Treating bile duct cancer

By NHS Choices Last updated Apr 23, 2021 9

Most cases of bile duct cancer cannot be cured. Instead, treatment is most commonly used to relieve symptoms.

Cancer treatment team

Due to the rarity of bile duct cancer, you are likely to be referred to a specialist unit that has experience in treating the condition for some or all of your treatment. These units are usually found in larger hospitals in cities such as London and Birmingham.

A multidisciplinary team (MDT) made up of different specialists will help you decide on your treatment. The team will make recommendations, but the final decision will be yours.

Before going to hospital to discuss your treatment options, you may want to write a list of questions to ask the specialist. For example, you may want to find out about the advantages and disadvantages of particular treatments.

Your treatment plan

Your recommended treatment plan will be determined by your general health and the stage the cancer has reached.

In cases of stage 1 and stage 2 bile duct cancer, a cure may be possible by surgically removing the affected part of the bile duct, and possibly some of the liver or gallbladder.

In cases of stage 3 bile duct cancers, the chances of achieving a successful cure will depend on how many lymph nodes have been affected. A cure may be possible if only a few nodes have cancerous cells in them, or it may be possible to slow the spread of the cancer by surgically removing the lymph nodes.

In cases of stage 4 bile duct cancer, achieving a successful cure is highly unlikely. However, chemotherapy, radiotherapy and surgery can often be used to help relieve the symptoms.

Read about diagnosing cancer of the bile duct for more information about staging.

Your treatment plan may also be different if you have intrahepatic bile duct cancer, as this is usually treated in a similar way to liver cancer.

Surgery

If your MDT think it is possible to cure your bile duct cancer, surgery will be needed to remove any cancerous tissue. Depending on the extent of the cancer, it may be necessary to remove:

the part of your bile duct that contains cancerous cells
your gallbladder
nearby lymph nodes
some of your liver

Unfortunately, due to the aggressive nature of bile duct cancer, fewer than one-third of patients are suitable for surgery.

After surgery, it is usually possible to reconstruct what remains of the bile duct so that bile can still flow into the intestine.

Similarly, it is often possible for the liver to resume normal function after surgery because we do not need all of our liver. For example, 25-30% of an otherwise healthy liver is enough for you to survive. The liver can also regenerate itself to some extent after surgery.

Having your gallbladder removed should not affect your digestive system, because the liver and bile duct can still store bile and aid digestion.

After surgery, it is likely you will need to stay in an intensive care unit (ICU) for a few days so the functions of your body can be supported while you recover from the effects of the operation. You may need to stay in hospital for two weeks or more after having bile duct surgery before you are well enough to go home.

Success rates of bile duct surgery depend on individual factors and circumstances, such as whether nearby lymph nodes are free of cancer and whether it was possible to remove all of the cancerous cells during surgery.

In addition, the underlying cause of the cancer may increase the risk of the condition returning.

As a general estimate, 10-40% of people who have surgery for bile duct cancer survive for five years or more after their operation.

Unblocking the bile duct

If your bile duct becomes blocked as a result of cancer, your MDT may recommend treatment to unblock the duct. This will help resolve symptoms such as:

jaundice – yellowing of the skin and the whites of the eyes
itchy skin
abdominal (tummy) pain

Unblocking the bile duct is sometimes necessary if the flow of bile back into your liver starts to affect the normal functioning of your liver.

The bile duct can be unblocked in several ways. The first is to use a variation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure.

During the procedure, a surgeon will guide a long, flexible tube with a light and video camera on the end (endoscope) into your bile duct and pass down a small metal or plastic tube called a stent. The stent is used to widen the bile duct, which should help to get the bile flowing again.

Alternatively, a stent can be placed in your bile duct using a variation of the percutaneous transhepatic cholangiography (PTC) procedure. This involves placing the stent in your bile duct through a small incision (cut) in your stomach. As this is not a major operation, it can be carried out using local anaesthetic, where an injection is used to numb the skin of your stomach.

Occasionally, an implanted stent can become blocked. If this occurs, it will need to be removed and replaced.

Radiotherapy

Radiotherapy cannot cure bile duct cancer but can help to relieve the symptoms, slow the spread of the cancer and prolong life. Two types of radiotherapy are used to treat bile duct cancer:

external beam radiotherapy – a machine is used to target radioactive beams at your bile duct
internal radiotherapy (brachytherapy) – a radioactive wire is placed inside your bile duct next to the tumour

Radiotherapy works by damaging the cancerous cells. However, it can also damage healthy cells and cause side effects. Side effects of radiotherapy include:

nausea (feeling sick)
vomiting
fatigue (severe tiredness)

Chemotherapy

Chemotherapy is used in a similar way to radiotherapy to relieve the symptoms of cancer, slow down the rate at which it spreads and prolong life. It is sometimes used in combination with radiotherapy.

Research carried out in 2010 found that combining two chemotherapy medications, called cisplatin and gemcitabine, is a particularly effective way of helping to slow the spread of cancer and improve survival rates.

As with radiotherapy, medicines used in chemotherapy can sometimes damage healthy tissue as well as cancerous tissue, and adverse side effects are common. Side effects of chemotherapy can include:

nausea
vomiting
fatigue
hair loss

However, these side effects should stop once the course of treatment has finished. Chemotherapy can also weaken your immune system, making you more vulnerable to infection.

Photodynamic therapy (PDT)

Photodynamic therapy is a new technique that can help to control – but not cure – the symptoms of bile duct cancer.

A special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumour.

The National Institute for Health and Care Excellence (NICE) has considered PDT and concluded there is limited evidence to show how effective or safe it is in the medium to long term.

If you are considering PDT, it is important to be aware of the current uncertainties about the effectiveness and safety of the procedure.

Clinical trials and experimental treatments

The treatments for bile duct cancer are not as effective as treatments for other types of cancer. Therefore, a number of clinical trials are being conducted to find better ways of treating the condition.

For example, ongoing trials are looking at new combinations of chemotherapy medicines, which may help extend the lifespan of someone with bile duct cancer.

Targeted therapies

Another promising field of research involves using targeted therapies to treat bile duct cancer. Targeted therapies are medications that target the processes that cancerous cells need to grow and reproduce.

In studies, a medication called sorafenib has proved reasonably effective. Sorafenib works by blocking a protein that cancerous cells need to create a blood supply. However, sorafenib is not currently used as routine treatment for cancer of the bile duct.

As bile duct cancer is a rare condition, there is a possibility you may be invited to take part in a clinical trial looking into the use of these types of experimental treatments.

All clinical trials are carried out under strict ethical guidelines based on the principles of patient care. However, there is no guarantee the treatment you receive during a clinical trial will be more effective, or even as effective, as existing treatments.