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Treating Biliary Tract Cancer

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8 Things to Know About Bile Duct Cancer

Medically Reviewed By William C. Lloyd III, MD, FACS
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Bile duct cancer is a rare cancer of the tubes that connect the liver, gallbladder, and small intestine. Here’s what to know about bile duct cancer symptoms, causes, and treatments so you can be more prepared when talking to your treatment team.

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Any cancer diagnosis can catch you off-guard. When you have a rare type like bile duct cancer, you may not know what to expect, or where to turn for information. A type of biliary tract cancer, bile duct cancer affects the tubes that carry the digestive fluid called bile from your liver to your gallbladder and small intestine. It’s important to become familiar with bile duct cancer treatments so that you can be an active participant in your own care.

1. Bile duct cancer is very rare

Each year, only 8,000 people in the United States receive a diagnosis of bile duct cancer. The real number of cases could actually be higher because bile duct cancer is hard to diagnose and its symptoms are easy to confuse with other cancers.

2. This cancer can start inside or outside your liver

Intrahepatic bile duct cancer grows in the bile ducts inside your liver. It’s the less common form of bile duct cancer. Extrahepatic bile duct cancer forms in bile ducts outside of your liver and comes in two types:

  • Perihilar bile duct cancer starts where the left and right bile ducts merge as they leave the liver.
  • Distal bile duct cancer forms near the small intestine.

3. Bile duct cancer symptoms can be confusing

Finding bile duct cancer early is a challenge. No screening tests are available, and often there aren’t any symptoms until the cancer spreads. You may not discover a problem until the tumor blocks one of your bile ducts.

Late bile duct cancer symptoms include:

  • yellowing of your skin or the whites of your eyes, called jaundice
  • itchy skin
  • clay-colored poop
  • dark urine
  • belly pain
  • unexplained weight loss
  • nausea and vomiting

These are also symptoms of many other conditions, including gallstones, other types of cancers, and some autoimmune diseases. Only a thorough exam from a doctor can confirm that you’re experiencing bile duct cancer symptoms.

4. Your stage determines your treatment

Staging plays an important role in determining which bile duct cancer treatment to choose. The stage indicates how large your tumor is and whether it has spread to your lymph nodes or other parts of your body. Your doctor stages your cancer using imaging tests like magnetic resonance imaging (MRI) and computed tomography (CT) scans that show where the cancer is in your body.

Bile duct cancer has four stages: 0 through 4. In its earliest stages, the cancer is only in the tissue lining the bile duct. Stage 4 cancer has spread to other parts of your body, like your liver or lungs.

5. Surgery offers the best chance of curing early stage bile duct cancer

Surgery is often the main bile duct cancer treatment. If you have an early stage cancer that can be removed completely, surgery could cure your cancer. Your surgeon will remove an area of healthy tissue around the cancer, called a margin, to prevent it from coming back in the future. Chemotherapy or other treatments, including immunotherapy, may be added to surgery to reduce the chance of a recurrence.

6. Surgery isn’t your only treatment option

You may need more than just surgery to control your cancer. Other bile duct cancer treatments include:

  • chemotherapy
  • radiation therapy
  • targeted medicines such as infigratinib (Truseltiq), ivosidenib (Tibsovo), and pemigatinib (Pemazyre)
  • immunotherapy such as durvalumab (Imfinzi), currently pending approval by the Food and Drug Administration
  • extreme heat (radiofrequency ablation) or cold (cryotherapy)

Which of these treatments your doctor recommends depends on the stage of your cancer, your health, and other factors.

7. You can always try a clinical trial

Clinical trials test out new therapies or combinations of treatments to see if they’re safe and effective. Enrolling in a clinical trial could give you access to a new bile duct cancer treatment before it’s approved. Your oncologist can tell you whether any open clinical trials are a good fit for you.

8. Survival numbers don’t tell the whole story

Looking at the survival rates for bile duct cancer can be scary. Keep in mind that these numbers are based on studies that were performed several years ago on large groups of people with this cancer, when treatment options differed.

Treatments continue to improve, and your situation may be different than the study participants based on factors like your age and health. Only your doctor can give you an accurate outlook for your unique situation.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Aug 10
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