Bile Duct Cancer

Treatment

Treatment for bile tract cancers depends on the type and stage of cancer as well as the patient's age, overall health, feelings and personal preferences. When cancer is advanced, choosing a treatment plan is a major decision, and it's important to consider the choices.

The treatment team for bile duct cancer patients can include specialists in: gastroenterology and hepatology, surgery, transplant surgery, radiology, medical oncology, radiation oncology and nuclear medicine.

Surgery

For very small tumors, surgical removal (resection) of part of the bile duct is usually the best choice. Sometimes this can be done using minimally-invasive surgery techniques. If the cancer is caught early, removing part of the bile duct may eliminate all the cancerous cells. If biliary cancer is more advanced, nearby liver tissue and lymph nodes may be removed as well as the tumor.

Liver Transplantation

Liver transplantation may be an option for people whose bile duct tumors have not spread outside of the liver, but cannot be completely removed. Mayo Clinic is one of the few institutions in the world that offers transplantation for bile duct cancer. Patients are treated with radiation therapy and chemotherapy before liver transplantation. Tumors can recur after transplantation. In some cases, liver transplantation has been curative.

A news release about liver transplantation for bile duct cancer patients describes Mayo's success with this therapy. Initial results of this treatment for cholangiocarcinoma at Mayo Clinic compare favorably with non-transplant surgery for this disease. Initial survival rates are similar to survival rates after liver transplants for other disorders.

Prior to transplantation, patients undergo exploratory abdominal surgery to look for regional lymph node metastases, peritoneal metastases or local extension of disease that would preclude complete removal of the tumor. Approximately one-third of patients have metastases discovered during a staging operation.

Chemotherapy

Current chemotherapy regimens for bile duct cancer do not result in cures but typically slow disease progression. Survival depends on the sensitivity of the tumor to the drugs used and the general condition of the patient. Prolonged tumor regression is unusual, and chemotherapy benefits usually last only weeks to months. Mayo Clinic oncologists actively conduct clinical trials of drugs, as part of an ongoing commitment to find new and better therapies for patients with metastatic bile cancer.

Radiation Therapy

Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink tumors. Radiation may also be delivered internally using radioactive sources placed temporarily inside the bile duct. Radiation therapy is usually delivered in conjunction with chemotherapy. Radiation and chemotherapy may be used in addition to surgery or transplant. Patients with localized disease who are not candidates for surgery may be treated with radiation and chemotherapy. Survival greater than five years has been observed in about 20 percent of patients treated with radiation and chemotherapy without surgery at Mayo Clinic.

Photodynamic Therapy

Photodynamic therapy can sometimes be used as a treatment. In this therapy, a light-sensitive chemical is injected into the patient. This chemical acccumulates in the fast-growing tumor cells. Then an endoscope with a laser fiber is inserted into the bile duct and the laser light is directed at the tumor. The light causes a chemical reaction in the tumor cells, killing them. This treatment is limited to cells on the surface which can be exposed to light.

Photodynamic therapy is useful in jaundiced patients who are not candidates for surgery or transplantation.

Biliary Drainage

Biliary drainage (via surgery or placement of stents) is a palliative treatment, therapy that provides relief of symptoms rather than a cure. Although quality of life is improved, neither tumor progression, nor survival rates are altered. Quality of life is markedly improved in patients who suffer from severe itching.

Stents (a tube inserted for draining) provide relief of symptoms in patients who have obstruction of the main bile ducts. However, once the tumor progresses from the hilum — the part of an organ where the vessels and nerves enter — into the smaller bile ducts, the relief provided by stents is limited.