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Cholangiocarcinoma (bile duct cancer)(CCA) : Causes, Types, Symptoms, Diagnosis and Treatment

What is Cholangiocarcinoma (bile duct cancer)?

Cholangiocarcinoma, or digestive juice duct|duct|epithelial duct|canal|channel} cancer, may be a rare type of cancer. It usually affects older adults and has typically developed on the far side of the bile ducts by the time it’s diagnosed. Treatment usually involves a mix of surgery, therapy or radiation therapy.

Channel cancer is a rare unwellness within which malignant (cancer) cells are kind within the bile ducts. Channel cancer is additionally referred to as cholangiocarcinoma.

 

A network of tubes, called ducts, connects the liver, gallbladder, and tiny intestine. This network begins in the liver wherever several small ducts collect bile (a fluid created by the liver to break down fats throughout digestion). the little ducts close to make the correct and left viscus ducts, that lead out of the liver. The 2 ducts are part of the liver and form the common hepatic duct. The cystic duct connects the vesica to the common hepatic duct. Gall from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is kept within the gallbladder.

 

Once food is being digested, bile stored in the gallbladder is discharged and passes through the cystic duct to the common channel and into the small intestine.

 

What is Cholangiocarcinoma (bile duct cancer)

 

 

Explanation of medical terms and concept Cholangiocarcinoma (CCA) 

Cholangiocarcinoma may be a form of willcer that forms within the slender tubes (bile ducts) that carry the succus bile. digestive juice ducts connect your liver to your vesica and to your little intestine.

 

Cholangiocarcinoma, additionally called common bile duct cancer, happens principally in folks older than age 50, though it can occur at any age.

Cholangiocarcinoma also called an adenocarcinoma of the bile duct or cholangiocarcinoma of the head of the pancreas is cancer that starts in the lining of bile ducts Its symptoms can be mistaken for other conditions In its early stages it produces no noticeable symptoms and is detected during tests ordered for a different condition If it spreads outside the liver it is more likely to have certain symptoms.

What are the symptoms? Jaundice: Yellowing of the skin and whites of the eyes (jaundice) can be a sign that a person is having trouble with their bile ducts Cholangiocarcinoma will cause jaundice because it stops bile from flowing freely Flu symptoms: People may also experience fatigue nausea vomiting loss of appetite and stomach pain among other flu-like symptoms These discomfort can last for weeks before transitioning into more serious symptoms.

Doctors divide cholangiocarcinoma into different types based on where the cancer occurs in the bile ducts:

  • Intrahepatic cholangiocarcinoma occurs in the parts of the bile ducts within the liver and is sometimes classified as a type of liver cancer.

  • Hilar cholangiocarcinoma occurs in the bile ducts just outside of the liver. This type is also called perihilar cholangiocarcinoma.

  • Distal cholangiocarcinoma occurs in the portion of the bile duct nearest the small intestine. This type is also called extrahepatic cholangiocarcinoma.

Cholangiocarcinoma is often diagnosed when it's advanced, making successful treatment difficult to achieve.

Some important facts about liver cancer include the following.

Key Points

  • Bile duct cancer is a rare disease in which malignant (cancer) cells develop in the bile ducts.

  • If you have colitis or certain liver diseases, that increases the risk of bile duct cancer.

  • If you have signs of bile duct cancer, these include jaundice and pain in your abdomen.

  • Tests that examine the bile ducts and organs near them are used to diagnose and stage bile duct cancer.

  • There are different ways to obtain tissue samples from a person with bile duct cancer and to diagnose the disease.

  • The chance of a successful recovery and the available treatment options depend on a number of factors.

 

Bile duct cancer is a rare disease in which cancer cells form in the bile ducts.

There is a network of tubes that connects the liver and small intestine.The network of bile ducts begins in the liver, where many small ducts collect bile (a fluid made by the liver to break down fats during digestion). The small ducts merge to form the right and left hepatic ducts, which lead to the small intestine. Bile from the liver is released into the body.The two ducts that carry liver fluid from the liver join outside of the organ and form a common hepatic duct. The cystic duct links the gallbladder to the common hepatic duct. Bile that comes from the liver is stored in the gallbladder.

