Treatment for bile duct cancer
Blog part -2
Cholangio -carcinoma Diagnosis.
Treatment for bile duct cancer
The treatment you have will depend on the position and size of cancer, whether it has spread beyond the bile duct and your general health. In some situations, the aim of treatment will be to relieve symptoms.
The main treatment for bile duct cancer is surgery to remove cancer. But this may involve a major operation and isn't always possible. The decision about whether surgery is possible and the type of operation that may be done depends on the size of cancer and whether it has begun to spread into nearby tissues.
If surgery is recommended, you will be referred to a surgeon who is a specialist in this rare cancer.
Removal of the bile ducts
If the cancer is at a very early stage (stage 1), only the bile ducts containing the cancer are removed. The remaining ducts in the liver are then joined to the small bowel, allowing the bile to flow again.
Partial liver resection
If the cancer has begun to spread into the liver, the affected part of the liver and the bile ducts are removed.
If the cancer is larger and has spread into nearby structures, then the bile ducts, part of the stomach, part of the small bowel (duodenum), the pancreas, gall bladder and the surrounding lymph nodes are all removed.
This is a major operation. After your operation, you may stay in an intensive care ward for the first couple of days. You will then be moved to a general ward until you recover. Most people need to be in hospital for about two weeks after this type of operation.
Surgery to relieve blockage (obstruction)
If it isn't possible to remove the tumour, you may have an operation to relieve the blockage. This will also help to relieve jaundice.
The surgeon operates to create a bypass of the blocked part of the bile duct, so the bile can flow from the liver into the intestine. Another method of relieving a blockage, without an operation, is to insert a tube (stent) into the duct holding it open.
If a part of the small bowel called the duodenum is blocked, it can cause sickness (vomiting). This may be helped with an operation where the surgeon connects the stomach to the next section of small bowel (the jejunum), bypassing the duodenum.
A stent is a tube put into the bile duct to hold it open and allow bile to drain away. The tube is about as thick as a ballpoint pen refill and about 5-10cm (2-4in) long. A stent may be put in using an ERCP or occasionally a PTC procedure.
The ERCP method
The preparation and procedure is the same as for ERCP. By looking at x-rays the doctor will be able to see the narrowing in the bile duct. The narrowing is stretched using dilators (small inflatable balloons), and the stent is inserted through the endoscope so that the bile can drain. If you have any discomfort while this is being done it's important to let your doctor know.
The PTC method
The procedure and preparation is the same as for PTC. A temporary wire is passed to the blocked area and the stent is guided along the wire. Sometimes a drainage tube (catheter) is left in the bile duct. One end of the catheter is in the bile duct and the other stays outside the body connected to a bag, which collects the bile. This is to help with the insertion of the stent or, sometimes, to enable x-rays to be taken to check the position of the stent after it has been put in place. It is usually left in for a few days. Once the catheter is removed the hole heals over within two days. Sometimes a combination of ERCP and PTC may be used.
You are given antibiotics before and after the procedure to help prevent any infection. It is likely that you will stay in hospital for a few days. A stent usually needs to be replaced every 3-4 months to prevent it from becoming blocked. If the stent becomes blocked you may have high temperatures and/or jaundice. It's important to tell your specialist as soon as possible if you develop these symptoms. You may need antibiotic treatment and your specialist may advise that the stent be replaced. This is usually done quite easily.
Radiotherapy treats cancer by using high-energy rays to destroy cancer cells, while doing as little harm as possible to normal cells. It may be given externally from a radiotherapy machine, or internally by placing radioactive material close to the tumour (brachytherapy).
Radiotherapy may occasionally be used after surgery for bile duct cancer. This is called adjuvant radiotherapy and is given to try to reduce the risk of cancer coming back.
Radiotherapy is also sometimes used if an operation isn't possible. It can't cure the cancer but it may help shrink it or slow its growth.
Chemotherapy may occasionally be used after surgery if all the cancer couldn't be removed by the operation. It may also be used if an operation isn't possible or the cancer has come back (recurred) after initial treatment. The aim of chemotherapy treatment is to try to shrink or slow down the growth of the cancer and to relieve symptoms.
Research is being carried out to find out if giving chemotherapy after surgery (adjuvant chemotherapy) can help to reduce the risk of cancer coming back.
Sometimes chemotherapy and radiotherapy are given together, this is called chemoradiation. It may be used after an operation to remove bile duct cancer or if the cancer can't be removed by an operation.
Photodynamic therapy (PDT)