EN
1. About bile duct cancer
|
2. Diagnostics
|
3. Treatment options
|
4. Treatment prognosis
|
5. Clinics recommendations
|
Cholangiocarcinoma is a rare and aggressive malignant tumour of bile ducts. Without timely treatment, the disease has an unfavourable prognosis. From the moment of diagnosis, the average life expectancy of patients is 24 months. From this article, you can learn about the latest methods of cancer treatment which are used to prolong the life of such patients.
Listen to the article:
What is cholangiocarcinoma (bile duct cancer)?
Cholangiocarcinoma (bile duct cancer) is a malignant tumour that develops from the epithelium of the bile ducts. It most often affects men aged 50-70 years. The share of pathology accounts for less than 2% of all cancerous neoplasms. In Europe, the incidence of bile duct cancer is 1-2 cases per 100,000 population.
Depending on where the tumour is located in the bile ducts, cholangiocarcinoma is divided into the following types:
Intrahepatic bile duct cancer – develops in the small branches of the bile ducts of the liver.
Perihilar bile duct oncology (Klatskin tumours) – forms in the gate, the junction of the hepatic ducts and the liver.
Extrahepatic cholangiocarcinoma – located lower in the bile duct, closer to the duodenum.
The exact cause of the development of oncopathology is unknown. However, risk factors include exposure to chemicals, biliary tract diseases, viral hepatitis, cirrhosis and biliary adenoma.
Symptoms of cholangiocarcinoma
The disease can be asymptomatic for a long time. As the malignant process progresses, the following signs appear in patients:
yellowing of the skin and whites of the eyes (jaundice),
itching of the skin,
discolouration of the stool,
constant fatigue,
abdominal pain on the right side, just below the ribs,
weight loss for no particular reason,
elevated body temperature,
nausea and vomiting.
Diagnostics of bile duct cancer
Bile duct tumours are not easily detected during routine medical examinations. In the initial stages, they remain symptomless. That is why this type of cancer is rarely diagnosed at stages 1 or 2.
Visual diagnostic tools are the basis for a correct diagnosis. They are required for an accurate detection of the signs of cholangiocarcinoma. Methods used to diagnose bile duct cancer include:
ultrasound,
computed tomography (CT),
magnetic resonance imaging (MRI),
magnetic resonance cholangiopancreatography (MRCP).
Magnetic resonance cholangiopancreatography (MRCP) is the preferred non-invasive method for the diagnosis of bile duct neoplasms. The sensitivity and specificity of this procedure correspond to endoscopic retrograde cholangiography (ERC) and percutaneous transhepatic cholangiography (PTC). It is used to assess the possibility of tumour removal and to plan options to combat the disease.
Oncomarker tests, liver function tests and biopsies are also used to detect cholangiocarcinoma. Abroad, the accuracy of oncological diagnosis reaches 100%. To book an appointment for an examination in one of the best foreign clinics, please leave your contacts.
Treatment methods for cholangiocarcinoma
The choice of treatment methods depends on the location and size of the neoplasm and whether it has spread beyond the bile duct. The patient’s general health and age also influence the oncotherapy programme. Key treatment options for cholangiocarcinoma include:
surgery,
radiation therapy,
radiofrequency ablation,
chemotherapy,
immunotherapy,
targeted therapies,
photodynamic therapy,
Abroad, patients with this disease are treated by a multidisciplinary team of specialists. It includes oncologist, surgeon, hepatologist, radiologist, chemotherapist, etc. For each patient, the most effective treatment programme is developed individually. The first-line treatment is usually surgery.
The main goal of surgical treatment of cholangiocarcinoma is to remove the maximum volume of the tumour. Surgery involves several options:
Resection of the bile duct – removal of the part of the bile duct affected by the tumour and the adjacent lymph nodes. The operation is indicated for small neoplasms.
Partial hepatectomy – removal of the part of the liver where the cancer is found, together with some healthy tissue.
Whipple’s procedure – a complex surgical intervention, during which the head of the pancreas, gallbladder together with the ducts, part of the stomach and small intestine are removed.
After surgical intervention, patients are given a course of adjuvant therapy. It involves the use of chemotherapy or radiotherapy. These methods help to get rid of residual cancer cells or reduce their number.
Chemotherapy is administered intravenously or directly into the tumour. Radiotherapy is given using special machines (external radiotherapy) or radioactive material is placed inside the body (brachytherapy).
To alleviate symptoms and improve the quality of life of patients, the following types of palliative care are recommended for stage 4 cholangiocarcinoma:
Bile duct bypass – creating a new pathway for the outflow of bile to bypass the duct blocked by the tumour.
Bile duct stenting – an endoscopic intervention to place a stent that drains bile into the small intestine.
Liver transplantation is indicated for some patients with late-stage intrahepatic cholangiocarcinoma. Before transplantation, a course of chemotherapy is prescribed. This will help destroy the cancer cells that have spread throughout the body. Liver transplantation is not a miracle treatment. After it, there is still a risk of recurrence.
New treatments for cholangiocarcinoma
Along with the standard therapies, new options for bile duct cancer treatment are available in modern hospitals. They include:
Targeted therapy – targeting the tumour with special agents that block cancer cell division. As of 22 July 2021, the FDA approved pemigatinib for the treatment of cholangiocarcinoma in patients with FGFR2 gene mutation. This drug may be a worthy alternative to chemotherapy.
Immune therapy is recommended for terminal cholangiocarcinoma. Drugs in this category help the immune system to “identify” malignant cells. They activate the body’s forces to resist cancer and do not damage healthy organs.
Radiofrequency ablation – involves the use of an electrical impulse to heat and destroy cancer cells. During the procedure, thin needles are inserted into the patient’s abdomen. They reach the tumour and heat it up. Cancer cells begin to break down at temperatures of 50 degrees or more.
Photodynamic therapy – relieves symptoms and slows tumour growth. During the procedure, a special drug is injected intravenously. It accumulates in the neoplasm and under the influence of laser radiation is destroyed together with the tumour. Several procedures are necessary to achieve maximum effect.
What is the survival rate of patients with cholangiocarcinoma?
The prognosis of cholangiocarcinoma depends on its stage and the methods used. The 5-year survival rate of patients at the initial stage of the disease is 20-35%. If the tumour has spread to the lymph nodes – it is about 20-15%. If the tumour metastasises to other organs and body systems, the 5-year survival rate does not exceed 2%.
Which clinics treat intrahepatic cholangiocarcinoma abroad?
Summary
Cholangiocarcinomas arise from epithelial cells of the intrahepatic and extrahepatic bile ducts. They most commonly affect men aged 50-70 years. The main causes of these tumours include chemical exposure to the body, biliary tract disease and hepatitis.
Surgery is considered the mainstay of treatment for bile duct cancer. Additional options to fight the tumour are chemotherapy, radiotherapy, targeted therapy, radiofrequency ablation, immunotherapy, and photodynamic therapy. Liver transplantation is indicated for some patients with cholangiocarcinoma.
Cholangiocarcinoma has a poor survival prognosis. From the time of diagnosis, patients have an average life expectancy of 2 years.
To combat this disease, medical tourists mainly go to medical centres such as Liv Vadistanbul, Medicana, Sheba, Ichilov, SoonChunHyang, Teknon, Cologne and Navarra University Hospitals.
To travel to one of the best cancer centres in the world for bile duct cancer treatment, please leave an application on our website. MediGlobus coordinators will help you choose a clinic and the doctor and organise your medical trip.
Sources:
- Cancer Treatment Centers of America
- Mayo Foundation for Medical Education and Research
- American Cancer Society
- National Cancer Institute
