Bile Duct Cancer

Cancer of the biliary tract is a very dangerous malignant disease with a very poor prognosis. The tumor develops from the wall of the bile ducts. It can occur either from small bile ducts located within the liver or from larger bile ducts outside the liver.


Note: There are two special subtypes of tumors of the bile ducts. One is the so-called Klatskin tumor that arises at the point where the left and right bile ducts join forming the common bile duct. The second is known as the ampuloma and it grows from the opening of the common bile duct into the intestine (papilla of Vater).


The exact cause of this cancer is not known. Obviously, there is an important role of genetic predisposition and the risk seems to be higher in patients with congenital defects of the biliary tract. Any chronic or recurrent inflammations in the area increase the risk as well. The bie duct cancers are reported to be more frequent in patients with primary sclerosing cholangitis.


Malignant tumors of the bile ducts are initially asymptomatic. When their growth disrupts the bile flow, they may manifest with painless jaundice, pale and oily stool, dark urine and recurrent cholangitis. Accumulated bile acids cause an unpleasant itching of the skin. Advanced and widespread stages of the disease may manifest with weight loss, loss of appetite, night sweats and other symptoms typical for malignant diseases.


The diagnosis can be determined from the symptoms, physical examination and the outcome of imaging methods such the abdominal ultrasound or computed tomography. The extrahepatic narrowing or obstruction of the bile duct may be also examined (and treated) by ERCP including the brush cytology, i.e. acquiring cells for cytological examination.


The therapy depends on the size, location and extension of the tumor and it requires a cooperation of surgeons, oncologists and internal physicians. Small tumors may be surgically removed, inoperable tumors may be treated by chemotherapy (however, the chemotherapy alone can not cure the patient). When there is present disruption of the bile flow, it is necessary to solve it at least as a form of palliative therapy. The therapeutic method of the first choice is the ERCP with insertion of a tube-shaped stent into the narrowed location. When this is not possible, the doctors can puncture the bile ducts above the narrowed place through the skin and so assure the outflow of bile.


The prognosis of patients with tumors of the biliary tract is generally very poor. The only chance of survival is when the tumor is found randomly, or when it causes jaundice in its early stage. In case of malignant ampuloma, the overall five-year survival is estimated at 50% making it possibly the least dangerous malignant tumor of the biliary tract.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources