Bile duct cancer - Treating bile duct cancer

Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms.

Cancer treatment team

Due to the rarity of bile duct cancer, you are likely to be referred to a specialist hepatobiliary unit with experience in treating the condition.

A multidisciplinary team (MDT) made up of different specialists will help you decide on your treatment, but the final decision will be yours. Your MDT may include:

• a liver surgeon – a specialist in treating cancers of the liver
• a medical or clinical oncologist – a specialist in the non-surgical treatment of cancer using techniques such as radiotherapy and chemotherapy
• a pathologist – a specialist in diseased tissue
• a radiologist – a specialist in radiological diagnosis and intervention 
• a cancer nurse – who usually acts as the first point of contact between you and the rest of the care team 
• a gastroenterologist – a specialist in the medical management of liver and biliary disease

Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out the advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan will be determined by your general health and the stage the cancer has reached.

In cases of stage 1 and stage 2 bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder.

In cases of stage 3 bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes.

In cases of stage 4 bile duct cancer, achieving a successful cure is highly unlikely. However, stenting, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms.

Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer. Read more about treating liver cancer.

A number of experimental treatments may be available as part of a clinical trial (see below).

Surgery

If your MDT thinks it is possible to cure your bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove:

• the part of your bile duct that contains cancerous cells
• your gallbladder
• nearby lymph nodes
• a large part of your liver

After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can still flow into the intestine.

Similarly, it is often possible for the liver to resume normal function after surgery because we do not need all of our liver. The liver can also regenerate itself after surgery.

You may need to stay in hospital for up to two weeks or more after having bile duct cancer surgery before you are well enough to go home.

Success rates of bile duct surgery depend on individual circumstances, such as whether nearby lymph nodes are free of cancer and whether it was possible to remove all of the cancerous cells during surgery.

As a general estimate, 20-40% of people who have surgery for bile duct cancer survive for five years or more after their operation.

Unblocking the bile duct

If your bile duct becomes blocked as a result of cancer, treatment to unblock it may be recommended. This will help resolve symptoms such as:

• jaundice – yellowing of the skin and the whites of the eyes
• itchy skin
• abdominal (tummy) pain

Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver.

The bile duct can be unblocked by using a small tube called a stent. The stent widens the bile duct, which should help to get the bile flowing again.

A stent can be inserted using either:

• a variation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure, which uses an endoscope to guide the stent into the bile duct
• a variation of the percutaneous transhepatic cholangiography (PTC) procedure, which involves making a small incision (under local anaesthetic) in your abdominal wall

Occasionally, an implanted stent can become blocked. If this occurs, it will need to be removed and replaced.

Radiotherapy

Radiotherapy is not a standard treatment for bile duct cancer, but may help to relieve the symptoms, slow the spread of the cancer and prolong life. Two types of radiotherapy are used to treat bile duct cancer:

• external beam radiotherapy – a machine is used to target radioactive beams at your bile duct
• internal radiotherapy (brachytherapy) – a radioactive wire is placed inside your bile duct next to the tumour

Radiotherapy works by damaging the cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include:

• nausea (feeling sick)
• vomiting
• fatigue (severe tiredness)

Read more about radiotherapy.

Chemotherapy

Chemotherapy is used in a similar way to radiotherapy to relieve the symptoms of cancer, slow down the rate it spreads and prolong life. It is sometimes used in combination with radiotherapy.

Research carried out in 2010 found that combining two chemotherapy medications, called cisplatin and gemcitabine, is an effective way of helping to slow the spread of cancer and improve survival rates.

Medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include:

• nausea
• vomiting
• fatigue
• hair loss

However, these side effects should stop once the course of treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

Read more about chemotherapy.

Clinical trials and experimental treatments

The treatments for bile duct cancer are not as effective as treatments for other types of cancer. Therefore, a number of clinical trials are being conducted to find better ways of treating the condition.

For example, ongoing trials are looking at new combinations of chemotherapy medicines, which may help extend the lifespan of someone with bile duct cancer.

Targeted therapies

Another promising field of research involves using targeted therapies to treat bile duct cancer. Targeted therapies are medications that target the processes that cancerous cells need to grow and reproduce.

In studies for some cancers, a medication called sorafenib has proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply. However, sorafenib is not currently used as routine treatment for bile duct cancer.

As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial looking at the use of these types of experimental treatments.

All clinical trials are carried out under strict ethical guidelines based on the principles of patient care. However, there is no guarantee that the treatment you receive during a clinical trial will be more effective, or even as effective, as existing treatments.

Read more about clinical trials and clinical trials for bile duct cancer.