Cancer of the bile duct ( Cholangiocarcinoma )
Oncology / / August 12, 2017
bile duct cancer - a cancer that forms in the thin ducts - bile ducts that carry bile from the liver.It is also called "cholangiocarcinoma."Bile duct cancer is a rare form of cancer that occurs mostly in people older than 50 years.Cholangiocarcinoma develops when one of the ducts that carry bile from the liver into the duodenum, develop malignant (cancerous) tumor.
bile duct cancer, like other cancers, is not infectious and can not be transferred to others.
bile ducts (biliary tract) - long tubes, diverting bile from the liver and gallbladder to the duodenum.Bile is a fluid that helps break down fats found in foods and also helps the body get rid of waste that is filtered through the blood to the liver.
bile ducts in the liver begin.Bile is drained from the liver cells in long branches which end in a common bile duct.At the end of the common bile duct empties into the duodenum.There are intrahepatic bile ducts and Extrahepatic bile ducts.
The gallbladder is a reservoir that stores bile for the entire time until the food reaches the intestines.The gallbladder is attached to a small channel - "cystic duct", which is in the common bile duct.
bile duct cancer types
Cancer can occur in any part of the bile duct.For the detection of bile duct cancer, doctors must determine the exact location of the tumor in the bile ducts.Based on the location of the tumor, a cancer of the bile duct can be:
- Extrahepatic. Part of the bile ducts, which are outside the liver is called "extrahepatic ducts."In this part of the bile duct cancer usually begins.The right and left hepatic ducts are connected.The tumor that begins in the field, also sometimes called "Klatskin tumor" (tumor splitting, dividing the common hepatic duct).The rest of the bile ducts outside the liver cancer begins, where there are right and left hepatic ducts, and where the common bile duct empties into the small intestine;
- Intrahepatic. 5% to 10% of cases of cancer of the bile ducts - intrahepatic cancer is disposed within the liver.
reasons and possible risk factors for cancer of the bile ducts
reasons for most cancers of the bile duct is unknown.There are a number of risk factors that may increase the risk of developing cancer of the bile ducts.These include:
- Inflammatory conditions. Patients who have chronic intestinal inflammatory condition, known as ulcerative colitis, are at increased risk of developing this cancer.People who have primary sclerosing cholangitis - an inflammatory disease that affects the bile ducts - are also at increased risk of developing cancer of the bile ducts;
- Abnormalities of the bile ducts. People who are born with abnormalities of the bile ducts (congenital anomalies) - for example, such as choledochal cysts (sacciform expansion of the bile duct), - have a higher risk of developing cancer of the bile ducts;
- Infection. large number of bile duct cancers, are believed to be caused by infection with the parasites;
- Age. Although cancer of the bile duct can occur in younger people, more than two-thirds occur in people older than 65 years.
- Removal of the gallbladder (cholecystectomy)
- Cholecystectomy from the cervix
- Echinococcosis gallbladder
- operations on the biliary tract and liver
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Symptoms of cancer of the bile ducts
Symptoms depend on the localization of the tumor and may include:
- jaundice (yellowing of the skin and whites of the eyes).Bile duct cancer can block the flow of bile from the liver to the intestine.This causes efflux of bile in the blood and tissues of the body, causing the skin and whites of the eyes sick person become yellow (icteric).It also causes dark yellow color of urine and pale stools;
- itchy skin;
- abdominal pain;
- weight loss;
- progressive weakness;
- expanded the gallbladder.
These symptoms may be caused by many reasons other than cancer and bile duct, but it is important to check with your doctor.
diagnosis of cancer of the bile ducts
diagnosis of bile duct cancer begins with a comprehensive medical examination, during which the patient has to describe your symptoms and medical history.
following tests are commonly used for the diagnosis of bile duct cancer:
- Laboratory tests. blood test will check liver function and look for markers that may indicate a tumor.Studies include:
- liver function tests;
- CEA (carcinoembryonic antigen) and CA-19-9 (CA - specific antigen) - blood tests that check the malignant tumors of the gastrointestinal tract;
- alpha-fetoprotein (AFP) - A blood test that is used to identify possible malignancy.
