Cholangiocarcinoma

Are you suffering from jaundice and have also lost a lot of weight lately? Watch out, for you may be having Cholangiocarcinoma. Read and know all about the causes, symptoms, diagnosis and treatment of the disease.

What is Cholangiocarcinoma?

Cholangiocarcinoma refers to a cancer of the bile ducts and is commonly known as “Bile duct cancer.” It is characterized by weight loss, jaundice, and abdominal pain.

Picture of Cholangiocarcinoma

Picture 1 – Cholangiocarcinoma

 

Cholangiocarcinoma Incidence

Although a rare disease, the rate of occurrence of this condition has been increasing every year. It is more common in males in comparison to females and generally occurs in the age group of 50-60.

Causes of Cholangiocarcinoma

The exact cause of this disorder is still unknown. However, a number of conditions have been suspected to increase the possibility of occurrence of this disease. These include:

 

Inflammatory bowel disease

People suffering from bowel disorders, such as Ulcerative Colitis, are more prone to bile duct cancer.

Abnormal bile ducts

People suffering from bile duct abnormalities, such as choledochal cysts, have been found to be more susceptible to this disorder.

Infection

People infected by a parasite called liver fluke are also at higher risk of developing this disorder.

Increasing age

Most cases of this disease are observed in people above 50 years of age. Due to this reason, older individuals are believed to be at an increased risk of developing this cancer.

Liver disease

Individuals with a history of liver disorders like Hepatitis or Cirrhosis are also prone to this form of cancer.

HIV Infection

Medical research has proved that HIV infection increases the risk of getting this disease.

Symptoms of Cholangiocarcinoma

The major signs and symptoms of this condition include:

  • Jaundice
  • Chills
  • Clay-colored stools
  • Fever
  • Itching
  • Poor appetite
  • Abdomen pain
  • Weight loss
  • Yellowing of the skin (jaundice)
  • Weakness and fatigue

Of these, jaundice is the most common and typical symptom. Cholangiocarcinoma results in blockage of the flow of bile (gall) from the liver to the intestine. As a result, the bile flows back to the blood resulting in jaundice. The dark color of urine and stools is also caused by the same phenomenon.

Diagnosis of Cholangiocarcinoma

Before using tests for this disorder, doctors typically enquire about the medical history of patients and any diseases they might have suffered from in the past. Patients should completely co-operate with doctors during the conversation, especially if they have had a case of any liver disorder. The tests used for diagnosis of this disorder generally involve:

Ultrasound scan

In this process, sound waves are used to check the condition of bile ducts. Patients must not have any food or liquid for six hours before the scan. This diagnostic process involves spreading gel on the abdomen and rubbing a device (which is attached to a computer) on a particular abdominal area. The audio waves produced by the device create an image of the section on the computer monitor.

CT (Computerized Tomography) Scan

It involves use of X-rays to get three-dimensional images of the internal organs of the body. As in ultrasound, this test also requires patients not to eat to drink anything for four hours before the test. This is a simple examination that takes only 20-30 minutes to be performed. The test only makes use of small amount of radiation so as to avoid any side effects. Before the test, a dye may be injected to the patient so as to increase the effectiveness of the exam.

Spiral CT scan

This is an advanced test used for diagnosing this disorder. It involves continuous rotation of the x-ray machine to create cross sectional images of the body.

MRI (Magnetic Resonance Imaging) scan

It makes use of magnetism rather than radiation. This is another simple test that requires a patient to lie on a cylinder tube for 30 minutes. This scan provides clearer and more detailed pictures in comparison to the other methods mentioned above.

ERCP (Endoscopic Retrograde Cholangio-Pancreatography)

This process involves passing a tubular structure, known as endoscope, into the stomach and duodenum through the mouth. The preparation for this test involves not eating or drinking anything for 4 hours before undergoing the process. Doctors may use a sedative or anesthetic to assist the movement of tube.

Endoscopic Ultrasound Scan (EUS)

This is a modified form of ERCP in the sense that an ultrasound probe is used in the process.

PTC (Percutaneous Transhepatic Cholangiography)

This is an advanced technique that is used for diagnosis of the disorder as well as to get a sample of tissue from the affected part.

Angiogram

The test is used to scan the blood vessels. It involves injecting a tube into the blood vessels, following which a dye is added through the tube. The dye moves towards the arteries assisting in the scanning process.

Biopsy

This is a confirmation diagnostic test for Cholangiocarcinoma. In this process, a sample tissue is taken from the affected part and analyzed with the help of a microscope.

Laparotomy

This process is carried out under the influence of an anesthetic. In this process, an incision is made in the abdomen. The condition of the bile duct is then evaluated with the aid of a laparoscope.

Staging and Grading of Cholangiocarcinoma

The different stages of cancer refer to the size of tumor. A cancer in high stages is considered to be more dangerous for a patient. The staging of cancer helps doctors to choose an appropriate treatment for their patients. Cholangiocarcinoma, being a type of cancer, is categorized into different stages.

Image of Cholangiocarcinoma

Picture 2 – Cholangiocarcinoma Image

Stage 1A

The cancer is limited to the bile duct.

Stage 1B

The cancer spreads towards the wall of bile duct.

Stage 2A

The cancer further infects the liver, pancreas and gall bladder.

Stage 2B

The cancer spreads to lymph nodes.

Stage 3

The blood vessels carrying blood to and from the liver are affected. The cancer spreads to the lymph nodes completely.

Stage 4

The cancer further spreads to lungs and other body parts.

Grading refers to the appearance of cancer cells under a microscope and represents the rate of development of cancer. Low grade cancer cells grow at a slow rate while high grade cells grow at faster rate.

Treatment of Cholangiocarcinoma

The treatment of this cancer mainly depends on its stage. The various curative approaches used for its treatment are:

Chemotherapy

It involves use of anti-cancer drugs, such as Cisplatin and Gemcitabine.

Surgery

It is the most commonly used method of treatment for this type of cancer. It is highly recommended if the size of the cancer is found to have grown abnormally. In case the cancer is in stage 1, the removal of bile ducts is sufficient. In order to maintain normal bile flow the liver ducts are attached to the small bowel. In case cancer spreads to the liver, the affected part of liver must also be removed. In case the cancer is in advanced stages, removal of bile ducts, lymph nodes, gall bladder and parts of the stomach is required. Operation for advanced stages takes some time to be performed and needs hospitalization for a few days. In case removal of tumor is not possible, a surgery may be needed to be performed to remove the blockage. This process involves making a bypass or inserting a tube in the duct. It usually ensures proper flow of bile and thus helps fight against jaundice.

Stent insertion

This technique involves putting a tube called stent in the bile duct that allows draining the bile away. It is about 5-10 cm long and ERCP and PTC procedures are generally used to insert the tube. Before performing stent insertion, antibiotics are administered to avoid any infection.

Radiotherapy

It involves the use of radiations to destroy the cancerous cells. It includes either the use of a device for providing radiations or placing a radioactive material near the tumor.