Bile Duct Cancer (Cholangiocarcinoma) (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- What is bile duct cancer (cholangiocarcinoma)?
- What are the symptoms of bile duct cancer?
- How is bile duct cancer diagnosed?
- What is the treatment for bile duct cancer?
- What is the prognosis for bile duct cancer?
- Can bile duct cancer be prevented?
- Find a local Doctor in your town
What are the symptoms of bile duct cancer?
Unfortunately, bile duct tumors may not cause any symptoms until they have often grown in size and spread (metastasized). Abdominal pain is often a late symptom and is usually located in the right upper quadrant of the belly and may be associated with an enlarged liver.
How is bile duct cancer diagnosed?
History and physical examination are key to clues for the diagnosis of bile duct cancer. Painless jaundice may be the only initial clue. The history often includes reviewing alcohol use, drug use or recent illnesses that can be associated with hepatitis, or inflammation of the liver. Other symptoms may be weight loss, loss of appetite, weakness, loss of energy, and easy bruising or bleeding.
The physical examination may be used to detect tenderness in the abdomen, especially in the right upper quadrant beneath the ribs, where the liver is located. A quarter of patients with bile duct cancer will have an enlarged liver that can be palpated or felt on exam. On general exam, the patient is often jaundiced, having yellow tinged skin. This may be seen most easily in the white portion (sclerae) of the eyes.
Jaundice is not normal and blood tests are often ordered by the health care professional. Testing often includes assessment of liver enzymes, bilirubin levels, complete blood count, electrolytes, BUN and creatinine, and INR/PTT (international normalized ratio/partial thromboplastin time) and PT (prothrombin time). Imaging may be helpful including ultrasound, CT scan, and MRI.
ERCP (endoscopic retrograde cholangiopancreatography) is a specialized test used to look directly at the bile duct as it enters the duodenum. ERCP is performed by a gastroenterologist using a fiberoptic camera at the end of a flexible viewing tube which is passed into the opening of the bile duct into the small intestine. This is used to detect diseases that affect the bile ducts including bile duct cancer, gallstones stuck in the bile duct, and abnormal narrowing of the bile duct. Dye can be injected to outline the bile ducts and detect obstruction. Biopsies or cell washings can be obtained to look for cancer cells. If a blockage is found, the gastroenterologist may be able to place a stent during the same procedure.
Once the diagnosis of bile duct cancer is made, it is important to stage the cancer to help direct potential treatment. The three parts of TNM staging include:
- T is for the primary tumor and how much it has grown locally and invaded other structures. For a bile duct tumor, this includes the liver, gallbladder, pancreas, stomach, and intestine.
- N is for the lymph nodes that are involved. The more nodes involved and the farther the distance from the bile duct, the more severe the cancer.
- M is for metastasis. Has the tumor spread to other parts of the body?
Cancer can be staged from 0 to 4, where 0 is no tumor, 1 is local tumor with no spread to lymph nodes or other parts of the body and 4 is significant local growth and lymph node involvement and spread to other parts of the body.
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