"Smoking increases the risk of Bile Duct Cancers."
Diagnosis
Bile duct cancers can be notoriously difficult to diagnose as obtaining tissue for diagnosis is sometimes very difficult and very often tests may need to be repeated many times. Most bile duct cancers are diagnosed after a series of tests. These include:
- Blood tests: to assess the level of jaundice, liver functions, tumour markers etc.
- CT scan of the abdomen: a triphasic scan of the abdomen is usually done to detect the exact location of the cancerous mass and determine its extent and relation to adjacent structures such as the liver and blood vessels. Especially in intrahepatic cholangiocarcinomas, certain typical features of the tumour on this scan help greatly in the diagnosis.
- ERCP and cholangioscopy: Endoscopic examination of the bile duct through the ampulla is usually required both for diagnosis of cancer (through cytology) as well as to relieve jaundice by inserting a plastic or metallic stent.
- Magnetic Resonance Cholangiopancreatography (MRCP): is a non-invasive technique using MRI to delineate the biliary tree and determine the location and extent of the tumour.
- PET-CT: Used to determine if there is any focus of the spread of the tumour from the biliary tree to any other part of the body.
- Biopsy: CT guided or Endoscopic ultrasound-guided biopsy or cytology is used to confirm the pathological diagnosis in most bile duct cancers. These may sometimes need to be repeated multiple times before a positive result is obtained. Occasionally a spy-glass cholangioscopy and brushings from the bile ducts may be required.
Treatment
- Surgery: When possible, this involves removing part of the bile duct and joining the cut ends. For more-advanced bile duct cancers, nearby liver tissue, pancreas tissue or lymph nodes may be removed as well.
- Liver transplant: In certain cases, surgery may be needed to remove your liver and replace it with one from a donor (liver transplant) for people with hilar cholangiocarcinoma. A liver transplant is generally a cure for hilar cholangiocarcinoma, but there is a small risk that the cancer will recur after a liver transplant.
- Chemotherapy: Chemotherapy may be used before a liver transplant. It may also be an option for people with advanced cholangiocarcinoma to help slow the disease and relieve signs and symptoms.
- Radiation therapy: Radiation therapy uses high-energy sources, such as photons (x-rays) and protons, to damage or destroy cancer cells. Radiation therapy involves a machine that directs radiation beams at your body (external beam radiation). It can also involve placing radioactive material inside your body near the site of your cancer (brachytherapy). External beam radiation may be used along with chemotherapy or alone or along with surgery also at a later time point.
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Biliary drainage. Biliary drainage is a procedure to restore the flow of bile. It can involve bypass surgery to reroute the bile around cancer or stents to hold open a bile duct being collapsed by cancer. Biliary drainage helps relieve the signs and symptoms of cholangiocarcinoma.
Other Gastrointestinal Cancers
