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Cholangiocarcinoma

Overview of Cholangiocarcinoma

Cholangiocarcinoma (pat nali ka sartam/ پت نالی کا سرطان ) is the bile duct cancer that results from the abnormal growth of cells which is present in the lining of bile ducts (the drainage system of bile).

Generally, the bile ducts contain bile that transfer into the gallbladder and then into the small intestine for the digestion process. Any replication of cells in the bile duct leads to cholangiocarcinoma. This cancer is also known as bile duct cancer.

There are three different general locations where cholangiocarcinoma can arise within the bile drainage system. This is further categorized into three types of cholangiocarcinoma:

  • Intrahepatic Cholangiocarcinoma- In this type, cancer affects the parts of the bile ducts within the liver. This is also considered a type of liver cancer.
  • Hilar Cholangiocarcinoma- Abnormal growth of cells present in bile ducts just outside of the liver. This type is also called perihilar cholangiocarcinoma.
  • Distal Cholangiocarcinoma- This type affects the portion of the bile duct nearest the small intestine.

Prevalence of Cholangiocarcinoma

The prevalence of cholangiocarcinoma is about 1-2 cases per 100,000 people each year. The risk of cancer increases with age, and mainly affects men more than women. People with primary sclerosing cholangitis are more likely to acquire cholangiocarcinoma. Other cases are reported from Asia, due to endemic chronic parasitic infestation. Nearly 30% is the average 5-year survival rate for a specific stage of bile duct cancer (cholangiocarcinoma).

 

 

Signs and Symptoms of Cholangiocarcinoma

The first sign of cholangiocarcinoma is jaundice (yellowing of the skin) after those following symptoms have appeared.

  • Dark urine and pale stools
  • Itching due to jaundice or the cancer
  • Pain in the abdomen that radiates to the back

General symptoms of cholangiocarcinoma may involve:

  • Chills
  • Fever
  • Loss of appetite
  • Weight loss
  • Fatigue

Other additional rare adverse effects may include enlargement of the liver, spleen, or gallbladder.

Types of Cholangiocarcinoma

Causes of Cholangiocarcinoma

The exact cause of cholangiocarcinoma is still unknown but the changes occur at genetic level. Mutation or sudden changes in the DNA of bile duct cells can change their information regarding cell division leading to cancer.

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Risk Factors of Cholangiocarcinoma

Some factors stimulate cancer to a greater extent. Some are as follows.

  • Primary Sclerosing Cholangitis- This disease results from the hardening and scarring of the bile ducts.
  • Chronic Liver Disease- This disease is caused due to scarring or any infection of the liver.
  • Congenital Problems- Some people have bile duct problems at the time of birth such as the formation of a choledochal cyst, which causes dilation and distortion of bile ducts.
  • A Liver Parasite- Liver fluke infection is associated with cholangiocarcinoma. This is due to eating raw or undercooked fish.
  • Older Age- People over the age of 50 years are more prone to cholangiocarcinoma.
  • Smoking- Smoking triggers the risk of cholangiocarcinoma.

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Prevention

By adopting a healthy lifestyle minimize the onset of cholangiocarcinoma. 

  • Quit smoking
  • Eat a healthy diet such as green vegetables
  • Stop drinking alcohol
  • Adopt physical activities in life regularly

If a person is experiencing the following signs and symptoms such as:

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Diagnosis

Oncologists suspect cholangiocarcinoma then any one of the following tests may recommend:

  • Liver Function Tests- The LFT test is a type of blood test that measures whether the liver is functioning properly or not. It also determines the cause of signs and symptoms.

  • Tumour Marker Test- Identifying the level of cancer antigen (CA) 19-9 in the blood may give the sign of cancer. The CA 19-9 protein is produced by the bile duct cancer cells. A high level of CA 19-9 in the blood is not only the marker of cholangiocarcinoma but also identifies other bile duct diseases such as bile duct inflammation and obstruction.

  • Endoscopic Retrograde Cholangiopancreatography - This test is conducted by a thin tube with a small camera inserted into the throat. From there, it passes down the digestive tract to the small intestine. In that way, a doctor examines the area where the bile ducts connect to the small intestine.

For clear scans of the test, a doctor also injects the dye into the bile ducts.

  • Imaging Tests- These tests help the doctor to determine any abnormalities in internal organs or signs of cholangiocarcinoma. Different techniques are used such as computerized tomography (CT) scans and magnetic resonance imaging (MRI) along with magnetic resonance cholangiopancreatography (MRCP). MRCP is a non-invasive technique that is used as an alternative to ERCP. It gives 3-D images without the use of dye for image clarity.

  • Biopsy- Removal of a small fragment of affected tissue to examination under a microscope is done in the biopsy.

 

As the doctors confirm a diagnosis of cholangiocarcinoma and then determine the extent (stage) of the cancer. This involves other imaging tests. On the basis of confirming the diagnosis, appropriate treatment is chosen.

 

Treatment of Cholangiocarcinoma | When to Consult a Doctor

Following are the treatment options for cholangiocarcinoma (bile duct cancer). The treatment is based on either natural remedies or medical therapies. Some are as follows:

  • Home Remedies- The natural herbs used for the treatment of cholangiocarcinoma are Curcumin, Ashwagandha, Tulsi, and Kachnaar.
  • Surgery- Surgeries remove the affected area of the bile duct either partially or completely. If bile duct cancer metastasizes to other parts, the surgery also removes the liver tissue, pancreas tissue, and nearby lymph nodes along with bile ducts.
  • Liver Transplant- In this procedure, the affected patient's liver is transplanted with a healthy one. A liver transplant is a treatment of hilar cholangiocarcinoma. After transplantation, there is a risk of recurrence.
  • Chemotherapy- Chemotherapeutic drugs are used to kill cancer cells. This therapy may be used before a liver transplant. The chemotherapy reduces the pain and signs and symptoms of cholangiocarcinoma.

  • Radiation Therapy- The high energy beams such as photons (x-rays) and protons, to damage or destroy cancer cells. The beam directly targets the affected part of the bile.

  • Photodynamic Therapy- In this therapy, a light-sensitive chemical is injected into a vein and accumulates in the fast-growing cancer cells. Laser light directly targets cancer causing a chemical reaction in the cancer cells and killing them. Photodynamic therapy can also relieve the signs and symptoms and slow the cancer progression. Avoid the sunlight after the treatment.

  • Biliary Drainage- Biliary drainage is a method for restoring the flow of bile. Biliary drainage also relieves the signs and symptoms of cholangiocarcinoma.

After or during treatment, follow-up is highly required for the patients for close monitoring.

 

In case you exhibit any concerning signs and symptoms of cholangiocarcinoma, consult a medical professional as soon as possible.