Bile is released when food is digested, and it goes through the cystic duct and into the common bile duct. Then, it passes into the small intestine.

Cholangiocarcinoma is also called bile duct cancer.

There are two types of bile duct cancer: Cholangiocarcinoma is a cancer that begins in the cells that line the bile ducts. Bile duct cancer can also start in the cells that produce bile, which is a greenish-yellow fluid that helps digest food.

Having colitis or liver diseases can increase the risk of developing bile duct cancer.

Risk factors are anything that increases your chance of getting a disease. Even if you have risk factors, it does not mean that you will get cancer; not having risk factors does not mean that you will not get cancer. If you think you may be at risk, talk to your doctor.

Some factors that increase the risk of developing bile duct cancer include the following:

  • Cholangitis is a disease in which the bile ducts become blocked by inflammation and scarring.

  • Chronic ulcerative colitis.

  • Bile ducts can have cysts that block the flow of bile, which can cause swelling in the bile ducts and inflammation.

  • If you get an infection from a Chinese liver fluke parasite, it will be very difficult to treat.

Symptoms Cholangiocarcinoma 

If you have signs of bile duct cancer, such as jaundice and abdominal pain, then you may have the condition.

If you have any of the following signs or symptoms, it is likely that you have bile duct cancer or another condition: -A lump in your throat -Nausea and vomiting -Loss of appetite -Frequent stomach pain or discomfort

  • Jaundice is a condition in which the skin or whites of the eyes turn yellow.

  • Dark urine.

  • Clay colored stool.

  • Pain in the abdomen.

  • Fever.

  • Itchy skin.

  • Nausea and vomiting.

  • Weight loss for an unknown reason.

Diagnosis Cholangiocarcinoma

If your doctor suspects cholangiocarcinoma, he or she may have you undergo one or more of the following tests:

Tests that look at the bile ducts and nearby organs are used to diagnose and stage bile duct cancer.

The process used to determine if cancer has spread to nearby areas or to other parts of the body is called staging. This procedure makes pictures of the bile ducts and surrounding area in order to figure this out.

Knowing if bile duct cancer can be removed through surgery is important for planning treatment.Some tests and procedures may be done at the same time to find out what type of cancer someone has and how far it has spread.

The following tests and procedures may be used to determine the quality of a decoupage:

  • Physical exam and health historyA physical exam of the body is conducted to check general signs of health, as well as for signs of disease. A history of the patient's health habits and past illnesses and treatments will also be taken.

  • Liver function testsAn exam to measure the amount of bilirubin and alkaline phosphatase in a person's blood is used to detect liver disease. If there is too much bilirubin and/or alkaline phosphatase in the blood, this may be an indication that liver cancer is present.

  • Laboratory testsMedical procedures that test samples of tissue, blood, or urine help to diagnose diseases, plan treatments, and monitor the disease over time.

  • A CEA and CA 19-9 tumor marker test is used to diagnose cancer.A test is performed to measure the amounts of certain substances in a person's blood, urine, or tissue. These substances are linked to specific types of cancer when they are found in increased levels in the body. These markers are called tumor markers.Higher than normal levels of CEA and CA 19-9 may mean that you have cancer involving the bile duct.

  • Ultrasound examSonograms are a procedure in which high-energy sound waves are bounced off internal organs and tissues, producing echoes. The echoes create a picture of the organ or tissue, which can be printed out and viewed later.

  • CT scan (CAT scan) Computerized pictures of organs and tissues inside the body are taken using x-rays. This is a procedure that creates detailed pictures of different areas inside the body. A dye may be injected into a vein or swallowed to make the images more visible. CT scanning is a procedure that uses a computer to create images of the inside of the body.

