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.
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What is the treatment for bile duct cancer?
Treatment for bile duct cancer depends upon where the cancer is located and whether it is possible for it to be completely removed by surgery. Unfortunately, those afflicted with this cancer tend to be older and may be unable to tolerate and recover from a significant operation. The decision regarding surgery needs to be individualized for the specific patient and their situation.
Photodynamic therapy is another alternative to help shrink the tumor and control symptoms.
Radioembolization is an option if the tumor cannot be removed by surgery. With radioembolization, small amounts of radioactive material are injected into the arteries that supply the tumor in hopes of shrinking the tumor size by impeding its blood supply.
ERCP may be used to stent the bile duct, keeping it open to allow bile drainage from the liver and gallbladder into the intestine. This is often very helpful in controlling symptoms but does not treat the tumor itself.
Pain control may be an issue because the enlarging tumor can cause significant pain in the abdomen and back. Regional anesthetic blocks may be useful in controlling pain.
As with all cancers, the treatment is individualized for the patient. Discussion between the patient, health-care professional, and family are important to help understand treatment options, including cure versus palliative care or symptom control and quality of life. The patient's wishes are key.
What are the complications of bile duct cancer?
Obstruction of the bile duct can lead to infection of the bile drainage system or cholangitis.
Cirrhosis may develop in bile duct cancer. This may be due to the tumor obstructing the bile duct and causing liver cell destruction and scarring. This is especially true in patients with primary sclerosing cholangitis. Both cirrhosis and sclerosing cholangitis are listed as potential risk factors for bile duct cancer.
Other complications may be a consequence of the procedures used to diagnose and treat the cancer. These include complications of surgery, chemotherapy, and radiation therapy.
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