Bile Duct Cancer (Cholangiocarcinoma)

There are two main types of biliary cancer.

Bile duct tumors can develop in the bile ducts within the liver (intrahepatic) or outside it (extrahepatic).

• Extrahepatic bile duct cancers: Most cholangiocarcinomas develop outside of the liver, and this can happen in two regions:

  • Hilar bile duct cancer is found where the right and left bile ducts join outside of the liver
  • Distal bile duct cancer is found in the ducts near the small intestine

• Intrahepatic bile duct cancers: Less commonly, cancer may develop in the bile ducts located inside the liver. Because of their location, these tumors are often treated similarly to liver cancer.

Treatments

Our experts work together to personalize your best treatment plan.

Our cancer doctors specialize exclusively in treating gastrointestinal cancers, including the bile duct. Because we're part of The Ruesch Center for the Cure of Gastrointestinal Cancers, our patients benefit from state-of-the-art therapies and surgical techniques backed by the latest research. Your treatment plan will involve recommendations from a team of specialists who have expertise in different disciplines. Together, we'll collaborate on a plan that will best address your individual needs.

Treatment depends on whether or not your tumor can be removed by surgery. For those that cannot, we may recommend treatments that could help shrink it and make it operable. In other instances, biliary tumors that can't be surgically removed may benefit from novel interventional radiology procedures that can improve outcomes.

Surgery

Surgery offers the best chance for a cure. But, the bile duct is a small, complex organ involving several blood vessels attached to critical structures. That's why it's important to seek care from an experienced cancer center. Our Center for Liver and Pancreas Surgery is one of the largest programs of its kind, and our surgeons have over 50 combined years of experience treating these types of cancers. In addition, we see more patients with pancreas, liver, and bile duct cancer than any other center in the region.

If a cancerous tumor is detected early before it has spread, it may be removed surgically using one of the following procedures:

• Bile duct resection: If the tumor is small, we can perform this procedure to remove the affected part of the bile duct. In some cases, we may administer chemotherapy, radiation, or both at the same time of surgery using innovative techniques.

• Partial hepatectomy: If you have an intrahepatic tumor inside the liver, we may need to remove some of the liver. As long as we can preserve enough healthy tissue in the liver, it will regenerate.

  • For patients who would not have enough remaining liver, we can help to improve liver growth using an innovative procedure called portal vein embolization. This involves blocking blood flow to one side of the liver so that it redirects to the other and stimulates growth. As a result, a patient may generate enough additional healthy liver tissue to become a candidate for surgery.

     

• Whipple procedure (Pancreatoduodenectomy): If you have an extrahepatic bile duct tumor near the pancreas, your surgeon may remove parts of the bile duct, stomach, small intestine, and pancreas in this complex procedure. It's most commonly performed to treat pancreatic cancer.

•  Liver transplant: This procedure is generally reserved for patients with disease limited to the bile duct and liver but cannot undergo a partial hepatectomy. For example, for someone who has bile duct cancer and damage to the liver, like cirrhosis, a liver transplant may be the only curative option.

   

If the tumor is too large for removal or if cancer has spread, we may use other surgical approaches to help relieve symptoms, such as placing a stent or rerouting the bile duct to the small intestine.

Interventional radiology

Our interventional radiologists are skilled at using innovative approaches to relieve symptoms and shrink tumors with the potential to make them operable. These treatments may include ablation, radioembolization, and others. These treatments are often combined with other therapies, such as chemotherapy, radiation therapy, or immunotherapy. We continue finding new ways to treat patients with these techniques through clinical trials, and these discoveries are advancing the standard of care for treatment.

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. Sometimes, we recommend chemotherapy to help shrink tumors and make them more easily operable, or "resectable". In other instances, chemotherapy may relieve symptoms and prolong life for patients with inoperable tumors.

We can also deliver regional chemotherapy directly into the hepatic artery using a hepatic artery infusion (HAI) pump to target the cancerous cells while limiting its impact to other parts of the body.

At MedStar Health, our medical oncologists are leaders in finding new combinations of chemotherapy and other therapies to expand the standard of care. If we think you'll benefit from chemotherapy, we'll work closely with the rest of your cancer team to design an individualized plan with the right type of chemotherapy drug given at the right time. Your treatment options may include clinical trials, which allow us to test new and effective ways to use chemotherapy to treat cholangiocarcinoma. And, you can expect us to proactively manage any side effects and help ensure you achieve the highest quality of life during and after treatment.

Immunotherapy and targeted therapy

Advances in personalized medicine allow us to deliver more targeted, effective treatments for tumors with certain genetic profiles. Depending on the stage and genetic makeup of your cancer, we may recommend a promising new therapy approved by the FDA or under investigation through clinical trials. In fact, we're leading many of these trials to find new uses for immunotherapy and other novel therapies that may slow or reverse tumor growth.

Radiation therapy

Radiation therapy plays a larger role in treating extrahepatic bile duct cancer than those found in the liver. Using high-energy beams, radiation may be used to treat this type of cancer in the following ways:

• To treat patients waiting for a liver transplant
• After surgery, to eliminate any remaining cancer cells
• As the primary treatment if the tumor cannot be removed with surgery
• Palliatively to minimize symptoms

At MedStar Health, our radiation oncologists are pioneers in using the latest technologies to deliver more precise radiation that limits exposure to healthy tissue. For example, we were the first in the world to use the HYPERSCAN^TM proton beam therapy system. This type of radiation therapy destroys cancer cells with exceptional accuracy, matching the tumor's exact size and shape.

In addition, we use other state-of-the-art technology that allows us to adjust the path or intensity of radiation, based on your individual needs. Your doctors will determine if radiation will help achieve your best outcome and which type (external or internal) offers you the most benefit.