Bile Duct Cancer

Overview

The liver is the largest internal organ in our body. It performs more than 500 different vital functions. One of which is the liver acts like a detoxifier of the body, helping the body to get rid of toxins. It has a system of tubes within it called the bile ducts which collects a chemical called bile that is produced by the liver. Bile is needed by us to help us to digest fat, along with the help of enzymes produced by the pancreas. This bile is transported by the bile ducts into a main tube outside the liver called the common bile duct, which connects the liver to the small intestine (duodenum). The gallbladder is a small bag-like organ that is attached to the common bile duct. Its function is to store excess bile.

Bile Duct Cancer is cancer of the cells lining the bile ducts. The scientific term for this kind of cancer is called cholangiocarcinoma.

Bile duct cancers are classified based on which part of the bile ducts the cancer occurs:

  • Intrahepatic cholangiocarcinoma occurs in the bile ducts located within the liver
  • Hilar cholangiocarcinoma occurs in the bile ducts just outside of the liver, at the junction where the right and left hepatic ducts join together
  • Extrahepatic cholangiocarcinoma occurs in the bile duct outside of the liver

Bile duct cancers are difficult to treat. Fortunately, they are uncommon.

Symptoms

  • The classical symptom is the development of painless jaundice (yellowing of the skin and the whites of the eyes). This is especially true for the hilar and extrahepatic types of cholangiocarcinoma
  • Along with jaundice, dark urine and pale stools
  • Itchiness of the skin
  • Abdominal pain
  • Weight loss

When to Seek Treatment

A person should seek urgent medical attention if he notices his urine to be dark coloured and/or his stools to be pale in colour. These are usually the signs that accompany jaundice. Sometimes a close friend or relative may notice a yellowish discoloration of the person’s eye or skin. Another peculiar symptom that accompanies jaundice is a generalized itch of the body.

When a person exhibits one or more of these symptoms, he should consult his doctor to perform a blood test to check if he indeed has jaundice.

Diagnosis

The doctor would usually order a specialized scan such as the CT scan or the MRI scan. He may also order a cancer marker, called CA 19-9

Treatment

Treatment will depend on how advanced the cancer is and the health of the patient. Bile duct cancer is a difficult cancer to treat and a multi-disciplinary approach is needed to determine the most appropriate treatment for the person. Surgery offers the best chance of a long-term cure. Other treatment options include chemotherapy, biological therapy and radiation therapy.
In cases where surgery is not possible, and the person is jaundiced, doctors may stent the bile ducts so as to relieve the jaundice.

Causes

Cancers, including cancer of the bile duct, are due to genetic mutations of the cells.

As a result of these gene mutations, the bile duct cells start to multiply uncontrollably. These cells also have the ability to detach from the bile duct and invade into the blood stream and spread to other parts of the body, or invade into the adjacent organs around the bile duct.

Risk Factors

What are the risk factors of developing bile duct cancer?

  • Older age – this cancer tends to occur in older individuals
  • Smoking
  • Congenital bile duct problems like choledochal cyst – a condition where there is an abnormal dilatation of the bile duct
  • Infection by a liver parasite, which can occur from eating raw or undercooked fish

Consult Our Doctors

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

Dr Chan Chung Yip
HepatoBiliary, Pancreas & General Surgeon

MBBS, MMed(Surg), FRCS(Edin), MD, FAMS

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