Bile duct cancer, also known as cholangiocarcinoma, is a type of cancer that affects the bile ducts in our digestive system. Bile ducts are tiny but important tubes that are situated in and around our liver. They help to transport a green-yellow liquid called ‘bile’ between the liver, gallbladder, and small intestine, where it breaks down fats in our food.
How common is bile duct cancer?
Bile duct cancer is quite rare. It is diagnosed in fewer than 8 in 100,000 people worldwide every year, though some areas, such as Thailand and other eastern countries, can have much higher rates. In the UK, around 3,100 people are diagnosed with the condition every year.
However, rates of bile duct cancer do seem to be increasing, and researchers don’t yet know exactly why this is. Some of this change is linked to increases in liver disease and our changing lifestyles, but we need more international cancer research to understand exactly how all of the pieces fit together.
There are three main types of bile duct cancer, which start in different areas of the biliary tract:
Intrahepatic bile duct cancer starts in bile ducts inside the liver, perihilar bile duct cancer starts in bile ducts just outside the liver, and distal bile duct cancer starts in bile ducts closest to the bowel.
Is bile duct cancer curable?
Bile duct cancer is sometimes curable if it is diagnosed before it has spread, and doctors are able to completely remove it with surgery, meaning that no traces of cancer remain, and it does not return.
Unfortunately though, bile duct cancer has often progressed and spread by the time it is diagnosed. This is partly because early bile duct cancer often causes few or no symptoms, which makes it harder to detect and diagnose. This can reduce the chance of a complete cure, although there are still many individual factors that can affect this.
Even if bile duct cancer is not able to be fully cured, it is often treatable. This means that doctors are able to use various treatments to slow its growth, and help with symptoms.
What causes bile duct cancer?
We still don’t really know exactly why bile duct cancer develops and in fact, there is still no clear cause for around 2 in 3 people who are diagnosed with the disease. For some cases though, researchers have identified some clear risk factors that can increase the likelihood of developing the condition:
Older age
While bile duct cancer can develop at any time, most people are diagnosed between the ages of 50 and 70 years old.
Existing health conditions
Like certain chronic conditions that affect the biliary tract and nearby organs e.g. cirrhosis of the liver, and some types of inflammatory disease. A link has also been found with gallstones or gallbladder disease that can lead to inflammation and infection.
Exposure to chemicals
Including plutonium and thorotrast. This is a dye that was sometimes used in x-rays in the 1960s, but isn't used anymore.
Infection with liver fluke parasites
These can harm the bile ducts. It is quite rare in the UK, but can be a more common cause of bile duct cancer in other countries.
Lifestyle factors
There is some research that suggests that certain lifestyle factors, such as smoking tobacco or being overweight may also be a risk factor for bile duct cancer, but the evidence for this is still not clear.
How is bile duct cancer diagnosed?
If your doctor has concerns about your symptoms, they will refer you to see a specialist, who may ask you to have some of these tests and scans:
- Ultrasound. A special camera that is used to create pictures of a part of your body. It may be done from outside your body, or using an internal camera called an endoscope.
- CT scans. Using x-rays to create detailed 3D images of inside your body. CT stands for computed tomography.
- MRI scans. Where you lay very still in a large machine that uses magnetism and radio waves to create a detailed picture of part of your body. MRI stands for magnetic resonance imaging.
- MRCP scan. A special type of MRI scan that can take detailed pictures of the bile ducts and other digestive organs. MRCP stands for magnetic resonance cholangiopancreatography.
- Biopsy. Where cancer cells are collected and analysed in a laboratory.
What are the symptoms of bile duct cancer?
Symptoms of bile duct cancer can be quite hard to spot. Early in the disease you may not notice any symptoms at all, or symptoms can be quite general. For example, you may feel tired all the time, or lose your appetite.
More specific symptoms may include:
- Pain or discomfort in the stomach and abdomen area
- Having a high temperature (fever) or feeling cold and shivery
- Losing weight
- Feeling sick or unwell
- Jaundice
Jaundice can appear as a symptom if the cancer blocks the bile duct. Symptoms of jaundice include:
- Yellow skin and eyes (which can be harder to spot with darker skin)
- Dark yellow urine
- Pale stools (poo)
- Itchy skin
These are all relatively common symptoms and can be caused by many other conditions, not just cancer. But if you are feeling concerned, it is always worth being checked out by a doctor.
How is bile duct cancer staged?
After diagnosis, further tests and scans will help doctors to stage and grade the bile duct cancer.
The stage of the cancer tells doctors the size and position of the cancer, and whether it has spread. The grade of the cancer tells doctors more about what the cancer cells look like under a microscope, and how quickly they might grow or spread.
Knowing the stage and grade of your bile duct cancer can help doctors make sure they find the best treatment for you.
How is bile duct cancer treated?
Treatment depends on the stage and grade of the cancer, and also sometimes on its molecular and genetic profile. For a small number of people, it may be possible to treat and completely cure the cancer. For others, treatment is aimed at controlling the growth of the cancer, and helping with symptoms.
