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Bile Duct Cancer (cholangiocarcinoma)

Washington University School of Medicine cancer physicians at Barnes-Jewish Hospital are shaping the way bile duct cancer patients are cared for through a multidisciplinary approach, clinical innovation and research.

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A regional referral center for bile duct cancer, Barnes-Jewish Hospital in St Louis, MO, is one of the few centers in the country that has a protocol for treating bile duct cancer and is among the top centers in the country in the number of bile duct cancer patients treated. Clinical studies show that patients treated in centers that specialize and have a depth of experience have better outcomes.

Washington University bile duct cancer specialists have extensive expertise and knowledge in the field. They are specialty trained, board certified, and have years of experience in treating hepatobiliary cancer. Our physicians care for patients before, during and after treatment. The majority of our physicians also are active researchers involved in clinical trials surrounding a variety of issues relevant to hepatobiliary cancer and disease.

What is bile duct cancer ?

Bile duct cancer is an uncommon cancer in which malignant cells are found in the bile duct tissue. The bile duct is a small tube that connects the liver and gallbladder to the small intestine. During digestion, bile is released from the gallbladder through the bile duct to break down fats.

How is it diagnosed ?

To diagnose bile duct cancer, a doctor completes a thorough medical exam that includes a review of the medical history, family's health history and a physical exam. The physical exam might include: a computed tomography (CT) scan, an X-ray which uses a computer to provide an image of the inside of the abdomen; a magnetic resonance imaging (MRI) scan, which uses magnetic waves to create the image; or an ultrasound, which uses high-frequency sound waves to echo off the body and create a picture.

An endoscopic retrograde cholangiopancreatography (ERCP) is another diagnostic test your physician may perform. During an ERCP, a flexible tube is inserted down the throat, and into the stomach and small intestine. By injecting dye into the drainage tube of the pancreas, your physician can see the area more clearly.

Another test, called a percutaneous transhepatic cholangiography (PTC), is another tool physicians may use to diagnose bile duct cancer. By injecting dye into the bile duct through a thin needle inserted into the liver, blockages can be seen on X-ray.

Sometimes a biopsy is performed in which a tiny sample of the bile duct fluid or tissue is examined under a microscope.

How is bile duct cancer treated ?

Surgery is most commonly used to treat bile duct cancer. Washington University cancer specialists have expertise in the very complex surgery required to treat bile duct cancer because of their extensive training and the volume of surgeries they perform. Our expertise lies in the ability to perform this difficult surgery with few complications and high survival rates.

If the cancer is found only in the bile duct, a surgeon would remove the bile duct and construct a new tube by connecting the openings in the liver to the intestine. Because bile duct cancer tends to travel to the lymph nodes, the lymph nodes would also be removed.

Surgeons are not able to determine if the lymph nodes are cancerous until they remove them, which gives the patient a better chance of cure. Sometimes a part of the liver also is removed if the tumor has spread up into the liver on one side.

If the lymph nodes are negative for cancer and the tumor is confined to the bile duct, the cure rate is more than 80 percent. If the cancer is not confined to the bile duct and the lymph nodes are negative, the cure rate is up to 60 percent. If the lymph nodes are positive, the cure rate is up to 20 percent.

Chemotherapy and radiation therapy may be used for added benefit. Chemotherapy uses drugs to kill cancer cells and may be administered orally, by injecting it into a vein (intravenously) or by injecting it into an artery (intra-arterially).

Radiation therapy, the use of high-powered X-rays that kill cancer cells and shrink tumors, may be used either before or after surgery. Typically given daily over a period of weeks, radiation therapy is not painful, although side effects such as stomach irritation may occur.

If the cancer has spread outside of the bile duct, surgery may still be performed to offer relief of pain to patients.

What support services are available?

Many services are available to support patients through the treatment decision process and assist them through the various treatment options. Siteman Cancer Center at Barnes-Jewish Hospital is an integrated, multidiscipliary care center, whose professional staff understand the fear of patients facing cancer.

What about research ?

Clinical trials may be available for consideration of patients who wish to pursue therapies deemed to be as good as - or potentially better than - the current standard therapies.

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Copyright 2015 Washington University School of Medicine
Copyright 2015 Washington University School of Medicine