  • MRI (magnetic resonance imaging)Nuclear magnetic resonance imaging (NMRI) is a procedure that uses a magnet and a computer to create a series of detailed pictures of areas inside the body.

  • Cholangiopancreatography is a medical test that uses a magnetic field and radio waves to view the inside of the stomach and small intestine.A procedure that uses a magnet and a computer to create detailed pictures of areas inside the body, such as the liver bile ducts, gallbladder, pancreas, and pancreatic duct.

To obtain a sample of tissue for diagnosis of bile duct cancer, different techniques may be used.

A biopsy is a procedure that removes cells and tissues from someone for examination under a microscope by a pathologist. The cells and tissue may be obtained in different ways, depending on the patient's health condition. For example, surgery may be used to get the sample.

There are many types of biopsy procedures, including the following:

  • Laparoscopy A surgery to look inside the abdomen for signs of cancer involves small cuts in the wall of the abdomen and the use of a laparoscope (a thin, lighted tube). Other instruments may be inserted. Doctors make cuts into your body to take tissue samples for cancer testing.

  • Percutaneous transhepatic cholangiography (PTC) is a procedure that allows doctors to see the inside of your liverA procedure used to x-ray the liver and gallbladder. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or gallbladder, and an x-ray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin tube may be inserted to allow the flow of bile.A flexible tube called a stent may be left in the liver to drain bile into the small intestine. This procedure may be used when a patient cannot have surgery.

  • Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that allows doctors to see the inside of your intestine.An x-ray is used to look at the ducts that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine.Bile duct cancer can cause these ducts to narrow, which can slow the flow of bile. This can lead to jaundice. A scope is passed through someone's mouth to see this.A dye is injected through an endoscope into the stomach and into the small intestine. An x-ray is taken to see if cancer is present. If the bile duct is blocked, a thin tube may be inserted to allow the dye to reach the duct.A stent is inserted into the duct to unblock it. This may be done if a patient cannot have surgery.

  • Endoscopic ultrasound (EUS) An endoscope is a thin tube-like instrument that is inserted into the body through the mouth or rectum. With this procedure, an endoscope has a light and a lens for viewing. The probe at the end of the endoscope can be used to bounce high-energy sound waves off internal tissues. Sonograms create images of body tissues by making echoes.A tissue sample is removed to check for cancer. This procedure is also called endosonography.

The chance of recovery and treatment options depend on a variety of factors.

The outlook and treatment options for a person depend on a variety of factors.

  • The cancer is located in which part of the bile duct system?

  • The stage of the cancer (whether it affects only the liver or has spread to other parts of the body).

  • If the cancer has spread to other areas of the body, such as nearby nerves or veins.

  • Can the cancer be completely removed by surgery?

  • Conditioning factors such as primary sclerosing cholangitis may affect the patient.

  • Is the level of CA 19-9 higher than normal?

  • This passage is about cancer that has just been diagnosed or has recurred (come back).

If the cancer is found early, treatment options may vary. Bile duct cancer most often occurs after it has spread and can be removed by surgery in a few cases. Palliative therapy may improve symptoms and the quality of life for the patient.

Stages of Bile Duct Cancer

Key Points

  • The results of diagnostic and staging tests are used to determine if cancer has spread.

  • Cancer can spread in three ways in the body.

  • Cancer may spread from where it began to other parts of the body.

  • Cancer is described using stages.

    • Intrahepatic bile duct cancer

    • Perihilar bile duct cancer

    • Distal bile duct cancer

  • There are different groups that help plan treatment.

    • Resectable (localized) bile duct cancer

    • This passage is about cancer that is not able to be treated with surgery.

The results of diagnostic and staging tests are used to determine if cancer has spread.

The process used to determine if cancer has spread to other parts of the body is called staging. For bile duct cancer, information gathered from tests and procedures is used to plan treatment, including whether the tumor can be removed by surgery.

Cancer can spread in the body in three ways.

Cancer can spread through tissue by the lymph system and the blood.

