Cholangiocarcinoma (bile duct cancer), also comprehended as bile duct cancer, occurs mostly in people older than 50, though it can occur at any age. The cancer type is formed in the bile ducts, and the role of the bile ducts is to attach the liver to the gallbladder and the small intestine.

Bile duct cancer or Cholangiocarcinoma is rare cancer that begins in the bile ducts. These ducts are thin tubes that carry bile from the liver and gallbladder to the small intestine. It's challenging to treat such types of cancer as the chances of recovery are usually poor. However, many targeted therapies and clinical trials are starting to change that stats.

In this blog, you can learn about the types of cholangiocarcinoma, its symptoms, associated risk factors, diagnosis, and treatment associated with bile duct cancer.

What are the cholangiocarcinoma types?

Doctors categorize cholangiocarcinoma into different types based on where cancer occurs in the bile ducts:

Intrahepatic Cholangiocarcinoma: is a type of bile duct cancer foundinside the liver. It should not be confused with liver cancer, more often referred to as hepatocellular carcinoma or HCC.

Distal cholangiocarcinoma: It occurs in the part of the bile duct closest to the small intestine. This type is also called extrahepatic cholangiocarcinoma.

Cholangiocarcinoma symptoms

Bile duct cancer is usually not noticeable initially, but the signs or symptoms appear later in the span of the disease. There are even occasions when the symptoms can occur earlier and lead to an early diagnosis.

When bile duct cancer does cause symptoms, it's usually because a bile duct is blocked. The symptoms tend to depend on whether the cancer is in the duct inside the liver (intrahepatic) or ducts outside the liver (extrahepatic) and may include

• Yellow skin and whiteness in eyes (jaundice)
• Extremely itchy skin.
• White-coloured stools.
• Tiredness.
• Abdominal pain below the ribs on the right side
• Weight loss without trying.
• Fever.
• Night sweat

What are different risk factors associated with cholangiocarcinoma?

The population with a higher risk of cholangiocarcinoma include individuals with abnormalities where the bile duct and pancreatic duct meet. The risk factors may consist of

• bile duct cysts
• Chronic ulcerative colitis.
• liver cirrhosis
• Clonorchiasis (infection with a Chinese liver fluke parasite).
• Suffering from Hepatitis B & C
• human immunodeficiency virus( HIV)
• inflammatory bowel disease
• Non-alcoholic fatty acid
• Primary sclerosing cholangitis (inflammation and scarring block the bile ducts).

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Cholangiocarcinoma diagnosis

Though challenging, the initial step of cholangiocarcinoma diagnosis involves performing a physical assessment and taking blood samples. The doctor will suggest blood tests to check how well the liver is functioning and can be used to look for tumour markers.

When the levels of tumour markers rise in people with cholangiocarcinoma, the patient may also need imaging scans such as ultrasound, CT, and MRI. The imaging scans can give a clear picture of the bile ducts and the areas around them to reveal tumours.

The imaging scans, in many cases, are helpful and permit the surgeon to remove a tissue sample in an imaging-assisted biopsy.

Occasionally, a procedure known as endoscopic retrograde cholangiopancreatography ERCP is suggested. In this procedure, the surgeon injects dye into the bile ducts, which helps the ducts to show up evidently on an X-ray, indicating any stoppages.

Sometimes, they'll also pass an investigation that takes ultrasound pictures in your bile ducts, called an endoscopic ultrasound scan.

Another way to diagnose the disorder is percutaneous transhepatic cholangiography (PTC). In this test, the doctor takes the X-rays after injecting dye into the liver and bile ducts.

Types of Treatment

Surgery

There are different types of surgery which are used to treat bile duct cancer:

Removal of the bile duct

This surgical procedure removes part of the bile duct if the tumour detected is small and is present within the bile duct only. In this procedure, the lymph node tissues are viewed under a microscope to see if there is cancer.

Partial hepatectomy

This is a surgical procedure carried out to remove the part of the liver where the cancer is found. The amount removed may be a wedge of tissue, an entire lobe or a more significant part of the liver, along with some normal tissue around it.

Whipple procedure

This surgical procedure involves the removal of the head of the pancreas, gallbladder, part of the stomach, part of the small intestine, and the bile duct. Enough of the pancreas is left to make digestive juices and insulin.

The doctor removes all cancerous cells that can be seen during the surgery. Some patients may be given chemotherapy or radiation therapy after surgery to kill cancer cells left behind. The treatment after the surgery lowers the risk of cancer recurrence. Though it is unclear whether chemotherapy or radiation therapy after surgery helps prevent cancer it is still done.

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