biliary tract cancer

Common Signs and Symptoms of Biliary Tract Cancer

Biliary tract cancer, also known as cholangiocarcinoma, can cause a range of symptoms depending on the stage and location of the tumor. Here are some common signs and symptoms:

• Jaundice: Yellowing of the skin and whites of the eyes due to high levels of bilirubin in the blood [1][3][7][8]
• Dark urine: Urine that is darker than normal due to the buildup of bilirubin [4][7]
• Clay-colored stool: Stool that is pale or clay-colored due to the lack of bile salts [4][7]
• Abdominal pain: Pain in the upper right or middle abdomen, which can worsen over time [5][9][12][14]
• Weight loss: Unintentional weight loss due to a decrease in appetite and metabolism [5][6][13]
• Itchy skin: Itching sensation on the skin due to the buildup of bilirubin [6][12]
• Loss of appetite: Decreased interest in food and drink due to the tumor's impact on digestion [6][14]
• Fever: Elevated body temperature, which can be a sign of infection or inflammation [6][14]

Important Notes

• These symptoms can also be caused by other conditions, so it's essential to consult a doctor for an accurate diagnosis.
• Biliary tract cancer often doesn't cause noticeable symptoms until the disease has advanced and spread to other organs and tissues [9][14].
• Early detection and treatment can improve outcomes, making it crucial to seek medical attention if you experience any of these symptoms.

References:

[1] Context result 1 [3] Context result 3 [7] Context result 7 [8] Context result 8 [4] Context result 4 [5] Context result 5 [6] Context result 6 [12] Context result 12 [14] Context result 14

Diagnostic Tests for Biliary Tract Cancer

Biliary tract cancer, also known as cholangiocarcinoma, can be diagnosed using various tests and procedures. Here are some of the diagnostic tests used to detect this type of cancer:

• Imaging tests: Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working. Examples include:
  • MRI: Magnetic resonance imaging scans may be able to distinguish between benign (noncancerous) and malignant (cancerous) tumors [5].
  • CT scan: Computed tomography scans can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
• Endoscopic retrograde cholangiopancreatography (ERCP): ERCP is the diagnostic test most performed to diagnose bile duct cancer [9].
• Blood tests: Blood chemistry tests can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
• Ultrasound imaging: Ultrasound scans can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working [6].
• Cholangiography: Cholangiography involves injecting dye into the bile ducts to visualize them on an X-ray. This test can help diagnose bile duct cancer.
• Biopsy: A biopsy involves taking a sample of tissue from the bile ducts and examining it under a microscope for cancer cells [1].
• Staging tests: Staging tests, such as imaging tests and biopsies, are used to determine the extent of cancer in the body and the likely prognosis.

It's worth noting that a biopsy isn't always done before surgery for a possible bile duct cancer. If imaging tests show a tumor in the bile duct, the doctor may decide to proceed directly to surgery and to treat the tumor as a bile duct cancer [1].

References:

[1] Context result 1 [5] Context result 5 [6] Context result 6 [9] Context result 9

Treatment Options for Biliary Tract Cancer

Biliary tract cancer, also known as cholangiocarcinoma, is a rare and aggressive form of cancer that affects the bile ducts. While treatment options are limited, various drugs have been approved or are being investigated to manage this disease.

Chemotherapy

Chemotherapy remains a mainstay in treating advanced biliary tract cancers. The most common chemotherapy drug combination used is cisplatin (or carboplatin) and gemcitabine [6]. This regimen has shown some efficacy in improving survival rates, although the overall prognosis remains poor.

• Cisplatin: A platinum-based chemotherapeutic agent that works by interfering with DNA replication, ultimately leading to cell death.
• Gemcitabine: A nucleoside analog that inhibits DNA synthesis, causing cancer cells to die.

Targeted Therapy

Recent advances have led to the development of targeted therapies for biliary tract cancer. These treatments specifically target molecular mechanisms driving tumor growth and progression.

• Durvalumab: An immune checkpoint inhibitor approved in combination with gemcitabine and cisplatin for adults with unresectable or metastatic biliary tract cancer [2].
• Pembrolizumab: Another immune checkpoint inhibitor approved for use with gemcitabine and cisplatin in locally advanced unresectable or metastatic biliary tract cancer [12].

Other Therapeutic Options

Several other drugs are being investigated or have been approved for treating biliary tract cancer.

• Zanidatamab: A first-of-its-kind treatment approved for adults with HER2-positive (IHC 3+) biliary tract cancer that has not responded to chemotherapy [9][11].
• Regorafenib: A multi-targeted kinase inhibitor being investigated in clinical trials for its potential in treating advanced biliary tract cancers.
• Bintrafusp alfa: An immunotherapy agent being studied for its efficacy in treating unresectable or metastatic biliary tract cancer.

Surgical Interventions

In some cases, surgical removal of the bile duct (choledochoduodenostomy) or part of the liver (partial hepatectomy) may be considered to treat early-stage disease [10].

While these treatment options show promise, it's essential to note that biliary tract cancer remains a challenging disease to manage. Further research is needed to improve outcomes and develop more effective therapies.

References:

[1] On November 20, 2024, the U.S. Food and Drug Administration granted accelerated approval to the drug zanidatamab (Ziihera) to treat advanced and metastatic bile duct cancer (cholangiocarcinoma) and other biliary tract cancers that have high levels of a protein called HER2 and do not respond to chemotherapy.

[2] On October 31, 2023, the Food and Drug Administration approved pembrolizumab (Keytruda, Merck) to be used with gemcitabine and cisplatin for locally

The differential diagnosis of biliary tract cancer involves a wide range of conditions that can present with similar symptoms and characteristics to biliary tract cancer.

Common Differential Diagnoses

• Acalculous Cholecystitis: Inflammation of the gallbladder without gallstones, which can mimic the symptoms of biliary tract cancer [2].
• Ampullary Carcinoma: Cancer of the ampulla of Vater, a small pouch where the bile and pancreatic ducts empty into the small intestine, which can present with similar symptoms to biliary tract cancer [3].
• Bile Duct Strictures: Narrowing or blockage of the bile ducts, which can cause similar symptoms to biliary tract cancer such as jaundice and abdominal pain [4][5].
• Bile Duct Tumors: Benign or malignant tumors that grow in the bile ducts, which can mimic the symptoms of biliary tract cancer [6][7].
• Cholangitis: Inflammation of the bile ducts, which can cause similar symptoms to biliary tract cancer such as jaundice and abdominal pain [8].
• Liver Tumors: Benign or malignant tumors that grow in the liver, which can present with similar symptoms to biliary tract cancer [9].

Other Differential Diagnoses

• Biliary Obstruction: Blockage of the bile ducts, which can cause similar symptoms to biliary tract cancer such as jaundice and abdominal pain [10].
• Acute Cholecystitis: Inflammation of the gallbladder, which can mimic the symptoms of biliary tract cancer [11].

Key Points

• The differential diagnosis of biliary tract cancer is broad and includes a range of conditions that can present with similar symptoms.
• Accurate diagnosis requires a thorough evaluation of the patient's medical history, physical examination, and diagnostic tests such as imaging studies and biopsies.

References:

[1] Not available

[2] Acalculous Cholecystitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[3] Ampullary Carcinoma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[4] Bile Duct Strictures. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[5] Bile Duct Tumors. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[6] Cholangitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[7] Liver Tumors. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[8] Biliary Obstruction. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-

[9] Acute Cholecystitis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-