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Bile duct cancer is a cancerous growth of the bile duct. Bile duct cancer is quite uncommon, but unfortunately it is quite an aggressive cancer.

The bile duct is a system of tubes that transport bile from the liver to the small intestine. It starts as small bile ducts in the liver, joining to form 2 main ducts, the right and left hepatic ducts. These two ducts then join outside the liver to form the common hepatic duct. The common hepatic duct is joined by the cystic duct from the gallbladder to form the common bile duct.  The common bile duct terminates at the duodenum where it empties the bile into the intestine to help in the digestion of food.

Bile duct cancer can be divided into:

  • Intrahepatic cholangiocarcinoma (arises from the bile ducts within the liver)
  • Klatskin tumour (arises where the right and left hepatic ducts join)
  • Extrahepatic cholangiocarcinoma (arises from the common bile duct)

Risk factors for bile duct cancer include:

1.  Parasites

    • There are some parasites that will invade the bile ducts. These parasites gain entry into humans through eating or drinking contaminated food or water. Hence such infections are more common in developing countries. Examples of such parasites include liver flukes like Clonorchis sinesis.

2.  Choledochal cysts

    • These are bile-filled cysts that are connected to the bile ducts. They tend to be present from birth, and enlarge as the person grows. The lining of such cysts are prone to developing bile duct cancer later in life.\

3.  Smoking

4.  Inflammatory bowel disease

    • Patients with a chronic inflammatory bowel disease called ulcerative colitis are more prone to developing bile duct cancer.

Patients with bile duct cancer may present with the following symptoms:
1.    Jaundice

    • Especially for bile duct cancer arising from the main bile duct outside the liver.
    • This may be associated with passing dark urine, pale stools and itchy skin.
    • This happens when the cancerous growth has blocked the flow of bile within the bile duct.

2.    Loss of appetite
3.    Loss of weight
4.    Upper abdominal discomfort or pain
5.    Tiredness
6.    Generalised abdominal swelling or abdominal lump

Because the symptoms of bile duct cancer may be very non-specific, it is not surprising that by the time many patients consult a doctor, the cancer is too advanced for curative surgery.

In general, if you experience unexplained weight loss or appetite loss, prolonged tiredness, or just feel unwell for no reason for more than 2 weeks, you should consult your doctor.

If you, or another person notice that you are jaundiced, you should see your doctor quickly.

1.    Blood tests, including tumour markers like CA 19-9
2.    Radiological imaging, like CT scans, MRI scans or PET scans
3.    Tissue biopsy, where a small sample of the tumour is obtained for microscopic examination

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 patient. Surgery is the best chance of a long-term cure. Other treatment options include chemotherapy, biological therapy and radiation therapy.

You can read more about our multi-disciplinary cancer team in Nexus Surgical Cancer Centre.

 

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