Bile duct cancer treatment

Bile duct cancer diagnosis

The diagnosis of cholangiocarcinoma begins with a comprehensive medical examination, during which the patient must describe his symptoms and medical history. The following examinations are commonly used to diagnose the disease:

Traditional blood tests can be very informative for preliminary screening. Liver function tests are blood tests to study the functional state of the liver. For example, examining unique proteins can detect disorders of the gallbladder and bile ducts. Tumour marker tests are methods of diagnosing blood or urine for the presence of markers that indicate bile duct cancer.

Abdominal ultrasound is the primary imaging method used to diagnose bile duct cancer. With the help of ultrasound, specialist detects changes in the liver, gallbladder, bile ducts, and pancreas. Doctors can find a bile duct tumour during regular CT or MRI scans of the abdomen.

Magnetic resonance cholangiopancreatography (MRCP) is a special and very accurate method of diagnosis that allows the doctor to examine the condition of the liver, gallbladder and bile ducts in detail.

Endoscopic retrograde cholangiopancreatography (ERCP) helps examine the inside of the bile and pancreatic ducts. First, a special device is inserted into the pharynx. Next, the doctor carefully passes it through the oesophagus, stomach and duodenum. Finally, the device reaches the place where the bile duct and the duct of the pancreas are connected to investigate the presence of suspicious changes.

Percutaneous transhepatic cholangiography (PTC) is based on the use of Х-ray radiation similar to ERCP. The difference is that the doctor performs a puncture and inserts a special needle directly into the ducts. As a result, the method has high reliability and informativeness.

A biopsy is prescribed to confirm and establish the stage of the bile duct cancer. The doctor takes a sample of the affected tissue and examines it under a microscope (so-called histological examination). As a result, doctors can precisely determine the type of malignant cells.

After getting the results of histological examination, the oncologist classifies bile duct cancer by stages:

• I - a single small tumour within one bile duct or gallbladder without damaging vessels and surrounding tissue;
• II - a single large tumour or several small, without vascular damage and metastasis;
• III - several malignant neoplasms that can penetrate blood vessels and surrounding organs but do not metastasise;
• IV - several different-sized tumours that can affect vessels and organs and metastasise.

The latest treatment options for bile duct cancer

The treatment plan depends on cancer's location and size, whether it has spread beyond the bile ducts, and how much it affects your overall health. In some cases, the goal of treatment is to relieve symptoms. However, removing the cancerous tumour is the primary treatment for bile duct cancer.

Surgical treatment - in the case of gallbladder cancer, surgeons remove the gallbladder and sometimes part of the bile ducts and the liver (partial hepatectomy) as part of an operation. In case of spreading cholangiocarcinoma to the pancreas, doctors perform Whipple surgery. This complex operation involves the removal of the head of the pancreas, part of the small intestine (duodenum), gallbladder, and the bile ducts. Liver transplantation is effective in the initial stages and if a donor presents. And if it's untreated cancer, only palliative surgery will help reduce symptoms and pain.

Chemotherapy - during chemotherapy, doctors use potent cell toxins, the cytostatics. As a result, chemotherapy slows down cancer cells' growth, preventing cell division and killing them. There are several locally advanced chemotherapy options: Transarterial chemoembolisation - the doctor uses tiny beads to block the blood supply to the tumour and destroy it with chemo drugs. Transarterial chemoperfusion - chemo drugs are injected directly into the tumour artery.

Immunotherapy - the method aims to activate your immune system against foreign malignant cells in the gallbladder and bile ducts. Target therapy - the technique of cholangiocarcinoma treatment, in which antitumor drugs target specific damaged enzymes of bile ducts. So it works on the cause and doesn't affect healthy cells.

Ablation therapy (RFA, MWA, Ethanol) - ablation therapy is the method of bile duct cancer treatment. A doctor can use radio waves (radiofrequency ablation, RFA), microwaves (microwave ablation), or alcohol (ethanol ablation).

Radioembolization - is an effective and breakthrough method for treating malignant neoplasms. It is based on destroying cancer cells with the help of radioactive substances delivered through arterial vessels. They block the blood flow to the tumour tissues and lead to the destruction of bile ducts cancer.

Radiation therapy - the method works with high-energy X-rays. Radiotherapy can stop the tumour from growing but cannot eliminate it. Therefore, radiotherapy is usually performed after (adjuvant) or before (neoadjuvant) the surgery to reduce possible relapse. Brachytherapy (internal radiotherapy) - the method of contact internal radiotherapy for cholangiocarcinoma uses the installation of radioactive drugs directly into the tumour. The most advanced radiotherapy option is proton beams. Proton therapy - is the type of radiation therapy for cholangiocarcinoma without damaging surrounding organs. In addition, it makes proton therapy more precise than conventional radiotherapy.

Photodynamic therapy (PDT) - first, doctors administer a substance that makes the cancerous tissue sensitive to laser beams, a so-called photosensitiser. Then, laser light is introduced into the bile duct via an endoscope, which destroys the tumour tissue. Healthy tissue is largely spared.