  • Cancer spreads from where it began by growing into nearby areas.

  • Cancer spreads from its original location by entering the lymph system. The cancer travels through the lymph vessels to other parts of the body.

  • Cancer spreads from where it began by entering the bloodstream. Cancer travels through the blood vessels to other parts of the body.

Cancer can spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from the original tumor and travel through the lymph system or blood.

  • Cancer spreads through the lymph system. The cancer gets into the lymph system and travels through the lymph vessels. It forms a tumor (metastatic tumor) in another part of the body.

  • Cancer cells get into the blood, travel through the blood vessels, and form a tumor (metastatic tumor) in another part of the body.

The cancer cells that have spread from the primary tumor are of the same type as the original cancer. For example, if bile duct cancer spreads to the liver, the cancer cells in the liver are actually bile duct cancer cells. This is not liver cancer.

Cancer deaths are often caused when the cancer moves from its original location and spreads to other parts of the body.This is a type of cancer that has spread to other parts of the body. This animation shows how cancer cells move from their original spot in the body to other areas.

Cancer is described in terms of stages.

Intrahepatic bile duct cancer

  • Stage 0:In stage 0 intrahepatic bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the intrahepatic bile duct. These abnormal cells may become cancerous and spread to nearby normal tissue. Stage 0 is also called carcinoma in situ.

  • Stage I:Intrahepatic bile duct cancer is divided into stages IA and IB.Tumor sizes are often measured in centimeters (cm). Common food items that can be used to demonstrate tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).

    • In stage IA, cancer has developed in an intrahepatic bile duct and the tumor is less than 5 centimeters in size.

    • In stage IB cancer, which is the earliest form of the disease, has been found in an intrahepatic bile duct and the tumor is bigger than 5 centimeters.

  • Stage II:In stage II intrahepatic bile duct cancer, one of the following is found:

    • The tumor has spread to a blood vessel inside the liver.

    • There are more than one tumor in the intrahepatic bile duct and they may have spread to a blood vessel.

  • Stage III:Stage III intrahepatic bile duct cancer is divided into stages IIIA and IIIB. In stage IIIB, the cancer has spread beyond the liver.

    • In stage IIIA, the tumor has spread throughout the capsule (outer lining) of the liver.

    • In Stage IIIB cancer, the disease has spread to nearby organs or tissues. This could be the duodenum, colon, stomach, common bile duct, abdominal wall, diaphragm, or part of the vena cava behind the liver.

  • Stage IV:In stage IV intrahepatic bile duct cancer, cancer has spread to other parts of the body- such as the bone, lungs, and distant lymph nodes- beyond where it was initially found.

Perihilar bile duct cancer

  • Stage 0:Cancerous cells are found in the inner layer of tissue surrounding the perihilar bile duct in stage 0 cancer. These cells may become cancerous and spread to nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.

  • Stage I:In stage I perihilar bile duct cancer, cancer has formed in the innermost layer of tissue lining the perihilar bile duct and has spread into the muscle layer or fibrous tissue layer of the perihilar bile duct wall.

  • Stage II:In stage II perihilar bile duct cancer, the cancer has spread to nearby fatty tissue or to liver tissue.

  • Stage III:Perihilar bile duct cancer is divided into three stages: IIIA, IIIB, and IIIC.

    • Cancer has spread to one side of a hepatic artery or portal vein.

    • Stage IIIB: cancer has spread to one or more of the following: The cancer has spread to one or more of the following locations: the body, the brain, or the lungs.

      • Look for the main vein on both sides of the portal.

      • the common hepatic artery;

      • The right and left hepatic ducts join to form the hepatic artery or portal vein.

      • The left hepatic duct and the right branch of the hepatic artery or of the portal vein come from the left side of the liver.

    • Cancer has spread to one to three nearby lymph nodes.

