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The facts -

Cholangiocarcinoma, also known as bile cancer, is a rare disease in which malignant (cancer) cells form in the bile ducts.

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What are the bile ducts? -

To understand this particular type of cancer, it helps to know about the bile ducts and the function they carry out.

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Bile duct function -

The bile ducts are a series of thin tubes that transport a fluid called bile from the liver to the gallbladder and to the small intestine to help digest fats in food.

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Types of bile cancer -

Bile cancer can be found anywhere in the bile duct system. Based on where the cancers start, they're grouped into three types: intrahepatic bile duct cancer; perihilar bile duct cancer; and distal bile duct cancer.

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Signs and symptoms -

How serious bile duct cancer is depends on where it is in the bile ducts, its size, whether it has spread, and your general health.

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Jaundice -

The most common physical signs of bile cancer include jaundice, the yellowing of the skin or the whites of your eyes.

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Dark urine -

Dark urine and clay colored stool deposits are also telltale signs that something is amiss.

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Itchy skin -

Excess bilirubin in the skin can cause generalized itching. In fact, most people with bile duct cancer notice this condition.

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Low energy -

Low energy levels and fatigue are commonplace, as is a loss of appetite.

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Feeling unwell -

A general feeling of malaise combined with a high temperature, hot flashes, and shivers are red flags.

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Nausea -

Nausea, vomiting, and abdominal pain or discomfort are conditions associated with bile cancer. It's important to stress, however, that all these signs and symptoms are indicative of many other complaints and are far more likely to be caused by something other than bile duct cancer. But get them checked out!

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Who is more likely to get bile cancer? -

It's not always clear what causes bile cancer. But there are certain risk factors that can promote its onset. One of these is age. Older people, those in their sixties and seventies, are more likely to be diagnosed with the disease.

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Certain medical conditions -

People who have chronic inflammation of the bile ducts have an increased risk of developing bile duct cancer.

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Inflammatory bowel disease -

Inflammatory bowel disease includes ulcerative colitis and Crohn's disease. These two medical disorders can increase the risk of developing bile duct cancer.

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Hepatitis -

Infection with hepatitis B virus or hepatitis C virus can promote the onset of intrahepatic bile duct cancers.

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Cirrhosis -

Cirrhosis—damage to the liver caused by scar tissue—is another risk factor. Cirrhosis is caused by irritants like alcohol and diseases like hepatitis. Cirrhosis can also result from a severe form of non-alcoholic fatty liver disease (NAFLD), called non-alcoholic steatohepatitis.

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Bile duct stones -

The risk of bile cancer can be elevated by bile duct stones. These are small gallstones that become trapped in the bile duct. Doctors may refer to this condition as choledocholithiasis.

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Liver fluke infection -

Anyone unfortunate enough to host a liver fluke in their body runs the risk of developing bile duct cancer. Liver fluke infections occur when people eat raw or poorly cooked fish that are infected with these tiny parasite worms. The infection is prevalent in many Asian countries.

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Geographical factors -

In fact, according to the American Cancer Society, bile duct cancer is far more common in Southeast Asia and China largely because of the high rate of infection with liver flukes in these parts of the world.

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Obesity -

Obesity is known to promote cancers of the gallbladder and bile duct. Being overweight elevates the risk of gallstones and bile duct stones, as well as the risk of NAFLD.

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Can bile cancer be detected early? -

Sadly, only a small number of bile duct cancers are detected before they have spread too far to be removed by surgery. But this type of cancer is treatable, albeit challenging.

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Testing for bile duct cancer -

Tests to diagnose bile duct cancer can include a physical exam and liver function tests, undertaken using a blood sample to measure the amounts of  bilirubin and alkaline phosphatase released into the blood by the liver.

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Ultrasound scan -

An ultrasound scan can be used to create real-time pictures or video of internal organs or other soft tissues, especially useful when examining a tumor.

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CT scan -

Similarly, a CT scan is a diagnostic procedure that provides highly detailed pictures of areas inside of the body.

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Biopsy -

A biopsy will be conducted to collect a small sample of cells from the bile duct to check for cancer.

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Surgery -

If tests reveal the presence of cancer, it still may be possible to carry out surgery to remove the bile duct.

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Chemotherapy and radiation -

If surgery proves impossible, radiation therapy may be used to treat the affected area. Another option is chemotherapy, which uses drugs to halt the growth of cancer cells.

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Liver transplant -

If feasible, a liver transplant may be done in patients with perihilar bile duct cancer.

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Palliative therapy -

If bile duct cancer has spread too far to be removed by surgery, and the results of chemotherapy and radiation are less than satisfactory, palliative care will be required to help control or reduce symptoms. This kind of treatment is not meant to cure the cancer.

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Grim prognosis -

Cholangiocarcinoma is a devasting cancer. Its deadly and aggressive nature means the five-year survival rate for those with it is less than 25%.

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Help and support -

Those diagnosed with bile duct cancer can call upon various support programs that offer advice on coping with the disease, such as providing a survivorship care plan. And, of course, the love and understanding of family and friends is vital when coming to terms with the condition.

Sources: (American Cancer Society) (National Cancer Institute) (NHS) (Macmillan Cancer Support)

See also: Surprising things that can cause cancer

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