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Cholangiocarcinoma

One of the most common diseases of the bile duct is gallstones, the other is tumors. Bile duct cancer is the 5th most common cancer among cancers that can develop in the digestive system. Since the body can continue to live even when the gallbladder does not function, symptoms of gallbladder cancer are generally noticed when it has advanced significantly. Gallbladder cancer, which is more common in people aged 60 and over, can progress very rapidly if precautions are not taken. Therefore, early diagnosis in the gallbladder, as in all other cancers, is very important. The General Surgery Department of Uniqacare Clinic provided information about bile duct cancer and its treatment.

What is Cholangiocarcinoma (Bile Duct Cancer)?


Bile duct cancer (Cholangiocarcinoma) is a rare tumor that originates from the cells of the bile duct wall. Although it can develop anywhere in the bile ducts, it originates from the bifurcation, where the right and left main bile ducts converge, in 60% of cases.


What are the causes of Cholangiocarcinoma (Bile Duct Cancer)?


The most common causes of bile duct cancer include primary sclerosing cholangitis, choledochal (common bile duct) cysts, Hepatitis B-C, ulcerative colitis, hepatolithiasis (liver stones), advanced age, obesity, bilioenteric anastomoses, and in older sources, chronic typhoid carrier status.


What are the symptoms of Cholangiocarcinoma (Bile Duct Cancer)?


In bile duct cancer, painless jaundice is one of the first detectable symptoms. It is followed by itching due to the accumulation of bilirubin under the skin. In advanced stages of the disease, there can be weight loss leading to cachexia. Fever can also accompany these symptoms.


How is Cholangiocarcinoma (Bile Duct Cancer) diagnosed?


Early diagnosis of gallbladder cancer is crucial. The initial step in the examination for bile duct cancer is to have a liver bile duct ultrasound. If dilation of the bile ducts is observed, cross-sectional imaging with computed tomography or magnetic resonance can assist in diagnosis. An abrupt termination of the bile ducts can be detected even without the presence of a mass in the bile ducts. Biopsy or cytology can be obtained using ERCP (endoscopic retrograde cholangiopancreatography). EUS (endoscopic ultrasound) can also be useful in evaluating particularly distally located cancers. If a patient presents clinically with jaundice, itching, and weight loss, and the tumor marker CA19-9 is elevated to 100 U/ml, it supports the diagnosis. Diagnostic methods are determined based on the patient's overall health, age, symptoms, and previous test results.


What are the treatment methods of Cholangiocarcinoma (Bile Duct Cancer)?


When the diagnosis of bile duct cancer is established, more than half of the patients have no chance of undergoing surgery. This is because the disease is insidious and tends to present late symptoms. The level at which the cancer is found determines the type of surgery that can be performed on patients who are eligible for surgery. For proximal cancers, hepatectomy is necessary, while for distal cancers, the Whipple surgery is usually performed.


The treatment of bile duct cancer is primarily based on the surgical removal of the tumor. During the treatment, which consists of a major operation, it may be necessary to remove a portion of the liver. Since the diagnosis of gallbladder cancer is often made at an advanced stage, most patients do not have a chance for surgery. However, early detection of cancer enables successful gallbladder cancer treatment. For those with advanced-stage disease that cannot be operated on, some endoscopic procedures, pain management, and percutaneous drainage (radiological intervention) can be performed to relieve jaundice and pain.


FREQUENTLY ASKED QUESTIONS ABOUT CHOLANGIOCARCINOMA (BILE DUCT CANCER)

What happens if the bile duct is blocked?


First of all, jaundice develops due to the blockage of the bile duct. There is dilation of the bile ducts within the liver. Increased pressure in the bile ducts and bacterial density leads to inflammation of the bile ducts (cholangitis). This condition, known as biliary sepsis, can be fatal.


What are the stages of bile duct cancer?


Bile duct cancer is divided into 3 stages.


In the first stage of bile duct cancer, the cancer is within the bile ducts. This is the group that responds best to surgery.

In the second stage, cancer invades the gallbladder, liver, pancreas, or a part of the portal vein and hepatic artery.

In the third stage, there is cancer metastasis to nearby organs, and in the fourth stage, there is metastasis to distant organs.


What are the types of bile duct cancer?


Bile duct cancers are classified according to their locations. They can be intrahepatic, hilar, or distal. The hilar region, where bile duct cancers are most commonly found, is specifically classified according to the Bismuth classification.


Type I: Cancer is in the common hepatic duct and distant from the bifurcation.

Type II: Cancer is in the common hepatic duct and has invaded the bifurcation.

Type III: Cancer is in the common hepatic duct and has involved the right or left hepatic duct along with the bifurcation.

Type IV: Cancer has involved both the right and left hepatic ducts along with the bifurcation, including the segments opening into these ducts.


Is a stent placed in the bile duct?


A stent is placed in the bile duct to lower bilirubin levels. Stenting may be due to benign strictures or cancer. In patients who will undergo surgery due to bile duct cancer, a stent is placed on the side where the liver segment will remain.


What should a patient be careful about after bile duct cancer surgery?


After the operation, they should take their chemotherapy (chemical treatment) regularly and be in close follow-up with their doctors. They should not neglect their follow-up imaging and tests.


Can gallbladder stones cause cancer?


The presence of gallbladder stones in over 90% of patients with gallbladder cancer has been proven by studies. However, although this situation has led to the idea that cancer can arise from gallbladder stones, the view that "Gallbladder stones cause cancer" has not been definitively established. Among the diseases caused by gallbladder stones, cancer is the last on the list. The strong association between gallbladder stones and cancer has raised suspicions for years, but the view that gallbladder stones cause cancer has not been conclusively proven. Gallbladder stones typically lead to infection, blockage of the bile ducts, jaundice, and inflammation of the pancreas.


What causes narrowing in the bile ducts?


Narrowing in the bile ducts is generally caused by the presence of stones in the bile ducts. In addition to this, it can also occur due to previous procedures (surgeries - stenting).


Is a polyp in the gallbladder dangerous?

Polyps in the gallbladder that are larger than 10 mm in size and more than one in number pose a risk of developing cancer. Cholecystectomy (laparoscopic or open) is suitable for removing the gallbladder. Polyps that are smaller than 10 mm and single are monitored with a 6-month ultrasound follow-up.


What deficiencies occur in the body when the gallbladder is removed?


There is no negative effect on the body from the removal of the gallbladder. Bile is produced by the liver. After gallbladder surgery, there is no shortage of bile in the patient.


Can gallstones cause cancer?


Gallstones can potentially cause cancer due to chronic inflammation. In patients undergoing surgery due to gallbladder cancer, gallstones were observed in over 90% of cases.

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