- Surgery can sometimes completely remove the cancer, or reduce its size.
- Chemotherapy can reduce the size and slow the growth of the cancer, or stop it coming back after surgery.
- Radiotherapy can be given on its own or along with chemotherapy to stop the cancer coming back after surgery.
- If the cancer is in the liver, a very precise type of radiotherapy called stereotactic ablative radiotherapy (SABR) may be used.
- Targeted therapies work by targeting specific molecules in the cancer cell. They might be used in combination with other treatments for more advanced types of bile duct cancer.
- Immunotherapies help our own immune system target the cancer. They can be used in combination with other treatments like chemotherapy, to help control the growth of the bile duct cancer.
What new treatments are there for bile duct cancer?
Thanks to international cancer research, treatments are continuously evolving, and doctors now have a wider range of powerful new treatments. This is particularly crucial for people with a more advanced disease that may not be completely curable, or that has come back.
These include targeted and immune-based therapies, which can help to slow the growth of cancer, and help people with more advanced disease to live longer and in better health.
Why do we still need more research into bile duct cancer?
We need to find out who is most at risk of bile duct cancer.
Bile duct cancer, or cholangiocarcinoma, is a relatively rare type of cancer, but it is becoming more common. We don’t really know why this is, but we do know that we need more research to understand who is most at risk of developing bile duct cancer, so that we can find ways to protect them, and prevent the disease from developing.
We need to find better ways to detect and diagnose bile duct cancer.
Bile duct cancer is often said to grow ‘silently’. This is because it tends to have very vague, or no symptoms at all in the early stages, and is often only detected when it becomes more advanced. This means that although cases of early-stage disease can sometimes be cured by surgery, unfortunately, this is just not an option for many patients.
If we can find a way to detect bile duct cancer earlier, we can give more patients the chance of a full cure. Thanks to research, amazing advances like liquid biopsies, which aim to detect cancer using samples of blood, are already on the horizon. With more research they can become more effective, for more people.
We need to find out the molecular ‘nuts and bolts’ of bile duct cancer.
Bile duct cancer is a very complex disease. Bile duct tumours are a jumble of ad-hoc genetic and molecular changes, each of which could potentially be targeted by a new treatment, or a biomarker that could help a new test quickly detect disease.
Discovery research has already uncovered many of these unique molecular signatures, and this knowledge is already helping doctors identify which targeted treatments and immunotherapies can help patients with more advanced bile duct cancer live for longer.
But we can do more, and many of our researchers are working to understand exactly how cancer works, and find new molecules that could be the basis for a powerful new targeted therapy.
What progress is Worldwide Cancer Research making?
Curestarters support us to fund bold ideas that take research in entirely new directions. One day, ideas like these could radically change the course of how we detect and treat bile duct cancer.
Professor Halder and his team in Belgium...
...are working on a new type of treatment called ‘regenerative cancer therapy’. This therapy could one day help people with bile duct cancer live longer.
Dr Fulvio Chiacchiera and his team in Italy...
...are exploring why tumours in the liver are more likely to develop when a protein called BAP1 is mutated. Some types of bile duct tumour also have changes to BAP1, and uncovering this process will help to identify better ways to diagnose and treat patients.
Your bile duct cancer (cholangiocarcinoma) FAQs:
How common is bile duct cancer?
Bile duct cancer is considered quite rare. It is generally diagnosed in fewer than 8 in 100,000 people worldwide every year. Though some areas, such as Thailand and other eastern countries, can have much higher rates.
Is cholangiocarcinoma the same as liver cancer?
No, cholangiocarcinoma (or bile duct cancer) is a cancer of the bile ducts - small vessels that carry bile in and around the liver and other organs. Liver cancer is a cancer of the liver cells.
Who is most at risk of cholangiocarcinoma?
We don’t yet fully know who is most at risk of developing cholangiocarcinoma, and that’s one thing researchers are working hard to find out.
We do know that certain groups of people, like those with chronic health conditions that affect the liver or nearby organs, or who have gallbladder problems, can be more likely to develop the disease. But this is not always the case for everyone.
Populations where infection with the liver fluke parasite is more common also seem to have a higher risk of developing bile duct cancer.
What are the early symptoms of bile duct cancer?
Bile duct cancer often has few or no symptoms in its early stages. Or symptoms may be vague and easily confused with other conditions - such as tiredness, nausea, or generally feeling unwell. That’s why we need more research to help us detect bile duct cancer earlier, when there is a greater chance of a cure.
Why is bile duct cancer considered difficult to treat?
Bile duct cancer can sometimes be considered difficult to treat because it is often not detected until it is more advanced, and has spread further than the local area.
This can make surgery difficult, and doctors often must rely on other treatments, such as chemotherapy, radiotherapy, and targeted treatments to control tumour growth, and reduce symptoms.
Bile duct cancer may also, unfortunately, develop resistance and come back after treatment - adding another layer of complexity to managing this type of cancer. More research into why bile duct cancer can sometimes come back will help to improve how effectively we can treat the disease.
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