Cancer bile duct liver

Definition

The bile ducts travel throughout the liver collecting bile, and then continue to the gall bladder and small intestine. Biliary duct cancer, also termed cholangiocarcinoma, may occur in various locations in and around the liver.

Causes & symptoms

Biliary cancer typically occurs in individuals aged 50-70 years old. Possible risk factors include congenital abnormalities of the bile ducts called choledochal cysts, gall stones (cholelithiasis) along with the resulting chronic inflammation of the gall bladder (cholecystitis), and inflammatory bowel disease. Patients with a history of ulcerative colitis are 10 times more likely to develop bile duct cancer than the general population. Most prevalent in southeast Asia, this cancer is thought to be associated with a parasitic infection of the liver contracted by eating raw or pickled fish from this region.

By the time the initial symptom of jaundice is present, the disease has often reached an advanced stage or spread to other organs. Other symptoms include itching, weight loss, abdominal pain, nausea and vomiting. There may be tenderness below the ribs, on the right side of the abdomen. Patients with bile duct cancer almost always have an enlarged liver.

Diagnosis

Laboratory studies help to determine the cause of jaundice. Abdominal ultrasound of the gall bladder and bile ducts may reveal enlargement as a result of increased pressure in the biliary tract due to an obstruction. Other specialized x ray studies may be ordered to assist in visualizing the affected structures. Magnetic resonance imaging (MRI) may be used to help determine if the bile duct cancer can be surgically removed. A chest x ray allows detection of tumor nodules that have spread to the lungs.

Treatment

The optimal treatment for bile duct cancer is surgery. Often, the cancer is not detected until it has spread throughout the bile ducts and into the liver. The resulting tumor cannot be completely removed. If a patient is ill from complications of infection or jaundice, a drainage tube (stent) may be inserted to assist in drainage of the bile ducts. Chemotherapy and radiation are occasionally used to shrink the tumors and relieve symptoms, assisting in maintaining quality of life. Various medications may also be used to assist in managing symptoms of the disease.

Prognosis

Careful follow-up is important after surgical treatment. Computed tomography scans (CT) may be needed every two to three months for the first year, as recurrence of the cancer may be removed if caught early. Those patients who are diagnosed prior to the spread of the disease to other tissues can experience long-term survival after surgical removal of the tumor.

Key Terms

Bile

A material secreted in the liver and stored in the gall bladder, which aids in digesting and absorbing fat.

Liver

The largest organ in the body, located in the upper right abdomen; it assists in various digestive processes of the body and in maintenance of the blood supply. It also stores glycogen and fat and assists in the disposition of the body's waste products.

Gale Encyclopedia of Medicine. Gale Research, 1999.