Cholangiocarcinoma or bile duct cancer is a rare cancer that forms inside the bile duct, a thin tube that takes your digestive fluid or bile from your liver to your small intestine via the gallbladder; it seems to result from pathogens.
What is bile?
Bile is important in aiding digestion. It is produced by the liver and is a yellow, green, orange or brown liquid which is concentrated and stored in the gallbladder from where it is ejected into the small intestine. Bile helps alkalise the contents of the intestine aiding the digestion and absorption of fat.
The main constituents of bile are cholesterol, bilirubin, phospholipid, conjugated bile salts and electrolytes.
Bile also helps the liver remove its waste.
What are Bile ducts?
There are bile ducts within the liver – a system of small tubes called the Intrahepatic Ducts. These connect to …
Bigger ducts – the Extrahepatic Ducts – one to the right of the liver, the other to the left, which then unite to form the Hepatic Duct which goes towards the small Intestine.
In turn, this is joined by the biliary duct which comes from the gallbladder and now forms the Common Bile Duct.
This passes through the pancreas and enters the small intestine.
Symptoms of Bile Duct Cancer
The symptoms are usually caused by a blockage.
- Jaundice
- Pain below the right ribs
- Nausea and vomiting
- Dark urine,
- Fever
- Fatty stools
- Itching
- Weight loss and loss of appetite
Causes of Bile Duct Cancer
It’s complex and the causes are not certain but there do appear to be risk factors.
For example, inflammation inside the bile duct can lead to scarring and this to bile duct cancer. People who have ulcerative colitis in the intestine often have an inflamed bile
duct.
There also seems to be a link to E. coli infection, and also to Pseudomonas aeruginosa.
Then there is a link to Liver fluke (common in India and SEA), although growing in the UK too. Two strains of fluke (Opisthorchis viverrini and Clonorchis sinensis) are linked to bile duct cancer.
If you have a fluke in your liver, this may be manifested in a fatty liver, higher blood cholesterol levels, gallstones and gallbladder problems.
Infections also cause toxins, m-RNA and inflammation.
Cholangitis may have been a previous problem - Gram- negative bacteria (e.g. Escherichia coli, Klebsiella, Enterobacter), gram-positive bacteria (e.g. Enterococcus, Streptococcus) and mixed anaerobes (Bacteroides, Clostridia) are the usual culprit organisms.
Choledochal cysts (usually there from birth are risk factors as are bile duct stones. Then liver poisoning, cirrhosis, hepatitis and alcohol are risk factors.
Treatments
Current treatments include
- Chemotherapy – the drugs Gemcitabine, Cisplatin are the ‘Gold Standard’.
- Targeted therapy – About 15 per cent of people have FGFR abnormal proteins causing bile duct cells to grow out of control. A drug, Pemigatinib (Pemazyre), has been developed to reduce the growth of these cells and restrict spread.
- Genomics Testing. The standard Chemo drugs do not seem to work very well, so ask your oncologist to do genomics testing to see if there are other drug opportunities more relevant to you.
- Surgery – although arteries can complicate this. Increasingly the Nanoknife is used. Depending on spread, you may have some or all of your bile duct, associated lymph nodes, liver, small intestine or part of your pancreas removed.
- Radiotherapy, or increasingly the safer Proton Beam Therapy.
- Photodynamic therapy is increasingly being used.
Go to: Review: Parasites and pathogens in cancer