Biliary Duct Cancer

Virginia Mason is an international center for treating patients with biliary tract disorders, including cancer of the bile ducts. Our gastroenterologists work with surgical specialists in the Floyd & Delores Jones Cancer Institute at Virginia Mason to provide the best care possible for patients with biliary duct cancer. When found early, this type of cancer is treated with surgery, and the majority of patients see long-term benefits. Unfortunately most cases are discovered at an advanced stage when surgery is no longer curative. Surgery, however, may be performed to remove a portion of the tumor and reroute the bile duct to allow better drainage of bile. Radiation therapy also can help shrink the tumor. For more information or to schedule an appointment, call (206) 223-2319.

Risk Factors for Biliary Cancer

Biliary cancer is a rare disease that strikes primarily older adults beyond the age of 70. Its prevalence is more common in Asian countries than in the United States. Patients with gallstones are at an increased risk of developing this cancer. Other risk factors include smoking and eating a high carbohydrate diet. Individuals who eat undercooked fish are at risk of a parasitic infection, called Chinese liver fluke that increases the risk of developing bile duct infections and cancer.

Symptoms of Biliary Duct Cancer

Cancer of the bile duct oftentimes has the same symptoms of other biliary tract disorders because most of them block the small ducts from releasing bile or digestive enzymes into the small intestine. Symptoms may occur over several years as a tumor develops.

Common symptoms and signs of biliary duct cancer include:

  • Abdominal pain on the right side of the body (where the liver and gallbladder are located)
  • Itching
  • Yellow skin or eyes (from the build up of bilirubin, a waste product)
  • Fatigue
  • Weight loss
  • Fever
  • Night sweats
  • Loss of appetite
  • Light-colored stools

Serious complications
A tumor that completely blocks a bile duct can lead to inflammation of organs within the biliary tract (gallbladder, liver and pancreas) as well as a serious bacterial infection within the liver (ascending cholangitis). Low blood pressure and sepsis (an infection within the blood stream) can result from these complications. The presence of any symptoms shown above should be brought to the attention of a physician without delay.

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Diagnosing Biliary Duct Cancer

Your gastroenterologist may suspect a bile duct disorder or cancer based on your appearance, a description of your symptoms, and whether a blood test shows high levels of bilirubin, a waste product in blood from the normal breakdown of red blood cells. A definitive diagnosis is made through a procedure called ERCP, for endoscopic retrograde cholangiopancreatography, which allows your gastroenterologist to view the biliary and pancreatic ducts.

Additional tests and procedures for diagnosing the presence of cancer include the following:

  • BLOOD TESTS
    In addition to a bilirubin test, your blood may be tested for the presence of elevated white blood cells used by the body to fight infection, and for abnormal levels of pancreatic and liver enzymes. If your gastroenterologist suspects cancer, he or she may order a blood test called CA 19-9 to test for tumor markers (indicators) in the body for cancers of the biliary tract. Other blood tests also may be performed.
     
  • ABDOMINAL ULTRASOUND
    This non-invasive procedure uses sound waves rather than x-rays to produce images. The images can reveal a narrowing within the common bile duct. During this procedure, an ultrasound probe is passed over the abdomen and images are sent to a computer monitor. Abdominal ultrasound is commonly used in women who are pregnant.
     
  • ABDOMINAL CT SCAN OR MRI A CT scan of the abdomen or MRI also can identify narrowing within the biliary tract and is a noninvasive procedure. During these scans, images are shown on a computer monitor.
     
  • ERCP
    Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the ducts of the gallbladder, pancreas and liver, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 30 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.
     
    During this procedure, and after first receiving a mild sedative and an anesthetic to numb the throat, an endoscope containing a miniature camera is passed down your esophagus and into the biliary tract. When your gastroenterologist sees the biliary and pancreatic ducts, he or she then passes a catheter (a narrow plastic tube) containing a contrast dye through the endoscope. The dye is injected into the pancreatic and biliary ducts and x-rays are taken that are viewed on a computer monitor. The procedure takes 60 to 90 minutes and is performed in the Endoscopy Suite within Virginia Mason's Section of Gastroenterology and Hepatology.
     
    Your gastroenterologist can treat a bile duct disorder at the same time it is being diagnosed by passing a cholangioscope containing miniaturized instruments through the ERCP. Special preparations are required for this endoscopic procedure. Please see the ERCP prep planner for more information.
     
  • ERCP WITH ENDOSCOPIC ULTRASOUND
    Increasingly, gastroenterologists at Virginia Mason are using endoscopic ultrasound (EUS) in place of X-rays for better viewing of the bile and pancreatic ducts. During this procedure, an ultrasound probe is passed through the ERCP, which sends images to a computer monitor.
     
  • MRCP
    Magnetic resonance cholangiopancreatography is newer technology being employed at Virginia Mason. This noninvasive diagnostic procedure is performed in Radiology using MRI technology (magnets and radio waves) to produce computer images of the bile ducts. A contrast dye is injected first through the skin near the gallbladder to enhance the images. Patients are not required to undergo endoscopy preparation and they do not undergo sedation. MRCP is being used primarily in patients who may have failed or who are not good candidates for ERCP, in those who do not want to undergo an endoscopic procedure, and in individuals considered to be at low risk of having a pancreatic or bile duct disorder. While ERCP allows for therapeutic options with cholangioscopy, MRCP is a diagnostic tool only.
     
    Virginia Mason also is involved in national clinical trials to determine the accuracy of MRCP in diagnosing disorders of the biliary tract.
     
  • PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM
    This procedure, performed by a radiologist, is an x-ray of the bile ducts inside and outside of the liver, and shows drainage of bile from the liver. After first receiving a local anesthetic, a long, thin needle is inserted through the abdominal skin (percutaneously) and into the liver. The needle injects a contrast dye near the ducts to be studied and images are shown on a fluoroscopic monitor. The images can reveal whether the bile ducts are enlarged, indicating that a stricture, stone or tumor may be blocking the duct.

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Treating Bile Duct Cancer

When biliary duct cancer has been diagnosed, surgery is the first line of treatment.

  • SURGICAL THERAPY
    Surgery for biliary duct cancer may be either curative in its early stages or, in advanced stages, palliative (providing comfort care). In the later stages of cancer, your surgeon may remove part of the tumor and all of the bile duct, and surgically attach the liver or gallbladder to the small intestine to improve the flow of bile. This open surgical procedure is performed in the operating room under general anesthetic. In some cases radiation therapy and/or chemotherapy may be recommended after surgery.
     
    If surgery is not the best option for patients with advanced cancer, radiation therapy alone may be recommended to help shrink the tumor.