bile duct cancer

What is Bile Duct Cancer?

Bile duct cancer, also known as cholangiocarcinoma, is a rare and aggressive disease in which malignant cells form in the bile ducts. The bile ducts are thin tubes that connect the liver to the small intestine, playing a crucial role in digestion by carrying bile fluid.

Types of Bile Duct Cancer

Bile duct cancer can occur in two main locations:

• Intrahepatic: within the bile ducts in the liver
• Perihilar or distal: outside the liver, affecting the bile ducts that connect to the small intestine

Causes and Symptoms

While the exact causes of bile duct cancer are still unknown, it is often associated with conditions such as:

• Inflammation of the bile ducts (cholangitis)
• Gallstones
• Liver disease
• Genetic predisposition

Symptoms of bile duct cancer may include: * Jaundice (yellowing of the skin and eyes) * Weight loss * Abdominal pain or discomfort * Fever * Itching (pruritus)

Incidence and Prognosis

Bile duct cancer is a rare disease, accounting for only 3% of all liver cancers. However, it has a poor prognosis, with a five-year survival rate of less than 10%. Early detection and treatment are critical in improving outcomes.

References:

• [1] Bile duct cancer is a rare disease in which malignant cells form in the bile ducts.
• [2] Nearly all bile duct cancers are cholangiocarcinomas (a type of adenocarcinoma).
• [3] Cholangiocarcinoma is a type of cancer that forms in the slender tubes (bile ducts) that carry the digestive fluid bile.
• [4] Bile duct cancer and gallbladder cancer are biliary tract cancers (BTCs).
• [5] Bile duct cancer (also called cholangiocarcinoma) can occur in the bile ducts in the liver (intrahepatic) or outside the liver (perihilar or distal).
• [6] Bile duct cancer, often called cholangiocarcinoma, begins in a bile duct.
• [7] Bile duct cancer (cholangiocarcinoma) develops within the small tubes (bile ducts) that move bile fluid among GI organs and help your body digest food.

Common Signs and Symptoms of Bile Duct Cancer

Bile duct cancer, also known as cholangiocarcinoma, can cause a range of symptoms that may vary in severity and duration. Here are some common signs and symptoms associated with this type of cancer:

• Jaundice: Yellowing of the skin and the whites of the eyes is one of the most common symptoms of bile duct cancer [1][2][3][4][5][6][7][8]. This occurs when the bile ducts become blocked, causing a buildup of bilirubin in the blood.
• Itching: Intensely itchy skin can also be a symptom of bile duct cancer [2][5].
• Dark urine and light-colored stools: The color of your urine and stool may change due to the blockage of bile ducts [6][7].
• Abdominal pain: Pain in the upper right or middle abdomen can occur as the tumor grows and presses on surrounding tissues [3][8].
• Loss of appetite and weight loss: As the cancer progresses, you may experience a decrease in appetite and subsequent weight loss [1].

It's essential to note that these symptoms can also be caused by other conditions, so it's crucial to consult with a healthcare professional for an accurate diagnosis.

References: [1] Oct 11, 2024 — Signs and Symptoms of Bile Duct Cancer · Jaundice [2] Jun 6, 2023 — Signs and symptoms of cholangiocarcinoma include: Yellowing of your skin and the whites of your eyes (jaundice) Intensely itchy skin. [3] Nausea and/or fever: These symptoms are often caused by abnormal liver function, infection caused by the blockage of bile ducts, or an increase in bilirubin. [4] The first sign of extrahepatic cholangiocarcinoma (cancer that grows on the bile ducts outside the liver) is almost always jaundice, or yellowing of the skin ... [5] Symptoms of bile duct cancer · yellowing of the skin and the white of your eyes - this is called jaundice · changes to the colour of your poo and pee · itchy skin. [6] May 15, 2024 — Signs and symptoms of bile duct cancer · jaundice (yellowing of the skin or whites of the eyes) · dark urine · clay colored stool · pain in the ... [7] Oct 29, 2024 — Symptoms of bile duct cancer · jaundice – yellowing of the skin and the whites of the eyes, itchy skin, pale stools and dark-coloured urine ... [8] Main symptoms of bile duct cancer · the whites of your eyes turning yellow or your skin turning yellow, which may be less obvious on brown or black skin ( ...

Diagnostic Tests for Bile Duct Cancer

Bile duct cancer diagnosis involves a combination of physical examination, medical history, and various imaging tests to confirm the presence of cancer in the bile ducts.

• Physical Exam and Health History: A thorough physical exam and health history are essential to identify any symptoms or risk factors associated with bile duct cancer [1].
• Imaging Tests: Imaging tests such as:
  • Ultrasound: An abdominal ultrasound is usually the first imaging test used to diagnose bile duct cancer [4][7]. It can show if there's a cancerous gallbladder or bile duct tumor.
  • CT Scan: A CT scan (computed tomography) is often used in combination with other tests to provide detailed images of the bile ducts and surrounding tissues [3][8].
  • MRI Scan: Magnetic resonance imaging (MRI) scans can also be used to diagnose bile duct cancer, especially when combined with other imaging techniques [3].
• Blood Tests: Blood tests are used to check for tumor markers such as carcinoembryonic antigen (CEA), which can indicate the presence of cancer in the bile ducts [2].
• Other Diagnostic Techniques: Other diagnostic techniques may include:
  • Endoscopic retrograde cholangiopancreatography (ERCP): This procedure involves inserting an endoscope into the bile duct to collect a sample for further examination.
  • Liver function tests: These tests can help identify any abnormalities in liver function that may be related to bile duct cancer.

