Bile Duct Cancer (Cholangiocarcinoma) | Symptoms & Treatment | MedStar Health

Our team approach leads to timely diagnoses and state-of-the-art treatment for bile duct cancer.

If you have symptoms of a bile duct tumor, our Pancreas and Liver Disease Program can provide you with expert care. Our gastroenterologists work in close partnership with other specialists, including experts in gastroenterology, pathology, radiology, surgical, medical, and radiation oncology, and interventional radiology. In addition to providing the standard of care for diagnosing and treating bile duct cancer, this multidisciplinary team of experts collaborates to develop and pioneer novel treatment options, including complex surgical techniques and innovative therapies. This ensures you have access to the most advanced care, sometimes years before it's available elsewhere.

The liver produces a fluid called bile, which is stored in the gallbladder and used for digestion within the small intestine. Bile moves through the body through small tubes called bile ducts. A bile duct tumor is an abnormal growth that may be benign (non-cancerous) or malignant (cancerous). It can affect the bile ducts inside the liver (intrahepatic) or outside the liver (extrahepatic). Most gallbladder tumors are benign, but malignant tumors may be indicative of this type of cancer, also called biliary cancer or cholangiocarcinoma.

Symptoms and risk factors

Jaundice and abdominal pain may be signs of this type of cancer.

Biliary tumors create blockages that can force bile to enter the bloodstream. Therefore, cholangiocarcinoma symptoms are similar to those of other duct-blocking conditions, such as gallstones. Symptoms include:

  • Dark urine
  • Light-colored or greasy stool
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Abdominal pain
  • Vomiting
  • Weight loss
  • Fever

These symptoms may also be signs of other health conditions, so it's important to discuss them with your doctor.

Certain liver conditions may increase your risk of bile duct cancer.

Several factors may increase your risk of developing this type of cancer, including a history of:

  • Chronic bile duct inflammation
  • Primary sclerosing cholangitis, which progressively scars the bile ducts
  • Chronic liver diseases, such as cirrhosis, bile duct stones, cholangitis, and polycystic liver disease
  • Bile duct cysts
  • Inflammatory bowel diseases, such as Crohn's disease or ulcerative colitis

Other risk factors may include age (over 50), obesity, smoking, and excessive alcohol consumption.

Screening and prevention

Because this cancer is rare, there is no standard screening test.

Unlike more common cancers, like breast cancer, there is no widespread screening recommendation for the general population. Most people with this cancer find out when they undergo imaging for another reason. Others may get tested if they experience symptoms like jaundice.

Although there is no known way to prevent this cancer, you can minimize your risk by living a healthy lifestyle. By exercising regularly and eating a nutritious diet, you can maintain a healthy weight and lower your chance of disease.

Diagnosis

We used advanced techniques to detect and stage biliary cancers.

If you have symptoms or an imaging test for another condition reveals something suspicious in the bile ducts, we'll work quickly to understand what's at the root of the issue. Getting an accurate diagnosis is important because it helps us formulate the best treatment approach for your unique case.

Your diagnostic process will begin with a review of your symptoms and medical history. Afterwards, your clinician may order laboratory tests to assess the level of bilirubin (a substance found in bile) in your bloodstream. Elevated bilirubin levels can indicate a bile duct blockage.

Our clinicians often use imaging tests (such as MRIs, CT or PET/CT scans, and ultrasounds) to assess the possibility of a tumor. If we need to examine the tumor further, we may perform an endoscopic procedure, such as endoscopic retrograde cholangiopancreatography (ERCP). This specialized procedure combines x-rays with an endoscope (thin, lighted tube) to examine your digestive system. At MedStar Health, we perform a high number of these procedures every year, making us skilled at using this type of advanced imaging.

If other tests indicate cancer in the bile duct, we may remove tissue samples through a biopsy. Many times we perform a biopsy during an ERCP. In other instances, we may need to collect tissue through minimally invasive or open surgery.

Types of cancer

There are two main types of biliary cancer.

Bile duct tumors can develop in the bile ducts within the liver (intrahepatic) or outside it (extrahepatic).

  • Extrahepatic bile duct cancers: Most cholangiocarcinomas develop outside of the liver, and this can happen in two regions:

    • Hilar bile duct cancer is found where the right and left bile ducts join outside of the liver
    • Distal bile duct cancer is found in the ducts near the small intestine
  • Intrahepatic bile duct cancers: Less commonly, cancer may develop in the bile ducts located inside the liver. Because of their location, these tumors are often treated similarly to liver cancer.

Treatments

Our experts work together to personalize your best treatment plan.

