Biliary Cancer

Biliary cancer, also known as bile duct cancer and gallbladder cancer are generally aggressive cancers. Bile ducts are the tubes that take bile from the liver and pass it through to the small bowel. Bile duct cancer arises from the cells within the bile ducts; both inside and outside the liver.

Gallbladder cancers are commonly identified incidentally when the gallbladder is removed for other reasons, such as for pain related to gallstone disease. Sometimes they present as an abdominal mass found on examination. In the more advanced cases they present in a similar way to bile duct cancer.

Different types of bile duct cancers include:

Klatskin Tumours
This begins where the right hepatic duct joins the left hepatic duct. Approximately 50% of all bile duct cancers are Klatskin tumours.

Intrahepatic Bile Duct Cancers
This begins in the bile ducts in that connect to the liver and is also known as primary liver cancer.

Common Bile Duct Cancers
This begins in the common bile duct which connects to the small bowel and where it meets the pancreatic duct.

Multifocal Bile Duct Cancer
This type of cancer means that there is more than one tumour present and they’re in different areas of the bile ducts.

Statistics

  • Biliary cancer is quite rare in Australia and survival statistics have improved significantly over time. Between 2006 and 2010, 5-year survival of gallbladder and biliary cancer doubled from 10% to 20%.
  • It is slightly more common in males and patients usually present in their 50’s.

Causes

It is not known what causes most bile duct cancers but some risk factors include:

  • Swelling or irritation: people with long term swelling or irritation in the bile ducts are more likely to get cancer.
  • Bowel disease: people that suffer from ulcerative colitis are at a higher risk of developing biliary cancer.
  • Primary Sclerosing Cholangitis (PSC): this is thought to be an autoimmune disorder, one in which the body’s own inflammatory cells attack the bile ducts. PSC causes scarring and narrowing of the bile ducts, which block bile from reaching the intestines. Some patients eventually need a liver transplant. In 10-20% of patients bile duct carcinoma develops. Many patients also have another autoimmune disorder, most commonly ulcerative colitis.
  • Congenital abnormalities of the bile ducts: these include choledochal cysts (dilation of the common bile duct).The overall lifetime risk of cholangiocarcinoma in these patients is 10%.
  • Benign tumors of the bile ducts: a major risk factor is biliary papillomatosis, which refers to multiple papillary tumours diffusely involving the bile ducts. These may progress to invasive carcinoma.
  • Hepatobiliary parasitic infection: Clonorchis is acquired when humans eat freshwater fish that harbor the Clonorchis cyst.

Exposure to toxins: exposure to chemical toxins such as asbestos can increase your chances of developing bile duct cancer

Symptoms

biliary-cancer-symptoms_for_web

Biliary and gallbladder cancer symptoms may include:

  • Jaundice (yellow skin, eyes and dark urine)
  • Itching
  • Unexpected weight loss
  • Pain in the right side of the upper abdomen
  • Loss of appetite
  • Excessive fatigue or weakness

Tests

There are a number of tests that can be done to diagnose biliary cancer including:

  • Biopsy tissue sample
  • Blood test
  • CT and MRI scan
  • Laparoscopy

Treatment

Treatment for bile duct and gallbladder cancer may include a combination of the following:

  • Surgery to remove the gallbladder/bile duct, and sometimes part of the liver
  • Chemotherapy
  • Radiation
  • Stent placement. A stent is a tube that allows the bile, which is made by the liver, to drain more easily into the intestine if a tumour is blocking the bile duct.

Surgery provides the only chance for cure in selected cases. Early diagnosis is the key in the appropriate management of gallbladder and bile duct cancer.

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