Bile Duct Cancer

Types & Stages

Bile duct cancers are grouped into different types depending on where in the bile ducts the cancer started growing. Some parts of the bile ducts are inside the liver and other parts are outside the liver, near the pancreas and small intestine.

• Extrahepatic cancers start in the bile duct branches outside of the liver. This is the most common type of bile duct cancer. There are two kinds of extrahepatic bile duct tumors:
   
  • Perihilar cancers start at the hilum, where the left and right hepatic ducts have joined and are just leaving the liver.
     
  • Distal cancers are found farther down the bile duct, closer to the small intestine.
     
• Intrahepatic cancers start in the bile duct branches inside the liver.

If you are diagnosed with bile duct cancer, your doctor will run tests to find out what stage it is. The stage means how big the tumor or tumors are and whether they have spread outside of the bile ducts. Early-stage bile duct cancer is only in the bile ducts. Late-stage bile duct cancer has spread to other parts of the body.

Signs & Symptoms

Symptoms of bile duct cancer include:

• yellowing of the skin and eyes (jaundice)
• intensely itchy skin
• white or light-colored stool
• loss of appetite

Causes & Risk Factors

Conditions that cause chronic inflammation in the bile ducts can raise your risk of developing bile duct cancer.

Conditions that raise the risk of bile duct cancer include:

• Cysts in the bile ducts, which can block the ducts and cause inflammation.
   
• Primary sclerosing cholangitis, a disease that causes chronic inflammation and scarring in the bile ducts.
   
• Ulcerative colitis, which is inflammation in the intestines. It is linked with primary sclerosing cholangitis.
   
• Parasites that live in the bile ducts, called Chinese river fluke. This parasite is common in Asia but rarely found in the U.S.

Not everyone with these risk factors will develop bile duct cancer. Sometimes people with no risk factors develop bile duct cancer.

Screening

There are no screening tests for bile duct cancer. Bile duct cancer is usually found when it has grown or spread enough to cause symptoms.

Diagnosis

At Stony Brook Cancer Center, our doctors use a combination of tests to diagnose bile duct cancer, such as:

• Blood tests to see how the bile ducts and liver are working.
   
• Imaging tests, like ultrasound and CT, to look at the bile ducts.
   
• Biopsy, to look at a sample of tissue from the bile ducts under a microscope.

Treatment

Your treatment will depend on many factors, including the stage of your cancer. Your treatment may include a combination of:

• Surgery to remove tumors in the bile ducts, lymph nodes, liver and/or nearby organs like the pancreas.
   
• Chemotherapy, a type of drug that stops the growth of cancer cells. Treatment for bile duct cancer often involves a combination of chemotherapy medicines.
   
• Radiation therapy. At Stony Brook Medicine, most of our radiation treatments are given with x-rays and electron beams generated by machines called linear accelerators.
   
• Targeted therapy, which is therapy that is targeted to the genetic or molecular changes in your tumors.
   
• Immunotherapy, a type of therapy that helps your immune system find and attack your tumors.

At Stony Brook Medicine, our Palliative Care Service is available to everyone, no matter the stage of your cancer. This specialized team helps patients and their families cope with the physical, emotional, and spiritual distress of cancer. They can provide relief from symptoms of bile duct cancer and/or its treatment, such as pain, nausea, fatigue and loss of appetite.