Extrahepatic Bile Duct Cancer Center

Extrahepatic bile duct cancer, a rare cancer, is a disease in which cancer (malignant) cells are found in the tissues of the extrahepatic bile duct. The bile duct is a tube that connects the liver and the gallbladder to the small intestine. The part of the bile duct that is outside the liver is called the extrahepatic bile duct. A fluid called bile, which is made by the liver and breaks down fats during digestion, is stored in the gallbladder. When food is being broken down in the intestines, bile is released from the gallbladder through the bile duct to the first part of the small intestine.

Biliary tract carcinomas are also often separated by location into carcinoma of the gallbladder and carcinoma of the extrahepatic (outside the liver) and intrahepatic (inside the liver) bile ducts. The term "cholangiocarcinoma" is sometimes used to refer to any primary cancer of the biliary system; however, its use is often restricted to intrahepatic tumors and, therefore, it is not included in this overview. Adenocarcinomas are the most common type of extrahepatic bile duct cancers.

Carcinoma of the extrahepatic bile duct is slightly more common in males, and most often occurs in between the ages of 50 and 60. Risk factors include:

• History of Primary Sclerosing Cholangitis (PSC) -- this is thought to be an autoimmune disorder, one in which the body's own inflammatory cells attack the bile ducts. PSC causes progressive scarring and narrowing of the bile ducts, which block bile from reaching the intestines. Many patients eventually develop liver failure, necessitating liver transplant. Ten to twenty percent of patients with PSC will develop bile duct carcinoma. It is thought that the progressive epithelial injury and subsequent regeneration predisposes patients with PSC to carcinoma. More than half of patients with PSC have a history of another autoimmune disorder, idiopathic inflammatory bowel disease. This is most often ulcerative colitis.
• Congenital abnormalities (abnormalities one is born with) of the bile ducts -- these include choledochal cysts (dilation of the common bile duct) and Caroli's disease (dilation of the intrahepatic bile ducts). It is thought that prolonged sludging of bile in these dilated spaces and subsequent infection predispose patients to carcinoma, again through progressive epithelial injury and repair. The overall lifetime risk of cholangiocarcinoma in these patients is ten percent.
• Benign tumors of the bile ducts -- bile duct adenomas (a single tumor) or bile duct papillomatosis (multifocal)
• Hepatobiliary parasitic infection -- these cases are most often seen in the Far East and include Clonorchis sinensis (most prevalent in Japan, Korea, Vietnam) and Opisthorchis viverrini (most prevalent in Thailand, Laos, Malaysia). Clonorchis is acquired when humans eat fresh water fish that harbor the Clonorchis cyst. The cysts develop into flukes (flatworms) in the friendly confines of the human intestine, and ascend from the duodenum (the first part of the intestine) into the common bile duct, where they mature. Carriage of this worm imparts a twenty-five to fifty fold risk of developing biliary tract carcinoma.
• Toxic exposures -- thorium dioxide (Thorotrast), used as a contrast dye in radiologic procedures between 1930-1950, has been shown to promote cancers in the liver and bile ducts.

If the tumor cannot be removed surgically, bypass procedures may be performed to prevent obstruction of the gastrointestinal and biliary tracts, and to relieve the patient's symptoms.

At Cancer Treatment Centers of America, we use many tools to help you fight extrahepatic bile duct cancer on all fronts. A powerful combination of traditional and new, innovative therapies are provided by cancer experts who work with you to determine the appropriate combination of therapies, which may include:

• Surgery is a common procedure used to treat extrahepatic bile duct cancer whenever practical. Surgery may help prevent future complications, such as blockage or bleeding.
• Intensity Modulated Radiation Therapy (IMRT) for the most advanced form of conformal radiotherapy. IMRT employs a powerful, advanced computer program that plans a precise dose of radiation in three dimensions based on individual tumor size, shape and location. Remarkably, it allows for higher radiation doses than traditional radiotherapy methods, while sparing more of the surrounding healthy tissue.
• Fractionated Dose Chemotherapy divides a powerful dose of drugs into smaller doses, given over several days. This approach exposes cancer cells to the drugs for a longer period of time, while also seeking to reduce the unpleasant side effects often experienced with larger doses.
• Biotherapy / Immunotherapy is a treatment that is sometimes used for extrahepatic bile duct cancer. Immunotherapy causes the body's own natural defenses (immune system) to attack the cancer.

In addition the therapies described above, CTCA enriches your treatment by offering complementary and alternative therapies such as naturopathic medicine, nutritional therapy, mind-body medicine, image enhancement and spiritual support. CTCA is with you every step of the way in what truly is the fight of your life.