Choosing the right treatment for bile duct cancer depends upon disease stage, the patient’s physical condition and tumor characteristics. Our treatment approach is individualized for every patient.
MD Anderson has experts with years of experience treating bile duct cancer with surgery, radiation and chemotherapy.
Complete removal of the tumor is the most effective surgery for biliary tract cancers. Bile duct cancer surgery is a complicated operation. Only specialized surgeons with significant experience should attempt bile duct cancer surgery.
Surgery is only performed on patients with early-stage disease who are in good physical condition. Depending on the location of the tumor along the bile duct, complete removal of the tumor can be performed in up to 56% of patients.
For all patients with intrahepatic tumors and nearly all patients with perihilar tumors, surgical treatment requires removal of portions of the liver (hepatectomy). Tumors at the far end of the bile ducts typically require removal of portions of the pancreas and small intestine. This is sometimes called Whipple’s procedure.
Portal Vein Embolization
If bile duct cancer patients will need to have part of their liver removed, doctors must determine whether enough liver remains to function properly before surgery takes place. If precise calculations indicate that the remaining liver will not be large enough, procedures to induce liver growth are needed.
MD Anderson is a leader in using portal vein embolization (PVE). This procedure involves the injection of tiny plastic pellets through a needle into the blood vessel closest to the tumor. The pellets block the blood vessel, which tricks the other side of the liver to grow to make up for the loss. A surgical approach that includes a team of specialized liver anesthesiologists and nurses, dedicated radiologists and interventional radiologists is critical in achieving optimal outcomes for bile duct cancer patients.
Our radiation oncologists are recognized as leaders in the oncology field for biliary cancers, and have pioneered the use of advanced technologies to deliver higher doses of radiation to treat these challenging diseases. Radiation can improve survival and provide a realistic chance of cure in patients who are not candidates for surgery.
MD Anderson offers several radiation therapy options for patients with biliary cancers. These include:
Stereotactic body radiation therapy (SBRT): This involves delivery of very high doses of radiation in the span of about one or two weeks. SBRT is best for smaller tumors that are not near the gastrointestinal tract.
Intensity modulated radiation therapy (IMRT) and 3D conformal radiation therapy: These techniques use high-energy photons to treat tumors. The radiation beams are controlled by changing beam intensity, by using customized shielding to shape the beams, or both. These options are used when the tumor is near the gastrointestinal tract.
Proton therapy: This radiation treatment uses high energy particles to precisely target tumors without harming nearby organs. This option may help to spare the normal liver better than IMRT in some cases.
MD Anderson uses state-of-the-art image guidance to monitor delivery of radiation and to make sure it doesn’t harm the stomach, small bowel, colon, and healthy parts of the liver. X-rays or CT scans are used in various ways during radiation treatment to make sure the patient is properly positioned for the most effective dose.
Most biliary cancers are discovered at an advanced stage, when surgical treatment options are limited. Chemotherapy is typically used at an advanced metastatic stage to control the spread of the cancer, alleviate symptoms and improve overall survival. Gemcitabine, cisplatin, 5-FU, oxaliplatin, irinotecan are some of the commonly used chemotherapies for bile duct cancer.
Clinical trials of new agents are available at MD Anderson to improve the prognosis and survival of metastatic biliary cancers. In certain cases of locally advanced cancers, pre-operative (or neoadjuvant) chemotherapy is given to improve the chances of successful surgery. In others, chemotherapy may be recommended after surgical resection (adjuvant therapy) to decrease chances of recurrence.
An important area of research in biliary cancer is targeted therapy. Several genetic mutations have been identified for bile duct cancer that provide effective treatment targets. Targeted therapies are created to seek out and destroy these abnormalities within cancer cells. Targeted therapies are given orally or by IV injection. MD Anderson is testing several promising targeted therapies for bile duct cancer in clinical trials.
Management of Biliary Obstruction
Obstruction of the bile ducts and infection (cholangitis) can be life-threatening complications of bile duct cancers. A gastroenterology team with expertise is needed to manage biliary obstruction. Stents are tubes made of plastic or wire mesh that are surgically inserted into the bile duct to keep it open. Stents are crucial in preventing or correcting obstructions and complications, such as infection.
Bile duct cancer or therapies used to treat it can cause complications that must be managed. A multidisciplinary approach that includes palliative care, gastroenterology, interventional radiology and pain management is needed to address these issues.
Complications from bile duct cancer include:
- Obstruction to the stomach (gastric outlet obstruction)
- Slowing of the stomach (gastroparesis)
- Weight loss
- Fluid buildup in the abdomen (ascites)
- Abdominal pain