Bile Duct Cancer Care at NYP
Care at NYPPeople with bile duct cancer (cholangiocarcinoma) can benefit from the care of a multidisciplinary team of healthcare experts. At NewYork-Presbyterian, our providers offer expertise in diagnosing and treating different types of bile duct cancer through surgery, radiation, or chemotherapy.
To support the quality of life in individuals with advanced bile duct cancer, we offer palliative care, including pain management services. For all patients with bile duct cancer, our nutritionists, social workers, palliative care experts, and others will help you and your loved ones address the effects of cancer and its treatment — physical, emotional, and spiritual. We understand the burden cancer can place on your life and the lives of your loved ones, and we do whatever we can to lessen it.
What is bile duct cancer?
What is bile duct cancer?Bile duct cancer, or cholangiocarcinoma, is a type of cancer that affects the bile ducts, the tubes connecting the liver to the small intestine. The bile ducts are part of the body’s biliary system, a subsystem of the digestive system that also includes your liver and gallbladder.
Bile ducts carry a digestive fluid known as bile, which is made by the liver and stored in the gallbladder. Bile eventually ends up in the small intestine, where it helps the body process nutrients and fats. It also assists in removing waste from the bloodstream.
Bile duct cancer is a rare and aggressive type of cancer that typically affects adults over the age of 50. There are several stages: The first is local, when the cancer has still not spread outside of the bile ducts. The cancer is locally advanced if it invades organs near the bile duct or nearby veins and arteries that cannot be removed.
Metastatic means the cancer has spread – either to another part of the liver or more distant organs in the body. The cancer is considered recurrent if it returns after surgery or another type of treatment.
Symptoms of bile duct cancer include jaundice, which is caused by the buildup of bilirubin in the blood. Jaundice involves the yellowing of the skin and eyes, dark urine and light-colored stool. Other symptoms may include loss of appetite, weight loss, stomach pain, fever and itchy skin.
What are the different types of bile duct cancer?
TypesBile duct cancer or cholangiocarcinoma is defined by where it develops. There are two main types:
- Extrahepatic bile duct cancer. The most common type of bile duct cancer – accounting for about 90 percent of cases – affects the extrahepatic bile ducts, which are located outside the liver. This type of bile duct cancer can also be called a Klatskin tumor or hilar cholangiocarcinoma if it starts where the two main bile ducts meet as they exit the liver. Distal bile duct cancer is another type of extrahepatic bile duct cancer, occurring in the ducts closest to the small intestine.
- Intrahepatic bile duct cancer. When cholangiocarcinoma starts inside the liver, it’s called intrahepatic bile duct cancer. It’s found in the smaller hepatic ducts located in the liver. Intrahepatic bile duct cancer is different from cancer that begins in liver cells, known as hepatocellular carcinoma (HCC), though sometimes they are confused.
How is bile duct cancer diagnosed?
DiagnosisBecause bile ducts are located deep inside the body, it’s often harder to diagnose early than some other cancers. As a result, cholangiocarcinoma or bile duct cancer is often found after it’s grown enough to cause visible symptoms like jaundice.
There are several ways to diagnose bile duct cancer, including:
- CT scans. Our doctors at NewYork-Presbyterian use a variety of different imaging techniques to diagnose cholangiocarcinoma or bile duct cancer. They include CT scans, which take cross-sectional images of the liver, bile ducts and lymph nodes.
- MRI, sometimes including magnetic resonance cholangiopancreatography, which takes detailed images of the liver and the bile ducts
- Ultrasound. Your doctor might also use an ultrasound, which can help detect tumors and find out whether they have developed into the main blood vessels.
- Positron emission tomography (PET) scans are another imaging test that can diagnose cancer.
- Blood tests. Bile duct cancer can also be diagnosed through blood tests that measure the level of bilirubin in the blood. Bilirubin is a chemical that comes from red blood cells and gives bile its yellow color. High levels of bilirubin typically signal dysfunction in the liver and bile ducts and can lead to jaundice. Other blood tests can measure different liver enzymes like alkaline phosphatase, GGT, AST and ALT, which can indicate the presence of cancer. Some tumor markers, such as CA19-9, can also be useful, though an elevated level does not necessarily mean someone has cancer.
- Endoscopy. Your physician might also conduct an endoscopy, which involves placing a long, narrow tube with a camera, called an endoscope, through the mouth and into the small intestine. Endoscopies can provide a closer view into the bile duct.
- Laparoscopy. A laparoscopy takes a slightly different approach, with a doctor placing a thin tube with a camera through an incision in the stomach to view tissues up close. This can help them see whether the bile duct cancer has grown or spread.
- Biopsy. When your care team needs to see a tissue sample, they will often perform a biopsy. A biopsy involves removing a small amount of cancerous tissue from the bile duct.
- Surgery. In some cases, doctors will perform surgery to remove a tumor sample if it’s too small for a biopsy.
What are the treatment options for bile duct cancer?
TreatmentNewYork-Presbyterian offers a number of treatment options for cholangiocarcinoma or bile duct cancer, depending on the location and the stage of the disease.
- Surgery. When possible, surgery is often the best option to treat bile duct cancer as it provides a greater chance for a cure. Surgery is especially effective if the cancer has not spread beyond the bile ducts, as it can remove the affected duct to prevent further growth and spread. There are different surgeries that can be performed.
- In a partial hepatectomy, which removes intrahepatic tumors inside the liver, surgeons remove the tumor as well as a piece of normal liver tissue around the cancer. Because the liver can regenerate after surgery, the remaining healthy liver tissue will grow back in weeks or months.
- Pancreatoduodenectomy, also known as a Whipple procedure, is a complex surgery option that removes extrahepatic bile duct tumors if they are near the pancreas or at a crossroads in the digestive system. In the Whipple procedure, surgeons remove part of the bile duct as well as part of the stomach, small intestine and pancreas, then join them together to make sure the patient can still process bile, enzymes and food.
- Chemotherapy. Chemotherapy is used to treat bile duct cancer if it has spread and surgery is not an option. In other cases, patients receive chemotherapy after surgery to destroy any remaining cancer cells, called adjuvant therapy.
- Liver-directed therapies. If appropriate, patients may be eligible for therapies targeting the liver if their cancer has spread there. Hepatic artery infusion (HAI) is a type of chemotherapy that is delivered to the liver via an implanted pump, which allows the drug to target the liver specifically while sparing other parts of the body.
- Radiation/systemic therapy. Our team can provide radiation therapy to attack cancer cells, sometimes by itself and other times in combination with chemotherapy or other therapies. The most common type of radiation is external-beam radiation therapy.
Our team
Our teamNewYork-Presbyterian’s liver cancer team is multidisciplinary and includes hepatologists, gastroenterologists, surgeons, medical oncologists, radiation oncologists, radiologists, interventional radiologists, nurses, and other specialists. We gather a personalized team of healthcare professionals to care for you through one medical center, which shares combined clinics and conferences. Your team will meet regularly in multidisciplinary tumor boards to ensure you’re receiving the most effective therapies.
Clinical trials
Clinical trialsAt NewYork-Presbyterian, we participate in clinical trials that explore novel treatments to advance the care of people with bile duct cancer, including those that don’t respond well to standard therapies. If appropriate, you might have the opportunity to participate in a clinical trial for a new treatment.
This content has been reviewed by the following medical editors.