The biliary system plays a role in digestion by creating a liquid called bile. Bile is produced in the liver and stored in the gallbladder. Think of the bile ducts as tree-like structures that exist in and around the liver and gallbladder. These ducts act like a transportation system, moving bile from the liver to the upper section of the small intestine, known as the duodenum.
Biliary cancer, also known as cholangiocarcinoma or bile duct cancer is a rare form of malignancy in the United States. It accounts for only 3% of all gastrointestinal malignancies. It has an incidence of 1.26 cases per 100,000 people per year.
Read More- Intrahepatic bile duct cancer (or intrahepatic cholangiocarcinoma): makes up around 10% of all bile duct cancer cases and can be confused with liver cancer. This type of lesion happens inside the bile ducts of the liver (inside the liver). Even though it’s not common, the number of cases of intrahepatic bile duct cancer is on the rise.
- Extrahepatic bile duct cancers are found in the bile ducts outside the liver. There are two main types of extrahepatic bile duct cancer:
- Perihilar bile duct cancer: This is the most common form of extrahepatic bile duct cancer, making up 40 to 60% of all cases. It occurs where the bile ducts exit the liver and is sometimes referred to as perihilar cholangiocarcinoma or a Klatskin tumor.
- Distal bile duct cancer: This type of cancer originates in the part of the bile ducts that runs through the pancreas and connects with the small intestine. It accounts for 20 to 40% of all bile duct cancer cases.
- Gallbladder cancer: A cancer that arises in the wall of the gallbladder. Gallbladder cancer is often found when looking for or doing surgery to remove gallstones.
Is Liver Cancer the same as Bile duct Cancer?
SurvivorNet talked to Dr. Elliot Newman, Chief of Surgical Oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan and he explained that to us:“Primary liver cancer and bile duct cancer are two separate entities but they both affect the same organ. The liver bile duct cancers can also affect the bile duct system that runs from within the liver to outside the liver. We have what are called intra hepatic cholangiocarcinomas, that’s bile duct cancer within the liver and extrahepatic bile duct cancers which are cholangiocarcinomas that are outside of the liver.”
“Primary liver cancer, often called hepatocellular carcinoma or hepatoma affects the liver itself. They are somewhat related in that they both have a relationship to the liver but they are often treated differently and the risk factors and etiologies can be different.”
Signs and symptoms
Unfortunately, early staged bile duct cancers are asymptomatic. Patients usually seek medical assistance once symptoms appears. And that usually means that the cancer has grown bigger. Bile duct cancer symptoms are:
- Jaundice: yellowing of your skin and the whites of your eyes
- Intensely itchy skin
- White or clay-like stool (acholia)
- Dark urine (choluria)
- Fatigue
- Abdominal pain on the right side, just below the ribs
- Losing weight without trying
- Fever
- Night sweats
Treatment
The most important thing when it comes to treating liver and bile duct cancers is a multidisciplinary approach, meaning that it’s not just one discipline that determines the care.
Surgeons, medical oncologists and sometimes radiation oncologists are all part of a team that are necessary to create a comprehensive and yet personalized plan for each individual patient.
Your treatment journey will be determined by factors such as the location and size of the cancer, its extent of spread, and your overall health.
Primary treatment options for bile duct cancer typically include surgical procedures and chemotherapy.
Unfortunately, most bile duct cancers are already diagnosed in advanced stages (indicating that the cancer has extended beyond the bile ducts). In such advanced cases, chemotherapy is generally the preferred treatment modality.
Surgery
When it comes to assessing patients for suitability for surgery with respect to liver cancer, we look at a number of different things.
- First of all, and most important, is whether the patient is suitable for a major operation. So that requires assessing the heart and lungs and other systems to be sure that they’re what we call a surgical candidate. Assuming that the patient is a surgical candidate, then we have to look specifically at the nature of the tumor that we’re dealing with and whether it can be safely removed.
- This involves, for example, assessing where the tumor is in relationship to some of the vessels that come into the liver or looking at the relationship of the tumor to some of the vessels that exit the liver. We have to be able to safely control those vessels as we remove part of the liver where the tumor is.
- The second question after we look at the vessels and the safety of that aspect of surgery is when we remove a piece of liver, will there be enough liver afterwards so that the patient can have good liver function and this is determined by the amount of liver that gets removed. Sometimes it’s possible to remove as much as 70% of the liver. However, in a diseased liver (somebody who has cirrhosis, which is a common risk factor for a primary liver cancer,) we may not be able to remove as much.
“Never die easy.”
That was the motto of NFL great Walter Payton, who passed away on 1999 from bile duct cancer.
Just 45 at the time, Payton’s cancer was a complication brought on by an also rare form of liver disease known as primary sclerosing cholangitis (PSC) which causes bile ducts to become inflamed, narrow and prevent bile from flowing properly.
Considered by many to be the greatest running back ever to play the game, Payton would spend all 13 seasons of his career with the Bears, winning the league MVP honors in 1977 and the Super Bowl in 1985.
Staying Positive Through Cancer
Walter Payton had a love for life, choosing to enjoy the time he had rather than bemoan the fact that his life would be cut short. Experts tell SurvivorNet that having this kind of positive attitude while being able to find the joy in life can make a big difference while battling cancer.
In an earlier interview, Dr. Zuri Murrell said, “My patients who thrive, even with stage 4 cancer, from the time that they, about a month after they’re diagnosed, I kind of am pretty good at seeing who is going to be OK. Now doesn’t that mean I’m good at saying that the cancer won’t grow.”
Dr. Murell said that having a positive attitude can improve prognosis, in some cases. “But I’m pretty good at telling what kind of patient are going to still have this attitude and probably going to live the longest, even with bad, bad disease. And those are patients who, they have gratitude in life.”
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