Our cancer doctors specialize exclusively in treating gastrointestinal cancers, including the bile duct. Because we're part of The Ruesch Center for the Cure of Gastrointestinal Cancers, our patients benefit from state-of-the-art therapies and surgical techniques backed by the latest research. Your treatment plan will involve recommendations from a team of specialists who have expertise in different disciplines. Together, we'll collaborate on a plan that will best address your individual needs.

Treatment depends on whether or not your tumor can be removed by surgery. For those that cannot, we may recommend treatments that could help shrink it and make it operable. In other instances, biliary tumors that can't be surgically removed may benefit from novel interventional radiology procedures that can improve outcomes.

Surgery

Surgery offers the best chance for a cure. But, the bile duct is a small, complex organ involving several blood vessels attached to critical structures. That's why it's important to seek care from an experienced cancer center. Our Center for Liver and Pancreas Surgery is one of the largest programs of its kind, and our surgeons have over 50 combined years of experience treating these types of cancers. In addition, we see more patients with pancreas, liver, and bile duct cancer than any other center in the region.

If a cancerous tumor is detected early before it has spread, it may be removed surgically using one of the following procedures:

  • Bile duct resection: If the tumor is small, we can perform this procedure to remove the affected part of the bile duct. In some cases, we may administer chemotherapy, radiation, or both at the same time of surgery using innovative techniques.

  • Partial hepatectomy: If you have an intrahepatic tumor inside the liver, we may need to remove some of the liver. As long as we can preserve enough healthy tissue in the liver, it will regenerate.

    • For patients who would not have enough remaining liver, we can help to improve liver growth using an innovative procedure called portal vein embolization. This involves blocking blood flow to one side of the liver so that it redirects to the other and stimulates growth. As a result, a patient may generate enough additional healthy liver tissue to become a candidate for surgery.

       

  • Whipple procedure (Pancreatoduodenectomy): If you have an extrahepatic bile duct tumor near the pancreas, your surgeon may remove parts of the bile duct, stomach, small intestine, and pancreas in this complex procedure. It's most commonly performed to treat pancreatic cancer.

  •  Liver transplant: This procedure is generally reserved for patients with disease limited to the bile duct and liver but cannot undergo a partial hepatectomy. For example, for someone who has bile duct cancer and damage to the liver, like cirrhosis, a liver transplant may be the only curative option.

     

If the tumor is too large for removal or if cancer has spread, we may use other surgical approaches to help relieve symptoms, such as placing a stent or rerouting the bile duct to the small intestine.


Interventional radiology

Our interventional radiologists are skilled at using innovative approaches to relieve symptoms and shrink tumors with the potential to make them operable. These treatments may include ablation, radioembolization, and others. These treatments are often combined with other therapies, such as chemotherapy, radiation therapy, or immunotherapy. We continue finding new ways to treat patients with these techniques through clinical trials, and these discoveries are advancing the standard of care for treatment.


Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells. Sometimes, we recommend chemotherapy to help shrink tumors and make them more easily operable, or "resectable". In other instances, chemotherapy may relieve symptoms and prolong life for patients with inoperable tumors.

We can also deliver regional chemotherapy directly into the hepatic artery using a hepatic artery infusion (HAI) pump to target the cancerous cells while limiting its impact to other parts of the body.

At MedStar Health, our medical oncologists are leaders in finding new combinations of chemotherapy and other therapies to expand the standard of care. If we think you'll benefit from chemotherapy, we'll work closely with the rest of your cancer team to design an individualized plan with the right type of chemotherapy drug given at the right time. Your treatment options may include clinical trials, which allow us to test new and effective ways to use chemotherapy to treat cholangiocarcinoma. And, you can expect us to proactively manage any side effects and help ensure you achieve the highest quality of life during and after treatment.


Immunotherapy and targeted therapy

Advances in personalized medicine allow us to deliver more targeted, effective treatments for tumors with certain genetic profiles. Depending on the stage and genetic makeup of your cancer, we may recommend a promising new therapy approved by the FDA or under investigation through clinical trials. In fact, we're leading many of these trials to find new uses for immunotherapy and other novel therapies that may slow or reverse tumor growth.


Radiation therapy

Radiation therapy plays a larger role in treating extrahepatic bile duct cancer than those found in the liver. Using high-energy beams, radiation may be used to treat this type of cancer in the following ways:

  • To treat patients waiting for a liver transplant
  • After surgery, to eliminate any remaining cancer cells
  • As the primary treatment if the tumor cannot be removed with surgery
  • Palliatively to minimize symptoms

At MedStar Health, our radiation oncologists are pioneers in using the latest technologies to deliver more precise radiation that limits exposure to healthy tissue. For example, we were the first in the world to use the HYPERSCANTM proton beam therapy system. This type of radiation therapy destroys cancer cells with exceptional accuracy, matching the tumor's exact size and shape.