It's essential to note that a combination of these diagnostic tests is often used to confirm the diagnosis of bile duct cancer. A healthcare professional will determine the most suitable tests based on individual patient needs and circumstances.

References: [1] May 24, 2024 — How is bile duct cancer diagnosed? [2] May 24, 2024 — How is bile duct cancer diagnosed? [3] Techniques used to diagnose bile duct cancer include ultrasound, computerized tomography (CT) scans and magnetic resonance imaging (MRI) combined with magnetic ... [4] Imaging – Imaging tests, such as X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans and abdominal ultrasounds can often show the ... [5] You have a number of tests to check for bile duct cancer. This includes blood tests and scans such as ultrasound and MRI scans. [6] Tests for bile duct cancer · blood tests · scans, like an ultrasound scan (sometimes from inside your body using an endoscope), CT scan, or MRI scan · collecting a ... [7] Imaging tests, such as an ultrasound and a CT scan, can often provide enough information to show if there's a cancerous gallbladder or bile duct tumour, and the ... [8] Jun 3, 2022 — Imaging. A variety of imaging tests may be used to diagnose bile duct cancer including those listed below. CT scan: A CT (computed tomography) ...

Treatment Options for Bile Duct Cancer

Bile duct cancer, also known as cholangiocarcinoma, can be treated with various drug therapies. Here are some of the most common treatment options:

• Chemotherapy: Chemotherapy uses drugs to kill cancer cells. Common chemotherapy drugs used to treat bile duct cancer include:
  • Gemcitabine (Gemzar) [5]
  • Cisplatin (Platinol) [5]
  • Capecitabine (Xeloda) [8]
  • Oxaliplatin (Eloxatin) [2]
• RET inhibitors: Selpercatinib (Retevmo) and pralsetinib (Gayreto) are RET inhibitors that can be used to treat advanced bile duct cancers with the RET mutation [1].
• Other drugs: Other drugs sometimes used to treat bile duct cancer include fluorouracil (5-FU), oxaliplatin, and capecitabine [5].

Combination Therapy

Chemotherapy may also be combined with other treatments such as surgery or immunotherapy. For example, chemotherapy may be used before a liver transplant.

New Treatment Options

There are ongoing clinical trials studying new treatment options for bile duct cancer, including the use of next-generation FGFR inhibitors like tinengotinib [4].

References:

[1] Oct 11, 2024 - Selpercatinib (Retevmo) or pralsetinib (Gayreto) are RET inhibitors and can be used to treat advanced bile duct cancers with the RET ...

[2] Oct 22, 2023 - The latest treatment for cholangiocarcinoma. The drug being studied in the clinical trial, tinengotinib, is an example of a next-generation FGFR ...

[4] Feb 10, 2022 - Results from the TOPAZ-1 trial found the immunotherapy drug durvalumab modestly improved survival in people with biliary tract cancer. Credit:

[5] The standard chemotherapy drugs for bile duct cancer are gemcitabine (Gemzar) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU) ...

[8] Chemotherapy is a common treatment for bile duct cancer. Common chemotherapy drugs include capecitabine, gemcitabine with cisplatin and a chemotherapy ...

Differential Diagnosis of Bile Duct Cancer

Bile duct cancer, also known as cholangiocarcinoma, can be challenging to diagnose due to its similarity in presentation with other conditions. The differential diagnosis for bile duct cancer includes:

• Liver metastases: This is a common differential diagnosis for bile duct cancer, particularly when the tumor is located in the liver.
• Hepatocellular carcinoma (HCC): HCC can present with similar symptoms to bile duct cancer, including jaundice and abdominal pain.
• Benign biliary tumors: These can mimic polypoid cholangiocarcinoma, making differential diagnosis challenging.
• Choledocholithiasis: The presence of stones in the bile duct can cause obstruction and inflammation, which can be mistaken for bile duct cancer.

Key Features to Consider

When considering a differential diagnosis for bile duct cancer, it's essential to look out for the following features:

• Jaundice with or without weight loss and abdominal pain: These symptoms are common in both bile duct cancer and other conditions.
• Abdominal pain: This symptom can be present in various conditions, including liver metastases and HCC.
• Weight loss: Unintentional weight loss is a common feature of many cancers, including bile duct cancer.
• Intrahepatic mass: A mass in the liver can suggest liver metastases or HCC.
• Extrahepatic mass: A mass outside the liver can indicate metastatic disease.

References

1. CCA remains a highly fatal malignancy because early diagnosis is difficult [1].
2. Cholangiocarcinoma is suspected based on signs of biliary obstruction, abnormal liver function tests, elevated tumor markers (carbohydrate antigen 19-9 and ...), and imaging studies [3].
3. The differential diagnosis of hilar cholangiocarcinoma (HCCA) that include primary malignancies, metastatic disease and benign lesions is challenging and requires a thorough evaluation [7].
4. Choledocholithiasis, Presence of stones in the bile duct causing obstruction and inflammation, can be mistaken for bile duct cancer [8].

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