Treatment for bile duct cancer depends on the location, type and extent of the tumor. Patients need a multidisciplinary care plan that incorporates all potential therapies in the treatment decisions and plan.
Surgery offers the only potential cure for bile duct cancer. If the tumor is located in a part of the biliary system that is within the liver (intrahepatic cholangiocarcinoma), surgeons will typically remove the affected bile duct as well as the section of the liver that it drains.
Tumors growing in a bile duct outside the liver can be treated in different ways depending on the location of the tumor. When the tumor is in a section of the bile duct close to the liver, surgery often includes removal of a portion of the liver. When the tumor is nearer to the end of the bile duct, surgery may include removal of part of the pancreas. After a portion of the extrahepatic bile duct has been removed, surgeons perform a reconstruction procedure to attach the remaining bile duct directly to the small bowel.
Extensive workup, including scans and endoscopy, is necessary to identify patient who are most likely to be eligible for surgery.
Following surgery to remove an extrahepatic bile duct tumor, a pathologist examines all resected tissues. If the examination reveals that the surgery was unable to remove the entire tumor, or if cancer cells have spread to nearby lymph nodes, patients may undergo radiation with chemotherapy in an attempt to eradicate remaining cancer cells. Radiation oncologists at Froedtert & the Medical College of Wisconsin have access to a variety of radiotherapy systems capable of precisely targeting tumors while sparing healthy tissue.
Some extrahepatic bile duct tumors are too extensive to be removed by surgery. For these patients, radiation therapy in various combinations with chemotherapy can be used to try to control the cancer. Typically, external beam radiation is delivered concurrently with low-dose chemotherapy. For patients with a less bulky tumor, chemoradiation can be followed by brachytherapy. This involves the placement of a radioactive particle into the diseased duct using catheter techniques.
Extrahepatic bile duct cancers that are inoperable may be eligible for treatment that includes chemotherapy and radiation therapy. For patients who are not good candidates for radiation treatment, chemotherapy is an alternative.
In addition to the most current standard therapy, researchers are also investigating a number of new “targeted” drugs for treatment of bile duct cancer.
When an intrahepatic cholangiocarcinoma recurs following surgery, selected patients can benefit from minimally invasive interventional radiology procedures that deliver treatment to the site of the cancer.
Interventional radiologists also perform minimally invasive stenting procedures to treat bile duct blockages and strictures caused by extrahepatic cholangiocarcinomas. A stent is a thin, flexible tube inserted into a duct to keep it open. Relieving bile duct blockages and strictures can help restore liver function, enabling patients to tolerate chemotherapy. A bile duct stent can also serve as a conduit for other therapies, such as the placement of radiation brachytherapy.
Patients with bile duct cancer may be eligible for novel therapies conducted under clinical trial protocols. See our clinical trials page for a complete list of investigational treatments currently available at Froedtert & the Medical College of Wisconsin.