Bile Duct Cancer: Symptoms, Stages, Causes, Diagnosis & Treatment

According to the American Cancer Society, cancer is the abnormal growth of cells in a part of the body which can spread from one part to the entire body as well, and is a life-threatening disease.

Bile duct cancer is a cancer arising from the bile ducts. Bile ducts are the group of slender ducts that carry digestive juices from the liver to the gall bladder. Bile duct collects the bile from the liver, where it is produced and then strains it into the gall bladder and small intestine, where the fats of the foods are broken down.

There are different parts of bile duct like the tiny tubes present in the liver, which are known as ductules that come together to make smaller tubes called ducts and the parts present in the liver are known as intrahepatic bile ducts. There are various types, causes, symptoms and treatment for the disease.

Bile Duct Cancer: Causes

The exact cause of bile duct cancer is unknown but like the other cancers it may affect a person due to the error in the DNA mutations. The abnormal growth of the cancer cells may lead to the formation of a tumor or mass which when untreated spread towards the nearby tissues and organs.

There are a few factors that puts a person at a higher risk of suffering from bile duct cancer than others. It is not sure that they suffer from cancer but they are at a higher risk of being affected.

• If you have gallstones that are formed due to high levels of cholesterol or bilirubin- a substance found after the damage of red blood cells.

• If the gallstones obstruct the bile duct resulting in inflammation of the gall bladder, known as cholecytisis which is an acute chronic disease.

• When the gall bladder turns into a white, porcelain-like substance by being calcified due to the condition of cholecytisis.

• According to the NIH, 5 percent of small growths in the gall bladder are cancerous and are known as gallbladder polyps.

• According to the American Cancer Society, women are four times more at risk of bile duct cancer than men.

• People who are more than 50 years of age, have a history of bile duct problems or have close family members suffering from bile duct cancer are at higher risk of suffering from it.

Bile Duct Cancer: Symptoms 

• Pain in the upper side of the abdomen

• Jaundice characterised by yellow skin and white eyes

• Enlarged gallbladder

• Dark yellow urine

• Nausea and vomiting

• Fever or feeling bloated

Bile Duct Cancer: Diagnosis

Generally a person is diagnosed with bile duct cancer when the gallbladder is removed due to cholecystitis or other health related problems. Other ways to diagnose bile duct cancer are:

• Blood tests that help to check the functioning of the gall bladder, bile ducts and the liver and help the doctor understand the reason for the symptoms.

• Ultrasound is the first easy and basic test that doctors recommend to diagnose bile duct cancer. This method uses sound waves to get the image of the liver and gall bladder.

• CT scan and MRI scans are the other common ways to diagnose bile duct cancer which get closer and detailed image of the liver as well as the surrounding organs.

• PTC is another test in which dye is used to diagnose the blockages in the bile duct system.

• ERCP tests use a thin tube with a torch and light at the end of which is moved from the mouth towards the small intestine and the dye is used to capture the blockages in the bile duct.

• Biopsy is another way to diagnose which part of the tumor is cut and observed under a microscope to confirm the bile duct cancer because all tumors are not cancerous.

Bile Duct Cancer: Stages 

Doctors prefer to test the stage of a cancer because it helps us know the severity and the extent of spread of the disease. It also helps the doctors to decide the kind of treatment that is best suited for the person.

According to the American Cancer Society, there are 3 stages of bile duct cancer:

• Intrahepatic bile duct cancer: It is the early stage of bile duct cancer also known as stage 0, it starts within the liver. It means that the cancer has affected only the inner layers of the bile duct and has not spread to the outer layers. There may be no tumour or a small tumour.

• Perihilar bile duct cancer: It starts at the uppermost layer of the liver and is the first or second stage of the disease depending on the severity of symptoms. It infects the deeper layers of the bile duct including the muscle and fibrous tissues. The tumor might grow into the liver tissue but does not affect the nearby organs or lymph nodes.

• Distal bile duct cancer: It grows beyond the bile duct and is the last stage of cancer. The cancer at stage grows in to the depth of the bile duct, affecting the liver, abdomen or lungs of the person.

Bile Duct Cancer: Treatment

There are various options for treating the bile duct cancer depending on the severity of the case and other health conditions of the patient. Few treatments are standard and others are under clinical trial.

• Surgery: There are various types of surgeries like partial hepatectomy, bile duct removal and whipple procedure. Bile duct removal involves removal of the bile duct, lymph nodes or the surrounding tissue which might have the tumor. Hepatectomy involves removing a small part of the liver and the whipple procedure requires parts removed from gallbladder, liver, stomach and other affected areas without any harm to their functioning.

• Radiation Therapy: In the radiation therapies, the cancer cells are killed or stopped from growing further. X-rays or other radiations are used to kill the cancer cells either by focusing the rays from the outside or putting radioactive substance with the help of needles, seeds near the infected organ or cancer cells.

• Chemotherapy: In this method, medicines and drugs are used to kill the cancer cells or prevent them from dividing further. The drugs are either taken orally or through injections. They might be injected into the bloodstream or near the bile duct to kill the cancer cells. They may also block the flow of blood to the tumor preventing them to grow further.