In addition, we use other state-of-the-art technology that allows us to adjust the path or intensity of radiation, based on your individual needs. Your doctors will determine if radiation will help achieve your best outcome and which type (external or internal) offers you the most benefit.

Looking for expert cancer care?

With multiple locations throughout the region, patients have access to many of the nation’s renowned cancer specialists offering high quality care, second opinions and a chance for better outcomes close to where they live and work. Georgetown Lombardi Comprehensive Cancer Center, one of the nation’s comprehensive cancer centers designated by the National Cancer Institute (NCI), serves as the research engine allowing patients access to clinical trials that often lead to breakthroughs in cancer care.

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Our locations

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MedStar Franklin Square Cancer Center at Loch Raven Campus

5601 Loch Raven Blvd.
Russell Morgan Building
First Floor
Baltimore, MD 21239

MedStar Georgetown Cancer Institute at MedStar Franklin Square Medical Center

9103 Franklin Square Dr.
The Harry and Jeanette Weinberg Cancer Institute
Suite 220
Baltimore, MD 21237

MedStar Georgetown Cancer Institute at MedStar St. Mary’s Hospital

25500 Point Lookout Rd.
First Fl.
Leonardtown, MD 20650

MedStar Health: Gastroenterology at MedStar Washington Hospital Center

110 Irving Street, NW
Room 3A-3
Washington, DC 20010

Why choose us

We treat more patients with bile duct, liver, and pancreas cancer than any other center in Washington, D.C. Our Center for Liver and Pancreas Surgery is the largest program of its kind in the region, treating hundreds of thousands of patients every year. Because we exclusively treat this type of cancer and other related diseases, we are highly specialized in treating and surgically removing these complex tumors.

Our world-class doctors work together to develop treatment plans that consider your individual needs. Your care team includes well-known gastroenterologists, surgeons, radiation oncologists, medical oncologists, interventional radiologists, pathologists, pathologists, nurses, social workers, and others. These specialists meet weekly to discuss each case and design treatment plans that will most effectively treat your cancer. Because each provider has expertise in different areas, patients benefit from a collaborative approach that considers their care from every angle.

You'll gain access to cutting-edge treatments before they become the standard of care. Our specialists are experienced in delivering the standard of care as well as emerging treatments that are revolutionizing how this cancer is treated. Through a dedicated program investigating GI cancers, The Ruesch Center for the Cure of Gastrointestinal Cancers, we offer and lead clinical trials testing innovative therapies and advanced approaches to surgery

Awards and recognition

Recipient of an Accreditation with Commendation, the highest level of approval, from the American College of Surgeons’ Commission on Cancer (CoC)

Numerous surgeons, oncologists, and gastroenterologists recognized as "Top Doctors" by both Baltimore Magazine and the Washingtonian

Magnet® designation from the American Nurses Credentialing Center (ANCC)

Clinical trials and research

Clinical trials

In addition to providing standard of care treatments, we offer the latest therapies and techniques only available through clinical trials. These studies are helping to advance patient care through novel treatments that improve survival and quality of life for patients with cholangiocarcinoma.

Research

The Georgetown Lombardi Comprehensive Cancer Center is the only program of its kind in the region designated by the National Cancer Institute. There, our experts at The Ruesch Center for the Cure of Gastrointestinal Cancers lead basic, clinical, and translational research transforming how bile duct and other GI cancers are treated.

Support services

Our cancer support services include education, support, and resources to help you navigate your cancer diagnosis and survivorship. From peer mentoring, support groups, and educational events to personalized plans in rehabilitation, nutrition, and more, our goal is to help you achieve both physical and emotional healing.


Genetic counseling

Biliary cancer isn't an inherited disease. However, if you have this type of cancer, you may benefit from genetic counseling. Our board-certified genetic counselors can help you learn about you and your family member's risk for other GI cancers. This information can help you make decisions related to risk management and prevention.


Personalized rehabilitation

We offer comprehensive rehabilitation services, including physical therapy, occupational therapy, and speech-language pathology, to help you deal with the effects of cancer and treatment. Specialists in those disciplines work together to design a rehabilitation plan that will help you meet your goals, whether related to pain, function, strength, or energy.


Survivorship

We're invested in your health even after you finish treatment. Through our Survivorship program, your care team will help you optimize your health through regular check-ups, mental health support, educational resources, and more.