  • Stage IV:Stage IV perihilar bile duct cancer is divided into stages IVA and IVB. In stage IVA, the cancer has spread beyond the perihilar bile duct but has not invaded other parts of the body. In stage IVB, the cancer has invaded other parts of the body.

    • Cancer has spread to at least four nearby lymph nodes.

    • Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, and distant lymph nodes or tissue in the abdomen.

Distal bile duct cancer

  • Stage 0:In stage 0 of distal bile duct cancer, abnormal cells are found in the innermost layer of tissue surrounding the distal bile duct. These abnormal cells may become cancerous and spread to nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.In millimeters, a sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.

  • Stage I:Cancer has not spread beyond the first few centimeters into the wall of the distal bile duct in stage I cancer.

  • Stage II:Stages IIA and IIB of distal bile duct cancer are divided into two categories.

    • Stage IIA: Cancer has spread:

      • If cancer has spread to 1 to 3 nearby lymph nodes, or if the cancer is located less than 5 millimeters into the wall of the distal bile duct, then the person has cancer.

      • The needle should go into the wall of the distal bile duct about 5 to 12 millimeters in.

    • Cancer has spread beyond 5 millimeters into the wall of the distal bile duct. This means cancer may have spread to 1 to 3 nearby lymph nodes.

  • Stage III:Third degree distal bile duct cancer is divided into stages IIIA and IIIB.

    • Cancer has spread to four or more nearby lymph nodes.

    • Cancer has spread to the large organs in the abdomen. Cancer may have spread to one or more nearby lymph nodes.

  • Stage IV:In stage IV distal bile duct cancer, cancer has spread to other parts of the body such as the liver, lungs, or tissue lining the wall of the abdomen and most organs in the abdomen.

Treatment Cholangiocarcinoma 

Your treatment set up for cholangiocarcinoma depends on the situation of the willcer and if it unfolds. Surgery can treat early duct cancers that haven’t spread. however most bile duct cancers have spread by the time they’re diagnosed. In these cases, your aid supplier might suggest a mixture of multiple treatments.

Doctors use these groups to plan treatment:

Resectable (localized) bile duct cancer

Cancer is located in an area such as the lower part of the common bile duct or perihilar area where it can be surgically removed.

This passage refers to cancer that is too difficult or impossible to remove surgically.

Some patients with cancer of the bile duct cannot have their entire tumor removed by surgery.

Cancer can spread from its original location to other parts of the body. For example, metastatic bile duct cancer may have spread to the liver or other parts of the abdominal cavity.

Recurrent bile duct cancer is cancer that has returned after being treated. The cancer may come back in the liver or gallbladder. Less commonly, the cancer may return in distant parts of the body.

Treatment Option Overview

Key Points

  • Treatment for patients with bile duct cancer can involve different techniques.

  • There are three common ways to treat pests: with chemicals, with physical methods such as swatting, or by using a natural method such as the use of ladybugs.

    • Surgery

    • Radiation therapy

    • Chemotherapy

  • Clinical trials are testing new treatment methods.

    • Liver transplant

    • Targeted therapy

    • Immunotherapy

  • Side effects of treatment for bile duct cancer may occur.

  • Some patients may want to take part in a clinical trial.

  • Patients can enter clinical trials before, during, or after starting their cancer treatment.

  • Follow-up tests may be needed.

There are different types of cancer treatment for patients with bile duct tumors.

There are different treatments available for patients with bile duct cancer. Some treatments are the current standard, while others are being tested in research studies in order to improve or obtain new information about them. New treatments for patients with cancer are being tested. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. If you're interested in taking part in a clinical trial, some trials are open only to patients who have cancer. I'm not yet starting treatment.

Three types of standard treatment are used to treat plants: 1. Mechanical removal, such as cutting the plant down or uprooting it; 2. Pesticides; and 3. Fertilization with plant food or compost.

Surgery

There are different types of surgery that can be used to treat liver cancer.

  • If the tumor is small and located in only the bile duct, it may be removed with surgery. Lymph nodes are also removed and checked for cancer cells under a microscope.

