Cholangiocarcinoma – Causes, Symptoms and Treatment
essentially refers to the cancer of the bile ducts. The bile ducts are best described as conduits which carry the greenish yellow fluid, namely, bile from the liver via the gallbladder in to the small intestine. Bile is an extremely important element as far as digestion is concerned. It helps to break down carbohydrates and sugar into energy.
It is referred to as an adenocarcinoma (starting in the epithelial lining of the bile ducts) or a glandular cancer. The cancer first surfaces as a mass of tissue or a tumor on the bile duct lining. The incidence rates of this cancer is low affecting about 1-2 persons per 100,000 in the Western nations. About 2 out of 3 patients suffering from this cancer are above the age of 65. However, it can affect anyone younger too.
The cancer of the bile ducts can be distinguished as Intra-hepatic or Extra-hepatic depending on the location where it originates. When the cancer originate in the bile ducts within the liver it is called intra-hepatic. When the cancer originate outside the liver it is called extra-hepatic.
Causes and Risk Factors of Cholangiocarcinoma
It is difficult to exactly point out the causes of this cancer. But certain conditions increases the risks of getting the cancer in the bile ducts. These conditions are as follows:
Primary Sclerosing Cholangitis
: It is a chronic liver disease in which the bile ducts get inflamed and infested with scar tissue. Eventually it starts inhibiting the flow of bile in to the duodenum. The accumulation of the bile in the bile ducts sets off a necrotizing action in which the cells of the bile ducts undergo degeneration and destruction. More than 80% of the patients of this condition has ulcerative colitis. Ulcerative colitis is a common manifestation of the Inflammatory bowel disease.
Parasitic liver diseases
: Certain parasites found in Asia and Africa like the liver flukes opisthorchis viverinni or clonorchis sinesis have been associated with this cancer.
Chronic Liver Diseases
: Chronic liver diseases like viral hepatitis, alcoholic liver disease, cirrhosis can increase the risk of the said cancer.
Congenital Liver abnormalities
: Somebody born with malformed liver and bile ducts as in caroli’s syndrome or choledochal cysts have a 15% additional risk of developing it in their lifetime.
: When the gallstones move down to the parts of the bile duct within the liver or the intra-hepatic bile ducts, the risk of the cancer increases.
Exposure to Thorotrast
: Exposure to the thorium dioxide which was earlier used in physical investigative procedures has been linked with the development of bile duct cancer.
Symptoms of Bile Duct cancer
The most common symptoms of bile duct cancer are as follows:
- Abnormal liver function tests.
- Jaundice or yellowing of skin and eyes. This is caused when the cancerous mass or tumor obstructs the flow of bile. This causes the bile to flow back into the blood and tissues. People with cancer in the extra-hepatic duct are more likely to have jaundice.
- Yellowing of urine and pale stools.
- Increased bile in blood can also trigger the condition called pruritus which is associated with a strong itching sensation.
- Abdominal pain.
- High Fever.
Treatment of Cholangiocarcinoma
The prognosis (outlook) of this cancer is not good. The treatment generally depends on the stage at which the cancer is currently in, the size, position, location and the extent to which it has spread and the general heath of the patient. The different treatment options are as follows:
: This is the most common line of action. The intention is to remove the cancerous cells as much as possible. If the cancer is detected in initial stage then only the bile ducts containing the cancer is removed. If the cancer is intra-hepatic and has spread into the liver then the affected part of the liver is also removed. In case the cancer has spread to nearby organs then a whipple procedure is conducted whereby part of the stomach, duodenum, pancreas, gallbladder and lymphnodes are all removed.
: Patients with this cancer are seldom cured and is at best managed with different therapies like chemotherapy, radiation therapy, photo dynamic therapy and other palliative measures.