- ultrasonography (transabdominal ultrasound). uses sound waves to create a picture of the biliary tract and surrounding organs.The patient is usually asked to not eat or drink for at least six hours before the scan.After the patient lies comfortably on his back, on his stomach to apply the gel.Then study surveyed the area through a small device that produces sound waves.Sound waves can take photos on your computer.The test is painless and takes only a few minutes;
- Computed tomography (CT).CT has the X-rays which show the three-dimensional image of internal body parts.Verification occurs painless and takes 10-30 minutes.CT scans use a small amount of radiation that is unlikely to harm the patient or the person with whom he comes into contact.The patient will be asked not to eat or drink for at least four hours before the scan.CT may require administration of contrast dye, which allows you to see the subjects specific areas of the body more clearly;
- spiral computed tomography. In this test, X-ray machine is rotated continuously around the body to create cross-sectional images;
- Magnetic resonance imaging (MRI). This study is similar to a CT scan, but uses magnetic waves instead of x-rays to create detailed images.The test helps to create a detailed picture of the areas of the patient's body.MRI is superior to CT in a little visualization of the bile duct tumors.From the latest technologies MRI - magnetic resonance cholangiography (MRHG) - a specific type of MRI to be used for the diagnosis of cancer of the bile ducts;
- biopsy. results of previous tests can make the doctor suspect the patient has cancer of the bile ducts, but the only way to be sure of this gives a biopsy.Some of the cells or tissue samples for a biopsy taken from the lesion area of the bile ducts.biopsy sample is then examined under a microscope.CT or ultrasound may be used at the same time to ensure that the biopsy is taken in the right (probably tumor affected) site;
- Gastrointestinal Endoscopy. patient receives anesthesia, and, if necessary, analgesic and sedative.The doctor inserts an endoscope through the mouth and into the esophagus.The endoscope is equipped with a camera that transmits the image to a monitor for viewing;
- Endoscopic retrograde cholangiopancreatography (ERCP). ERCP uses an endoscope to view the special side.The endoscope allows the physician to enter the contrast agent into the patient's bile ducts.X-ray contrast and highlight any deviations.During ERCP, your doctor may perform a biopsy to remove tissue and bile duct for analysis;
- cholangioscopy. cholangioscopy - a special type of endoscope, which the doctor inserts into the bile ducts.Cholangioscopy used to test and biopsy of the tumor directly.During cholangioscopy can be made and ERCP;
- Endoscopic ultrasound (EUS). This procedure combines endoscopy with ultrasound for imaging a patient's gastrointestinal tract.The procedure is very similar to an upper endoscopy.EUS is useful in the diagnosis of cancer of the bile ducts;
- Endoscopic retrograde cholangiography. doctor inserts a small needle through the liver and into one of the patient's bile ducts, and then enters the contrast agent through the needle.After the X-ray images that are done - in order to see the bile ducts.In some cases, endoscopic retrograde cholangiography is more useful than ERCP;
- Angiography. This test allows us to investigate the blood vessels.Bile ducts are very close to the large blood vessels that carry blood to the liver and from it.An angiogram may be used to check for the presence of blood vessels in their cancer.
cancer classification bile duct
classification of cancer cells under a microscope gives an idea of how quickly the cancer may develop.Coarse classification means that the cancer cells are very similar to normal cells.They tend to grow slowly and are less likely to spread.With high-grade cells look very abnormal.Moreover, they are likely to grow more quickly and are more likely to spread further.
stage of cancer of the bile ducts
stage cancer - is the term used to describe its size and extent of the limits of the former place.Knowing the stage of the cancer helps doctors select the appropriate, most correct treatment.
cancer can spread in the body through the blood or lymphatic system.The lymphatic system is part of the defense of the body against infection and disease.It consists of a network of lymph nodes, connected by thin pipes.Doctors tend to examine the lymph nodes of the biliary system, to determine the stage of cancer.
- Stage 1A. Cancer is found only in the bile ducts.
- Phase 1B. cancer has spread to the wall of the bile duct, but has not spread to nearby lymph nodes or other structures.