  • Hepatectomy: A surgery in which part of the liver where cancer is found is removed. The removed area may be a wedge of tissue or an entire lobe, as well as some normal tissue around it.

  • The Whipple procedure removes the head, gallbladder, stomach, small intestine, and bile duct of the pancreas. This leaves enough of the pancreas to produce digestive juices and insulin.

After the doctor removes any cancer that can be seen during surgery, some patients may receive chemotherapy or radiation therapy afterwards to kill any cancer cells that remain. Treatment given after surgery to lower the risk of the cancer returning is called adjuvant. Chemotherapy or radiation therapy given after surgery is not yet known to be effective in preventing the cancer from coming back.

There are several types of surgery that may be used to relieve symptoms caused by a blocked bile duct and improve the quality of life.

  • If cancer is blocking the bile duct and bile is accumulating in the gallbladder, a biliary bypass may be performed. During this operation, the doctor will cut the gallbladder or bile duct near the blockage and attach it to the part of the bile duct that is past the blockage or to another part of the body. The small intestine will create a new pathway around the blocked area.

  • If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to allow bile drainage. The doctor may place the stent through a catheter that drains the bile into a bag on the outside of the body or the stent may go around the blockage. Remove the blockage and pour the bile into the small intestine.

  • A procedure used to x-ray the liver and bile ducts is Percutaneous Transhepatic Biliary Drainage. A thin needle is inserted through the skin below the ribs and into the liver. A dye is injected into the liver or bile ducts, and an x-ray is taken. If the bile duct is blocked, a thin flexible tube called a stent may be inserted. A stent may be left in the liver to allow bile to drain into the small intestine or a collection bag outside of the body.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to destroy cancer cells or keep them from growing.There are two types of radiation therapy: internal and external. 1. External radiation therapy uses x-rays or other types of radiation that are applied to the outside of the body. 2. Internal radiation therapy uses radioactive materials that are injected into the body.

  • External radiation therapy uses a machine outside the body to deliver radiation to the area of the body with cancer.

  • Internal radiation therapy uses a radioactive substance that is sealed inside needles, seeds, or wires that are placed directly into or near the cancer.

Radiation therapy is used to treat bile duct cancer on the outside and inside of the body.

It is not yet known whether external radiation therapy helps treat resectable bile duct cancer. Some new ways to improve the effect of external radiation therapy on cancer cells are being studied:

  • Hyperthermia therapy: A treatment that exposes the body to high temperatures in order to make cancer cells more sensitive to the effects of radiation therapy and anticancer drugs.

  • Radiosensitizers: Drugs that make cancer cells more sensitive to radiation, which may result in more cancer cell death.

Chemotherapy

Chemotherapy is a treatment for cancer that uses drugs to stop the growth of cancer cells. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter your bloodstream and can reach all of the cancer cells in your body. Chemotherapy is a treatment that is delivered into the cerebrospinal fluid or an organ such as the abdomen. The drugs affect cancer cells in those areas (regional chemotherapy).

Systemic chemotherapy is used to treat cancer that has spread throughout the body. It is not yet known whether it helps with treating cancer that has been removed by surgery.

Intra-arterial embolization is being studied for unresectable metastatic or recurrent bile duct cancer. After anticancer drugs are given to blood vessels near the tumor, the flow of blood to the tumor may be stopped. Sometimes small beads filled with anticancer drugs are attached to the beads. The beads are injected into an artery that feeds the tumor. The beads block blood flow to the tumor, allowing a higher concentration of the drug to reach the tumor for a longer amount of time. This may lead to more cancer cell death.

Clinical trials are testing new types of treatments.

This summary section describes treatments that are being studied in clinical trials. Some of these treatments may not have been mentioned yet. You can find more information about clinical trials on the National Cancer Institute website.

Liver transplant

In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients who have perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment may be given as needed.

