Cancer treatment team
Due to the rarity of bile duct cancer, you are likely to be referred to a specialist unit that has experience in treating bile duct cancer, for some or all of your treatment. These units are usually located in larger city hospitals, such as London and Birmingham.
Multidisciplinary teams (MDTs) will be used to treat bile duct cancer. MDTs are made up of a number of different specialists (see the box, left). If you have bile duct cancer, you may see some or all of these healthcare professionals as part of your treatment.
It can be difficult to decide what treatment is best for you. Your cancer team will make recommendations, but the final decision will be yours.
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 about the advantages and disadvantages of particular treatments.
Your treatment plan
Your recommended treatment plan will be determined by the stage that the cancer has reached (see Cancer of the bile duct - diagnosis for more information about staging).
In cases of stage one and stage two 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 three bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been obstructed. 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 four bile duct cancer, achieving a successful cure is highly unlikely. However, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms.
A number of experimental treatments may be available as part of a clinical trial (see below for more information).
Surgery
If your MDT think 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
- some of your liver
Unfortunately, due to the aggressive nature of bile duct cancer, only 1 in 10 people are suitable candidates for surgery.
After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can still flow normally. Similarly, it is often possible for the liver to resume normal function after surgery because it can regenerate itself.
Having your gallbladder removed should not affect your digestive system because the liver and bile duct can still store bile and aid digestion.
After surgery, it is likely that you will need to stay in an intensive care unit (ICU) for a few days so that the functions of your body can be supported while you recover from the effects of the operation. You may need to stay in hospital for at least two weeks after having bile duct surgery before you are well enough to go home.
The success rates of bile duct surgery depend on a range of individual factors and 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. Both factors will affect the chances of the cancer returning.
As a general estimate, about 40% of people who have surgery for intraheptic bile duct cancer (cancer that begins inside the liver) survive for five years or more after surgery.
20-30% of people who have surgery for extraheptic bile duct cancer (cancer that develops outside the liver) survive for five years or more after surgery.
Unblocking the bile duct
If your bile duct becomes blocked as a result of cancer, your MDT may recommend treatment to unblock the duct. This will help to 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 in several ways. The first is to use a variation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure.
During the procedure, a surgeon will guide the endoscope into your bile duct and pass down a small metal or plastic tube called a stent. The stent is used to widen the bile duct, which should help to get the bile flowing again.
Alternatively, a stent can be placed in your bile duct using a variation of the percutaneous transhepatic cholangiography (PTC) procedure. This involves placing the stent in your bile duct through a small incision (cut) in your stomach. As this is not a major operation it can be carried out using local anaesthetic, where an injection is used to numb the skin of your stomach.
Occasionally, an implanted stent can become blocked. If this occurs, it will need to be removed and replaced.
Radiotherapy
Radiotherapy cannot cure bile duct cancer but it can 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 (also known as 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)
See the Health A-Z topic about Radiotherapy for more information.
Chemotherapy
Chemotherapy is used in a similar way to radiotherapy to relieve the symptoms of cancer, slow down the rate at which it spreads and prolong life.
Research carried out in 2010 found that combining two chemotherapy medications, called cisplatin and gemcitabine, is a particularly effective way of helping to slow the spread of cancer and improve survival rates.
As with radiotherapy, the medicines that are 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.
See the Health A-Z topic about Chemotherapy - introduction for more information.
Photodynamic therapy (PDT)
Photodynamic therapy is a new technique that helps to control (but not cure) the symptoms of bile duct cancer. A special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumour.
The National Institute for Clinical Health and Excellence (NICE) has considered PDT and concluded that there is limited evidence to show how effective or safe PDT is in the medium to long term.
If you are considering PDT, be aware of the current uncertainties about the effectiveness and safety of the procedure.
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 and combining chemotherapy with radiotherapy, both of which may help to 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 medication which target the processes that cancerous cells need to grow and reproduce.
Initial tests of a medication called sorafenib have proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply.
As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial that is looking into the use of these types of experimental treatments.
All clinical trials are carried out under strict ethical guidelines that are based on the principles of patient care. However, there is no guarantee that the treatment that you receive during a clinical trial will be more effective, or even as effective, as existing treatments.
See the Cancer of the bile duct - clinical trials and the Health A-Z topic about Clinical trials for more information.
