptatic biliary dilation. The aim of the procedure is to drain the obstructed bile into the intestine by placing stents through small openings in the bile ducts. This requires undergoing the procedure in regular intervals in order to replace the stents to avoid infection.

Liver transplant

If the cholangiocarcinoma cannot be removed through surgery and has not spread to neighboring organs, a liver transplant can offer a good long-term survival outcome. The patient is enrolled in a protocol of liver transplant to evaluate if he or she is an adequate candidate. The new liver can originate from a healthy person who chooses to donate a part of their liver for the patient. Those who receive a liver transplant are prescribed medications for the rest of their life to avoid their body’s rejection of the transplanted liver.