Targeted therapy

Treatment with drugs or other substances is used to identify and attack specific cancer cells. These treatments usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following targeted therapies are being studied in patients with bile cancer: If you have localized cancer that has spread to other parts of your body, it is not treatable with surgery.

  • Ivosidenib is a type of targeted therapy that blocks a specific mutation in a gene called IDH1. This stops the growth of cancer cells.

  • Pemigatinib and infigratinib are types of targeted therapies that block specific changes in a gene called FGFR2. This may help keep cancer cells from developing and may kill them.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or manufactured in a laboratory are used to activate or restore the body's natural defenses against cancer. This cancer treatment is a type of biological therapy.

Immune checkpoint inhibitors are a type of immunotherapy that may be used to treat liver cancer.

  • Treatment with PD-1 inhibitors and PD-L1 inhibitors: When PD-1 attaches to PD-L1, it stops the T cell from attacking the cancer cell. These treatments work by inhibiting the expression of these proteins. Keep the PD-1 and PD-L1 proteins from attaching to each other. This will allow the T cells to kill cancer cells. Pembrolizumab is a type of PD-1 inhibitor that may be used in patients whose cancer is locally advanced or has spread to other parts of the body.

An immune checkpoint inhibitor helps keep the immune system in check. These proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep the immune response from attacking and destroying the cancer cells. When these proteins bind together, it blocks the ability of T cells to kill tumor cells (left panel). The inhibitor allows the T cells to kill tumor cells (on the right panel).Immunotherapy involves using the body's immune system to fight cancer. This animation explains how one type of immunotherapy uses immune checkpoint inhibitors to treat cancer.

Side effects of treatment for bile duct cancer may occur.

Please see our Side Effects page for more information about the side effects of cancer treatment.

Some patients may want to take part in a clinical trial.

Some patients may choose to take part in a clinical trial in order to find out if a new cancer treatment is safe and effective. Clinical trials are part of the cancer research process. They are done to see if new treatments are better than the standard treatment.

Clinical trials are tests that doctors perform on people to see what treatments work best. Sometimes, patients who take part in the trial will receive the standard treatment and other times they will be among the first to receive a new treatment.

Clinical trials are important because they help improve the way cancer will be treated in the future. Even when clinical trials do not result in any new treatments, they often provide important information that helps move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include people who have not yet received treatment. Other trials test different treatments for people whose cancer has not gone away. There are also clinical trials that test new ways to stop cancer from coming back or reduce the side effects of cancer treatment.

Clinical trials are happening all over the country. You can find information about clinical trials that NCI supports on our clinical trials search webpage. Clinical trials that other organizations support can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose or determine the stage of the cancer may be repeated. Tests will be repeated in order to see how well the treatment is working. This information will help decide whether to continue changing or stopping treatment.

After treatment has ended, some of the tests will still be done from time to time. These tests can show if your condition has changed or if the cancer has come back (reoccurred). These tests are sometimes called follow-up tests or check-ups.

How to treat liver cancer that has been localized (treated)

If you have cancer that has not been able to be removed by surgery, treatment may include radiation and/or chemotherapy.

To Learn More About Bile Duct Cancer

For more information about bile duct cancer from the National Cancer Institute, see the following:

For information about cancer and other resources from the National Cancer Institute, see the following:

About This PDQ Summary

About PDQ

The PDQ database is a comprehensive cancer information resource maintained by the National Cancer Institute. It includes summaries of the latest published information on cancer prevention, detection, genetics, treatment, and supportive care. This passage contains accurate cancer information written in easy-to-understand language. Both versions are available to health professionals and patients. The professional versions have detailed information, while the patient versions are written in easy-to-understand language. Both versions are up to date and contain accurate information about cancer. There are also Spanish versions of this book.

The PDQ summaries are based on an independent review of the scientific evidence. They are not official statements from the NCI or NIH.

Purpose of This Summary

This PDQ cancer information summary is designed to help patients and their families make informed decisions about treatment for bile duct cancer. It does not give specific instructions on how to take care of your health.

