What is the bile duct?
Bile is a fluid that the digestive system uses to help break down fats. The bile duct is made up of a series of tubes, which begin in the liver, connect to the gallbladder and end in the small intestine. The function of the bile duct is to help move bile from the liver into the gallbladder, before it is then moved into the small intestine.
Types of bile duct cancer
Cancer of the bile duct is a rare but aggressive type of cancer that develops in the bile duct. Health professionals sometimes use the term cholangiocarcinoma to refer to cancer of the bile duct.
There are two main types of bile duct cancer:
- Intraheptic bile duct cancer: bile duct cancer that develops inside the liver.
- Extraheptic bile duct cancer: bile duct cancer that develops outside the liver.
How common is bile duct cancer?
Bile duct cancer is very rare. It accounts for just 3% of cancers that affect the digestive system. Most cases of bile duct cancer occur in people who are 70 years of age or over. Bile duct cancer is slightly more common in men than in women.
Risk factors for bile duct cancer include a rare type of chronic liver disease called primary sclerosing cholangitis (PSG) and viral hepatitis.
Prognosis
The prognosis for bile duct cancer is poor. Bile duct cancer can only be cured if cancerous cells are limited to the bile duct, in which case some, or all, of the bile duct can be surgically removed.
However, most cases of bile duct cancer are only diagnosed after the cancer has spread beyond the bile duct by which time a cure in not usually achievable. Only 5% of people with bile duct cancer will survive for five years or more after receiving their initial diagnosis. However, even if a cure is not achievable, treatments such as chemotherapy can help to control symptoms and improve quality of life.
Stages of bile duct cancer
Health professionals use a staging system to describe how far bile duct cancer has advanced. These stages are described below.
- Stage one: the cancer is limited to the bile duct.
- Stage two: the cancer has moved beyond the bile duct, but no further than nearby liver tissue, the gallbladder or pancreas.
- Stage three: the cancer has moved to nearby lymph nodes.
- Stage four: the cancer has affected much of the liver, nearby tissue, and the lymph nodes, and/or it has spread to other parts of your body such as your lungs, or kidneys (metastasis).
In cases of stage one and stage two bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct and possibly some of the liver or gallbladder.
In cases of stage three bile duct cancer, the chances of achieving a successful cure will depend on how many lymph nodes have been obstructed. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes.
In cases of stage four bile duct cancer, achieving a successful cure is usually highly unlikely. However, chemotherapy and radiotherapy can be used to help relieve symptoms.
Symptoms of cancer of the bile duct
Bile duct cancer does not usually cause any symptoms until the cancer has reached an advanced state and is blocking the flow of bile from the liver into the intestine. The blockage will cause bile to move back into the blood and body tissue resulting in symptoms such as:
- yellowing of your skin and the whites of your eyes (jaundice),
- dark yellow coloured urine, and
- your stools may take on a paler appearance.
Other possible symptoms of bile duct cancer include:
- mild abdominal pain,
- high temperature,
- itchy skin,
- loss of appetite, and
- weight loss.
You should always see your doctor if you experience the symptoms of jaundice (yellowing of the skin and whites of the eyes) that last more than a few weeks. While it is unlikely to be the result of bile duct cancer, prolonged symptoms of jaundice could be the result of underlying problems with the liver, such as hepatitis.
Complications of cancer of the bile duct
Being diagnosed with cancer, particularly if it is incurable, can be very distressing. For many, the news is difficult to take in and comprehend. Many people who are diagnosed with cancer experience the classic stages of the grieving process. These are outlined below.
- Denial: you may not believe the diagnosis at first and think that there is nothing wrong with you.
- Anger: you may lash out at friends, family or medical staff.
- Bargaining: sometimes people with terminal conditions will try to ‘bargain’ with their doctors, asking for any sort of treatment that can prolong their life.
- Depression: you may lose all interest in life and feel that your situation is hopeless.
- Acceptance: in time, most people will eventually accept the diagnosis.
If you have been diagnosed with cancer, talking to a counsellor or psychiatrist may help you to combat feelings of depression and anxiety. Anti-depressants, or medicines that help to reduce feelings of anxiety may also be recommended for you as you move through the grieving process.
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