Cholangiocarcinoma, commonly known as bile duct cancer, is a rare form of cancer. It impacts the bile ducts, a network of tubes that transport bile from the liver and gallbladder to the small intestine. Bile helps the body eliminate waste and digest fats. 

As the cancer grows, it very often leads to bile duct blockage and gallbladder or liver problems. Available treatments can help control symptoms and improve the life quality in people with cholangiocarcinoma.

Dr. Deep Goel specializes in treating bile duct cancer. With extensive experience and a compassionate approach, he offers advanced surgical interventions tailored to each patient. Dr. Goel’s commitment to excellence and patient well-being makes him a trusted figure in bile duct cancer management.

What Is The Anatomy Of The Bile Duct?

Bile duct cancer can form anywhere inside the biliary tract or biliary tree. The biliary tract starts with the common hepatic duct (inside the liver), which meets the cystic duct (connects the gallbladder) at the top of the common bile duct. The bottom of the bile duct joins the pancreatic duct (connects the pancreas) before forming the ampulla of Vater, which opens into the duodenum of the small intestine.

What Types Of Cancer Are Associated With The Bile Duct?

Bile duct cancers are classified into three types based on their location in the biliary tract:

• Intrahepatic Cholangiocarcinoma (IC): This type starts in the hepatic duct.
• Perihilar Cholangiocarcinoma (PC): A perihilar cholangiocarcinoma or Klatskin tumor is an extrahepatic bile duct tumor that forms at the junction between the common hepatic ducts and the cystic ducts (the top of the common bile duct).
• Distal Cholangiocarcinoma (DC): This extrahepatic type begins in the bile duct near the small intestine. These types may impact the gallbladder or the section of the tract that passes through the pancreas or duodenum.

What Are The Available Treatment Options?

The type, stage, location, and size of the tumor, as well as your general health and preferences, affect the course of treatment for bile duct cancer. The treatment primarily aims to destroy the cancer cells, alleviate bile duct obstruction symptoms, and stop or delay cancer recurrence or spread.

The main types of treatment are discussed below.

a) Surgery

This is the only potentially curative treatment for cholangiocarcinoma. Surgery may involve removing part or all of the bile ducts and affected organs to reroute bile and alleviate blockages. However, only a small percentage of people with this cancer are eligible for surgery, as most tumors are too advanced or located in difficult places to be removed entirely.

Bile duct surgeries consist of:

• Bile duct resection: Remove the affected bile duct and reconnect the remaining bile ducts to the intestine. It is used for cancers that affect bile ducts outside the liver.
• Whipple procedure: The damaged bile duct, adjacent lymph nodes, and a portion of the small intestine and pancreas are removed. It is used for tumors that are near the pancreas and small intestine.
• Biliary bypass: Creates a new route for bile to flow from the liver or gallbladder to the intestine, bypassing the blocked bile duct. Relieves discomfort, jaundice, and itching caused by bile duct blockage.
• Stent placement: Opens a blocked bile duct by inserting a metal or plastic tube (stent) to keep it open and allow bile to flow—Relieves bile duct blockage symptoms.
• Radiosurgery: Targets and destroys cancer cells in a precise area using high-energy radiation beams. Treats small tumors that cannot be surgically removed or have recurred after surgery. It may also help resolve symptoms in palliative or end-of-life care.

Liver surgeries that can help those with cholangiocarcinoma include:

• Partial hepatectomy: The removal of a portion of the liver along with the damaged bile ducts to treat hepatic bile duct cancer.
• Hepatic lobectomy: Removal of a whole liver lobe (anatomic section) along with the affected bile ducts. It is used for cancers that have spread inside the liver.
• Liver transplant: Replacing the liver with one from a healthy donor liver. It may be required for cancers that have spread too much inside the liver or are difficult to reach.

b) Chemotherapy

Chemotherapy involves administering medications to destroy or prevent the growth of cancer cells. Chemotherapy is used:

• To reduce the size of the tumor before surgery to make it easier to remove (neoadjuvant chemotherapy).
• To reduce the risk of recurrence after the surgery (adjuvant chemotherapy).
• As the primary treatment for advanced or inoperable tumors (palliative chemotherapy).

