Treatment
Treatment for bile duct cancer depends on the location and extent of the disease and whether or not the tumor can be removed through surgery. The doctor may recommend any of the following procedures to treat bile duct cancer:
Surgery
Surgery is the primary treatment for resectable bile duct cancer, or cancer that can be completely removed with surgery. Unfortunately, due to the advanced nature of the disease at diagnosis, only about 10% to 20% of patients have resectable tumors at initial evaluation. If the tumor is unresectable or the cancer is widespread, the doctor may recommend palliative surgery to treat symptoms and complications of the disease, such as a blockage of the bile ducts. The doctor may recommend any of the following surgical procedures:
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Bile duct removal
For early-stage extrahepatic tumors that are confined to a bile duct, the surgeon may be able to remove only the portion of the bile duct that contains cancer. The doctor then reattaches the remaining bile ducts to the small intestine to allow bile to flow normally. However, in most cases partial hepatectomy is required as part of the operation described below.
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Partial hepatectomy
The doctor may recommend a partial liver surgery or hepatectomy to treat intrahepatic bile duct cancer, or cancer that starts in the bile ducts inside the liver. In this procedure, the surgeon removes the part of the liver where the tumor is located.
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Whipple procedure
This operation removes the head of the pancreas, a portion of the stomach, a portion of the small intestine, a portion of the common bile duct, the lymph nodes near the pancreas, and the gallbladder. The doctor may recommend this procedure for bile duct tumors located near the pancreas. This is a complicated operation but when performed by a surgeon who performs many of these procedures regularly, severe side effects and complications are uncommon.
Palliative surgery
In some cases, the tumor may be blocking the bile ducts, preventing the flow of bile from the liver to the small intestine. This often results in jaundice, itching and other symptoms. If the tumor is unresectable, the doctor may recommend surgery to relieve these symptoms and complications. The doctor may also place a stent to allow bile to drain out of the blocked area.
Additional Treatments
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Radiation Therapy
Radiation therapy uses high-energy rays produced by a machine to destroy cancer cells. Doctors may give radiation therapy to shrink the tumor before surgery and eliminate any traces of cancer left after surgery. The doctor may also use radiation as a primary treatment for patients with unresectable tumors, or palliatively to shrink tumors and relieve complications. The most common form of radiation for this disease is external beam radiation, in which a large machine delivers radiation to the tumor from outside the body directed from multiple different angles. In internal radiation, radioactive pellets are placed inside a small tube, which is placed inside the bile duct temporarily. Other types of radiation therapy include stereotactic body radiation therapy (SBRT), intensity modulated radiation therapy (IMRT) and proton beam radiation therapy. SBRT involves the delivery of very high doses of radiation in the span of about one or two weeks and is best for smaller tumors. IMRT is used when the tumor is near the gastrointestinal tract. IMRT shapes the radiation beams, aims them from different angles, adjusts their intensity to limit damage to healthy tissue and reduces side effects. Proton beam radiation involves the use of high energy particles to target tumors without harming nearby organs. Speak to your doctor about which type of radiation therapy is right for you.
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Chemotherapy
Chemotherapy uses cancer-killing drugs that travel through the bloodstream and destroy any cancer cells they encounter. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). The doctor may recommend chemotherapy before surgery to shrink the tumor or after surgery to kill any remaining cancer cells in the body. The doctor may also use chemotherapy as the main treatment for more widespread cancers.
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Targeted Therapies
Targeted therapies or precision medicines are designed to block a specific target, usually a protein or genetic change, that can influence the growth and development of cancer cells. Since targeted therapies directly attack the cancer cells, they tend to have less side effects than traditional medications such as chemotherapy, which target all rapidly-dividing cells. Recently several genetic targets have been identified in bile duct cancers. These include IDH1/2, FGFR and HER2gene mutations that are found through molecular testing. Talk to your doctor to see if your tumor should undergo molecular testing and if targeted therapy is a treatment option for you.
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Immunotherapy
Immunotherapy is a new cancer treatment that stimulates the body's immune system to attack cancer cells. In combination with chemotherapy, it has been shown to improve survival in patients with widespread bile duct cancer.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. They can be open in one site or multiple sites throughout the country. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.
