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Woman with liver pain

All About Bile Duct Cancers

Bile duct cancers are a very diverse group of gastrointestinal cancers that originate from the bile duct system that is contained both within and outside the liver. Some of these cancers occur within the gallbladder itself. Approximately 10,000 or so new cases are diagnosed annually in the United States. 

Prevalence of Bile Duct Cancers

These cancers typically manifest few signs of their presence and are frequently diagnosed at more advanced states. They are very lethal. Curiously, gallbladder cancer is more common in areas of South America, increases with age, and also affects women at roughly four times the rate for men. In certain parts of Asia, bile ducts cancers have an incidence forty times greater than the United States. 

Risk Factors and Symptoms

Risk factors include: viral hepatitis, gallstone disease, cirrhosis, obesity, elevated blood sugars, certain infections of the biliary tract, primary sclerosing cholangitis, cigarette smoking, aflatoxins found in peanuts and soybeans, and liver flukes (parasitic liver worms). Those suffering from the cancer may present with right upper quadrant abdominal pain that is often associated with anorexia, nausea, vomiting and later, malaise and weight loss. If the bile duct is obstructed by cancer, jaundice accompanied by pruritus (itching), clay-colored stools, fevers, and dark urine may occur. 

How Bile Duct Cancers are Diagnosed

As for the diagnostic and staging work-up of these cancers, your doctor may order several of the following studies: abdominal ultrasound, endoscopic ultrasound, CT, MRI, or PET-CT. 

Ultimately, the diagnosis depends on resecting a portion or all of the cancer. The extent of surgery depends on how advanced the disease is at the time of diagnosis. Sometimes, the cancers are quite small and are found incidentally after a person has undergone gallbladder removal for suspected benign gallbladder disease. 

Treatment Options for Bile Duct Cancers

But in other cases, the surgery to remove the cancer can be extensive if the goal is potential cure. If the cancer is advanced at the time of discovery, surgery may consist of only a biopsy to make the diagnosis and treatment typically involves radiation and/or chemotherapy. Recent promising treatment advances include the incorporation of new immunotherapeutic agents to improve survival for this very deadly cancer. The average five-year survival for all completely resected bile duct cancer is roughly 35%.

Doug Clark, MD
Doug Clark, MD

Doug Clark, MD is a Radiation Oncologist with CHI Health.

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