Reviewers and Updates

Editorial boards write PDQ cancer information summaries and keep them up to date. These boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when new information is discovered. The date on each summary is current as of the date that it was published.This is the most recent change.The (updated) date is the most recent change.

This patient summary was taken from the health professional version, which is updated regularly and reviewed by the PDQ Adult Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question such as whether one treatment is better than another. Trials are based on what has been learned in the laboratory. Each trial tries to find new and better ways to help cancer patients. Clinical trials are conducted to collect information about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than what is currently being used, the new treatment may become standard. Patients may want to consider taking part in the trial. A clinical trial is a study that is open to people who have not started treatment.

Clinical trials can be found online at the NCI website. If you have more questions, you can call the Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237).

What you can do

  • Be aware of any pre-appointment restrictions, such as restricting your diet.

  • List your symptoms, including any that seem unrelated to the reason you scheduled the appointment.

  • List key personal information, including recent changes or stressors.

  • List all of your medications, vitamins and supplements, including doses.

  • Ask a relative or friend to accompany you, to help you remember what the doctor says.

  • List questions to ask your doctor.

  • Bring copies of your medical records to your appointment, if you're seeing a new doctor for the first time. If you've had scans done at another facility, ask that files containing those images be placed on a CD and bring that to your appointment.

Some basic questions to ask your doctor include:

  • Do I have bile duct cancer? What type?

  • What is the stage of my cancer?

  • What does my pathology report say? Can I have a copy of the pathology report?

  • Will I need more tests?

  • What are my treatment options?

  • What are the potential side effects of each treatment option?

  • Is there one treatment you think is best for me?

  • How will my treatment affect my daily life?

  • How much time can I take to make my decision about bile duct cancer treatment?

  • What is your experience with bile duct cancer diagnosis and treatment? How many surgical procedures for this type of cancer are done each year at this medical center?

  • Should I see a bile duct cancer specialist? What will that cost, and will my insurance cover it?

  • Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • When did you first begin experiencing symptoms?

  • How severe are your symptoms? Are they occasional or continuous?

  • Does anything improve or worsen your symptoms?

General summary

When cholangiocarcinoma is diagnosed in its early stages surgery or other procedures may enable a patient to regain good health The disease kills about one-third of people who are diagnosed with it The symptoms often are vague and can be misdiagnosed for months or even years at a time When the disease has advanced it becomes terminal and surgical removal is no longer possible

What is the best treatment for cholangiocarcinoma?

The prognosis for individuals with cholangiocarcinoma varies depending on the stage of s/he disease at the time of diagnosis and treatment options include surgery chemotherapy and radiation therapy While there are no FDA-approved medications to treat this cancer type ongoing clinical trials might be able to provide those who have cholangiocarcinoma with hope for a cure.

Does anyone survive cholangiocarcinoma?

Many people diagnosed with cholangiocarcinoma survive several months but some live for years or even decades There is no typical survival time for patients who receive this type of cancer treatment However the outlook is often incredibly poor for those who are diagnosed in the later stages of cholangiocarcinoma The median survival rate from the time of diagnosis to death is just nine months For those who have liver metastasis the median survival rate falls at about three months Moreover 30 percent to 60 percent of people with metastatic cancers do not live beyond five years after their diagnoses.

Are there any new treatments for cholangiocarcinoma?

Cholangiocarcinoma or bile duct cancer can be difficult to treat because it metastasizes to lymph nodes and the lungs But new research implicates a protein called oncogenic TGF-β1 which may help researchers develop more targeted drug therapies While cholangiocarcinoma is not common—causing about 1 percent of all breast cancers in women and less than 3 percent of all liver cancers—it does tend to be aggressive The average survival rate from diagnosis is between six and 18 months But with these recent studies shedding light on the genetic pathways that contribute to.

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Cholangiocarcinoma (bile duct cancer)(CCA)  : Causes, Types, Symptoms, Diagnosis and Treatment

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