Chemotherapy can be given by mouth (orally), by injection into a vein (intravenously), or directly into the liver through an artery (hepatic arterial infusion). Chemotherapy is typically administered in cycles of three to four weeks to give the body time to heal. The number and duration of cycles depend on the response and tolerance of the patient.

The most commonly used chemodrugs for cholangiocarcinoma are Gemcitabine and Cisplatin. These drugs are usually given together as a combination therapy. Other drugs that may be used include Fluorouracil (also called 5-FU), Oxaliplatin (Eloxatin), and Capecitabine (Xeloda).

The effectiveness and side effects of chemotherapy may vary from person to person. Chemotherapy frequently causes side effects such as nausea, vomiting, hair loss, exhaustion, low blood cell counts, and an increased risk of infection.

c) Radiation Therapy

Cancer cells are damaged or destroyed in radiation therapy using high-energy rays or particles. As with chemotherapy, radiotherapy can be used in the form of neoadjuvant, adjuvant, or palliative radiation therapy.

Radiation therapy can be administered from inside the body (brachytherapy) or from the outside (external beam radiation therapy). These are usually issued in successive doses for weeks to months. Chemo can also be combined with radiation therapy (chemoradiotherapy) or radiosurgery to increase its effectiveness.

Some side effects of radiotherapy for cholangiocarcinoma include fatigue, low blood cell counts, skin irritation, nausea, vomiting, diarrhea, and increased risk of infection. Depending on the dose, duration, and type of radiotherapy, the side effects can change. Newer techniques and supportive care help reduce side effects and improve outcomes.

d) Other Treatments

These are treatments that use heat, cold, electricity, or radiation to destroy cancer cells in the bile ducts, such as:

• Radiofrequency Ablation uses high-frequency electric currents to heat up and get rid of small tumors in the liver.
• Cryoablation uses extreme cold to freeze and remove small tumors in the liver.
• Photodynamic Therapy uses a light-sensitive drug and a laser to activate it to eliminate tumors that block or narrow the bile ducts.
• Selective Internal Radiation Therapy uses tiny radioactive beads to deliver radiation directly to the tumors that have spread inside or outside the liver.

Some of these therapies may be good options for getting rid of leftover tumor cells in the area after surgical removal.

Dr. Deep Goel explains how these treatment options help. He says, “We have different ways to treat your problem. These treatments are tools in a toolbox, and we choose the ones that best fit your situation. This way, we can ensure you get the best care possible, designed to help you feel better and return to a healthy life.”

“Dr. Deep Goel’s expertise in bile duct cancer treatment changed my life. His tailored approach and surgery gave me hope. The team’s care and understanding made my journey smoother. Grateful for the renewed chance at a healthy life,” says one of Dr. Deep’s patients.

“Choosing Dr. Goel for bile duct cancer was the best decision. His personalized treatment, including surgery and chemotherapy, made a significant difference. The team’s support and Dr. Goel’s compassionate care made my recovery remarkable. Forever thankful,” says another of Dr. Deep’s patients.

What Is The Cost Of Bile Duct Cancer Surgery In India?

The cost of Bile Duct Cancer procedures in India varies according to the type of surgery, facility, and patient health. Typically, it ranges from ₹5,00,000 to ₹15,00,000 (about $6,700 to $20,000). 

Conclusion

Treating bile duct cancer involves surgeries like resection or bypass, depending on the tumor’s location. Chemotherapy and radiation therapy play roles, too. Costs in India vary based on the procedure and health facility. Understanding treatment options is crucial for informed decisions.

FAQs

Q: Is bile duct cancer common?

A: No, bile duct cancer, or cholangiocarcinoma, is considered rare.

Q: Are all bile duct cancers treated with surgery?

A: Only a small percentage of cases are eligible for surgery, depending on factors like tumor size and location.

Q: Can chemotherapy cure bile duct cancer?

A: Chemotherapy aims to control and manage cancer, but its effectiveness varies. It may be used as part of the treatment plan.

Q: Is radiation therapy always necessary for bile duct cancer treatment?

A: No, radiation therapy is used based on factors like tumor size and location, and it may not be part of every treatment plan.

Q: Can bile duct cancer be inherited or passed down through families?

A: In most cases, bile duct cancer is not inherited, but genetic factors may play a role. Discussing family medical history with healthcare providers for a more personalized understanding is advisable.

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