Management of Cholangiocarcinoma (Bile Duct Cancer)

Washington University liver surgeons at Barnes-Jewish Hospital offer the option of liver removal and liver transplantation to patients with cholangiocarcinoma (bile duct cancer) confined to the bile ducts. Cancer of the bile duct can occur anywhere along the course of the bile ducts, from within the liver to the bile duct outside of the liver along its course of drainage into the small intestine. About a third of the cases of cholangiocarcinoma are located in the liver, about a third are located just outside the liver where the left and right bile ducts join, and about a third are located in the lower end of the bile duct where it empties into the intestine.

The preferred treatment of cholangiocarcinoma is surgical removal, and this usually can be performed for cholangiocarcinomas that arise in the liver or in the lower end of the bile duct within the pancreas gland (usually with the “Whipple procedure”). Tumors that develop where the bile ducts exit the liver (so-called “Klatskin tumors”) can be the most difficult to treat, because they often require both a bile duct and a large liver resection (surgical removal). In addition, the tumors at this location can infiltrate surrounding tissues and vessels, making curative removal difficult. When we treat a patient with a Klatskin tumor, our preferred approach is always standard surgical removal; however, when this is not possible, we now consider liver transplantation as a treatment option.

Patients with cholangiocarcinoma who are not candidates for removal but are eligible for liver transplantation undergo radiologic imaging and laparoscopic examination to ensure there is no cancer outside of the bile ducts and liver. They receive courses in chemotherapy and chemoradiation to control their cancers. After a four- to six-week rest, their lymph nodes are checked for cancer. If the lymph nodes are negative, they are listed for transplant surgery.

The Transplant Center at Barnes-Jewish Hospital is one of only a few U.S. centers to offer this option, which holds promise for a highly select group of patients.

The Bile Ducts and Cholangiocarcinoma

The bile ducts are tubes that carry bile from the liver and gallbladder to the small intestine. Bile is a fluid that breaks down fats in the small intestine during digestion. Bile is made in the liver and stored in the gallbladder.

Cholangiocarcinoma is a cancer that develops anywhere along the biliary ducts. The disease affects both men and women. According to the U.S. National Library of Medicine, cholangiocarcinoma is rare, occurring in approximately two out of 100,000 people, and most cases occur in people over the age of 65.

Symptoms

Symptoms result from tumors blocking the bile ducts. They may include:

• Jaundice (yellow color in the skin, mucous membranes or eyes)
• Itchy skin
• Abdominal discomfort or pain
• Loss of appetite
• Weight loss
• Fever
• Chills

Other Treatment Options

Both the cancer and the obstruction are treated in patients with cholangiocarcinoma. Surgical removal is the treatment of choice when it is possible.

Cholangiocarcinoma is typically slow growing and late to spread. However, by the time the cancer is detected, many tumors are too advanced to be removed surgically.

Palliative treatment to clear obstructions and relieve jaundice may be undertaken in patients with unresectable disease.