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Bile Duct (Cholangiocarcinoma) & Gallbladder Cancer

The bile ducts collect bile that is produced in the liver and deliver it to the small intestine. The presence of bile in the intestine is important for normal digestion and nutrient absorption. Cancers that grow from the bile ducts are termed cholangiocarcinoma. Cholangiocarcinoma may arise from the bile ducts within the liver or outside of the liver. Cholangiocarcinoma is less common than hepatocellular carcinoma. Surgery is the mainstay of therapy, with radiation and chemotherapy used under certain circumstances. Gallbladder cancer is either detected after removal of the organ for other reasons or if the tumor itself causes symptoms. Surgical removal of the gallbladder and surrounding liver tissue is the preferred treatment for gallbladder cancer. Both cholangiocarcinoma and gallbladder cancer can be difficult to treat because they are commonly diagnosed at an advanced stage. Cure is possible when cholangiocarcinoma or gallbladder cancers are detected early, and treatment by an oncology team with experience in managing these rare tumors is important.

Risk Factors

Conditions that predispose to cholangiocarcinoma include sclerosing cholangitis and certain parasitic infections which are rare in the United States. Sclerosing cholangitis is a disease in which the bile ducts are chronically inflamed and developed blockages due to scar tissue formation.

Gallbladder cancer is associated with the presence of gallstones, particularly stones larger than 3 cm. Although most patients with gallbladder cancer have gallstones, the overwhelming majority of patients with gallstones (98%) do not develop gallbladder cancer. The presence of polyps in the gallbladder is another risk factor for cancer. Polyps size correlates with the degree of risk for developing gallbladder cancer.

Treatment

Treatment for both cholangiocarcinoma and gallbladder cancer centers around surgical removal of the tumor and surrounding normal tissue to ensure complete clearance. When cholangiocarcinoma arises within the liver itself, then removal of that portion of the liver is the treatment of choice. Some forms of cholangiocarcinoma arise from the bile ducts outside of the liver, which requires removal of the bile ducts, portion of the liver, and reconstruction by bringing a segment of the small intestine up to the liver for bile drainage. The surgical treatment of gallbladder cancer will depend on how deep the tumor penetrates through the wall and if there is evidence of spread to other sites. For the most superficial gallbladder cancers, removal of the gallbladder or cholecystectomy may be sufficient. For deeper gallbladder cancers, we typically also remove a portion of the liver as gallbladder cancer has a high tendency to invade the liver in these situations. For cholangiocarcinoma and gallbladder cancer, an extensive evaluation is performed to rule out the presence of distant spread or invasion of vital blood vessels, which may make complete tumor removal impossible.

Cholangiocarcinoma and gallbladder cancer may present additional problems by blocking the bile ducts. Blockage of the bile ducts results in jaundice, which manifests as yellow discoloration of the skin and eyes. Jaundice may also be associated with severe itching. Your surgical oncologist may recommend a procedure to drain the bile to help relieve symptoms or improve liver function before surgery. If surgery is not possible due to an advanced tumor stage, we will recommend procedures to drain the bile to minimize discomfort and allow for other treatment options to be pursued. The gastroenterologists and interventional radiologists at the Roger Williams Medical Center are experts in performing bile drainage procedures.