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Bile Duct Cancer (Cholangiocarcinoma)

bile_duct_cancer
Possible locations of Bile Duct Cancer.
A: Upper third of the bile duct also known as Klatskin Tumor or a Hilar Cancer.
B: Middle third of the common bile duct.
C: Lower third within the head of the pancreas
 

What is Bile Duct Cancer (Cholangiocarcinoma)?

Bile duct cancer also known as cholangiocarcinoma is cancerous transformation of the ducts that carry bile from the liver to the duodenum. Cancer of the bile duct is very rare and often occurs in older patients. Approximately 2,000 cases are diagnosed in the United States each year. The patient usually presents with jaundice, clay-colored stools, itching, fever, chills and rigors, loss of appetite, weight loss or abdominal and back pain as a consequence of the obstruction of these bile ducts. These are indolent tumors and often grow slowly and spread gradually. The bile ducts are in close proximity to some of the main blood vessels going into the liver. These include the main vessels such as the hepatic arteries and the portal vein. If these structures are involved it becomes difficult to clear the tumor and therefore deemed locally advanced. It is imperative to have these cancers treated at specialized centers such as ours, where the disease can be mapped with specialized interventional procedures and then adequately treated with either definitive surgical therapy or multimodality therapy, as deemed appropriate.


What is a Klatskin tumor?

Klatskin tumors are the most common bile duct cancers and are located at the junction of the right and left hepatic bile ducts (Location A as seen in the figure). The main therapy is surgical resection to clear margins. This surgery is best performed by specialized surgeons as these cancers need to be cleared off the major blood vessels to the liver. The reconstruction of the bile ducts is performed with a loop of intestine (Roux-en-Y procedure).

 

roux-en-y
Excision of the middle third of the bile duct and aRoux-en-Y reconstruction.




 

What is the treatment for these tumors?

The key is localization and mapping the extent of the tumor followed by surgical excision when deemed possible. Localization involves a high resolution CT(computerised tomography) scan or MRI(Magnetic Resonance Imaging) with very fine slices. The extent is additionally mapped out by the interventional radiologist or an interventional gastroenterologist by injection of a dye (Cholangiogram) and possible placement of a stent across the tumor. At the Liver and Pancreas Center we perform this scan with a specialized protocol with multiple phases. Experience of the surgeon is a key factor and we offer several surgical options for removing the tumor. These include:

  • Radical Excision of the Bile Duct Tumor followed by a Roux-en-Y reconstruction
  • Whipple Operation  for lower third bile duct cancers
  • Bile Duct Excision with concomitant Liver Resection
  • Bypasses and Stenting

Our favored approach to removing these tumors is the classic open approach but selectively for early cancers laparoscopic/robotic may be an option.
 

 

 

Related Links:

What is a Whipple Operation?        
What is a Liver Resection?    
What is a Klatskin Tumor?