- Stage 2A . cancer has spread to the liver, pancreas, gall bladder, or nearby blood vessels, but not to the lymph nodes.
- Stage 2B . cancer has spread to nearby lymph nodes.
- Stage 3. Cancer affects the major blood vessels that take blood from the liver, or has spread to the intestines, stomach or abdominal wall.Also, the lymph nodes in the abdomen may be affected.
- Stage 4. cancer has spread to distant parts of the body - such as the lungs.
If the cancer comes back after treatment, it is called "cancer recurrence."
Treating cancer of the bile ducts
bile duct cancer is an aggressive form of cancer, which progresses rapidly and is difficult to treat.
Treatment will depend on the position and size of the cancer and whether it beyond the bile duct, and how it affects the overall health spread.In some cases, the goal of treatment is to relieve symptoms.
main bile duct cancer treatment is surgery to remove a cancerous tumor.But it can lead to serious health consequences, and is not always possible.The decision about whether to carry out an operation and what type of operation, in the case of carrying out mandatory, may be needed depends on the size of cancer and whether the cancer has become whether spread to adjacent tissue need.
- Removal of the bile ducts. If the cancer is at a very early stage (stage 1), it only removes the bile ducts containing the cancer cells.The remaining channels in the liver and then attached to the small intestine, which allows bile flow again.
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- Partial resection liver. If the cancer has begun to spread to the liver, the affected part of the liver and bile ducts removed.
- Whipple procedure (surgery on the pancreas to remove tumors and other entities) . If the cancer is large and spread to neighboring structures, the bile ducts removed, part of the stomach, the small intestine (duodenum), pancreas, gall bladder and the surrounding lymph nodes.This is a very serious operation.
- surgery to relieve obstruction of the bile ducts. If it is impossible to remove the tumor, it is possible, at least to have an operation to liberate from blocking the bile ducts.It will also help in the treatment of jaundice.
surgeon creates a bypass blocked parts of the bile ducts.Thus, bile may enter the intestines from the liver.In another method of unlocking without surgery - a tube (stent) is inserted into the channel, opening it.If part of the small intestine (duodenum) is blocked, this can lead to disease.Surgery may help if the surgeon connects the stomach to the next section of the small intestine, bypassing the duodenum.
- Stent placement. thick and long tube stent is inserted into the bile duct to keep it open and, if possible, to drain bile.The stent typically requires replacement every 3-4 months, to prevent it from clogging.If the stent is locked, a person may have a high body temperature, and / or jaundice.It is important to inform your doctor as soon as possible if you develop these symptoms.You may need antibiotic treatment, and the doctor may recommend replacing the stent.
- Radiation (radiation) therapy (radiation, radiotherapy). Radiotherapy treats cancer by using high-energy rays that can destroy cancer cells.Radiation can be given externally by radiotherapy machine, or internally - by placing radioactive material very close to the tumor (brachytherapy).
Radiation therapy can sometimes be used after surgery for cancer of the bile ducts.This is called "adjuvant radiotherapy" and assigned to try to reduce the risk of cancer returning.Radiotherapy is also sometimes used, if the operation is not possible.It can not cure the cancer, but it may help to reduce or retard its growth.
- Chemotherapy. Chemotherapy - is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells.It inhibits the growth of cancer cells.
Chemotherapy can sometimes be used after surgery, if surgery using all of the cancer can not be removed.It can also be used if the operation is not possible or the cancer came back (again) after initial treatment.The objective of chemotherapy is to try to reduce or slow the growth of cancer cells and alleviate the symptoms.combination of drugs Cisplatin and Gemcitabine (Gemzar) can be used for the treatment of bile duct cancer.
Studies conducted to find out whether help chemotherapy after surgery (adjuvant chemotherapy) to reduce the risk of cancer returning.
- Chemoradiotherapy. Sometimes chemotherapy and radiotherapy (radiation therapy) are given together.This is called "chemo-therapy".This type of treatment can be used after surgery to remove cancer of the bile duct, or if the cancer can not be removed by surgery.