Cholangiocarcinoma is a cancer of the biliary system, which incorporates the gallbladder, bile ducts inside the liver, and bile ducts extending outside of the liver that drain into the intestine. This is a fairly rare type of cancer, affecting about 9,000 Americans every year. Most cases (2/3) are limited to the gallbladder, while the other third extends to the bile ducts. Risk factors include chronic inflammation from infection or autoimmune disease, particularly primary sclerosing cholangitis (a chronic disease caused by progressive inflammation and scarring of the bile ducts).
Symptoms and Diagnosis
Early symptoms of cholangiocarcinoma may include:
- Change in urine or stool color
- Bloodwork that shows elevated liver enzymes
Later symptoms can include jaundice (yellowing of the skin or whites of the eyes), abdominal pain, fever, and weight loss. Because these symptoms are common in a variety of other diseases, further testing is needed to confirm a diagnosis of cholangiocarcinoma.
Fortunately, several diagnostic tools are available, including noninvasive radiological imaging tests such as ultrasound, CT scan, or MRI, and more “invasive” tests such as:
- Endoscopic retrograde cholangiopancreatography (ERCP) uses an endoscope to gain access to the bile duct from the duodenum (the portion of the small intestine that connects to the stomach).
- Cholangioscopy involves insertion of a miniature endoscope into the bile duct so that the physician can (1) get an image of blockages and (2) perform a visual-guided biopsy.
- Endoscopic ultrasound (EUS) involves insertion of an ultrasound probe to provide highly detailed images of the biliary system.
- Percutaneous transhepatic cholangiography involves injection of a radiopaque dye into the biliary tree to help physicians gauge the extent of a tumor into the liver.
Tumor Removal (Resection)
The type of surgery recommended depends on the type of cholangiocarcinoma:
- For intrahepatic cholangiocarcinoma (found in bile ducts inside the liver), if confined to a single lobe of the liver, tumors are removed (resected) along with the surrounding lobe.
- For extrahepatic (found in bile ducts outside of the liver),
- If tumors are found to be operable (resectable), they are removed along with lymph nodes that may be affected.
- If tumors are found to be inoperable (unresectable), the patient will be referred for radiation and/or chemotherapy.
Endoscopic therapy allows the surgeon to permanently widen the bile duct to a diameter that allows unrestricted bile flow. The process involves:
- dilating the obstructive biliary segment with rigid or balloon dilation catheters, and
- inserting a metallic biliary stent.
In the case of unresectable lesions in which endocscopic stenting is not possible, a percutaneous stent may be placed through the abdominal wall to allow for bile drainage.
To find out more about the Methodist Center for Liver Disease and Transplantation, call us at 713-441-8839 or 866-94-LIVER (866-945-4837) or send us an email.