Treatment for bile duct cancer
What is the treatment for bile duct cancer?
This page is about treating bile duct cancer. This type of cancer is also called cholangiocarcinoma (col-an-jee-oh car-sin-oh-ma). There is information about
The main treatment for bile duct cancer is surgery. But surgery isn’t always possible. Many cancers of the bile duct are diagnosed when they are already advanced. If your surgeon can’t remove the tumour you may have radiotherapy, or chemotherapy, or both. This will help to control the cancer and your symptoms.
The treatment you have will depend on
- Where your cancer is in the bile duct
- The size of the tumour
- Whether it has spread to other parts of the body (the stage)
- Your general health
We have separate information about bile duct cancer, which tells you about the different types and how they are diagnosed and staged.
The type of surgery you have depends on where the cancer is in the bile duct. It also depends on whether it has spread into other nearby organs. Any surgery for bile duct cancer is a major operation.
You may have
Removal of the bile duct
If the tumour is at an early stage (stage 1) it may be possible for your surgeon to just remove the bile duct.
Removal of the bile duct and part of the liver
If your tumour is in the bile ducts within the liver (intrahepatic) or is a perihilar tumour, you will need to have part of your liver removed. You may also have the nearby lymph nodes removed. The surgeon joins the bile duct to your small bowel. The liver usually recovers well afterwards. You can find more information about this in the surgery for primary liver cancer section.
Whipple’s operation
If your tumour is near the pancreas (a distal tumour) and is large you may have a Whipple’s operation. Your surgeon will remove your bile duct, pancreas, part of your small bowel, gallbladder and part of your stomach as well as the nearby lymph nodes. You can find more information about this operation in the surgery for cancer of the pancreas section.
You will need to be in intensive care for a few days afterwards and will have to stay in hospital for at least 2 weeks.
After surgery for bile duct cancer it is not unusual to have complications. About 1 in 3 people (30%) have at least one complication after their operation. Possible complications include
- Wound infection
- General infection
- Slowed emptying of the stomach
- An abscess (a collection of pus)
- A leak from where the bile ducts were rejoined or from the pancreas
After your operation, you will have antibiotics to try to prevent any infection. Your doctor and nurses will keep a close check on you to look for these complications and treat any problems as soon as possible.
If your surgeon cannot remove the tumour you may have surgery to relieve your symptoms.
If your cancer has spread too far for your doctor to remove it, you may have radiotherapy. Radiotherapy uses high energy rays to kill cancer. Radiotherapy won’t cure the cancer but may help to shrink or slow it down. Shrinking the tumour is likely to help with symptoms, such as jaundice and pain.
You may also have radiotherapy after surgery, to lower the risk of the cancer coming back.
You can have radiotherapy externally or internally. External radiotherapy is from an machine outside the body similar to an X-ray machine. Internal radiotherapy is also called brachytherapy (brak-ee-therapy). Your doctor puts a small radioactive wire inside your body, near the tumour. We need more research to find out how best to use radiotherapy for bile duct cancer.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. Chemotherapy on its own won’t cure your cancer but doctors give it to
- Lower the risk of the cancer coming back after surgery
- Shrink the cancer and relieve your symptoms
Doctors sometimes give a combination of chemotherapy and radiotherapy. Researchers are looking at how best to use chemotherapy for bile duct cancer. The chemotherapy drugs you may have include
The UK ABC02 trial looked at treatment for people with advanced bile duct cancer or gallbladder cancer which can’t be operated on. It reported in 2009 that adding gemcitabine to cisplatin reduced the chance of the cancer growing by 28 per cent. People given the combination chemotherapy also lived longer than people who had cisplatin alone.
The ABC 03 trial is looking at whether it is helpful to add a biological therapy called cediranib to chemotherapy for cancer of the bile duct.
If your bile duct is blocked and you have jaundice, your doctor may suggest putting a small tube (stent) into your bile duct. The stent allows the bile to flow again. This will relieve jaundice and other symptoms, such as itching, within a few days. Sometimes the stent can get blocked. Then, you may have it replaced.
There are several ways your doctor can put the stent in. The most common way is with an endoscopy. This is similar to having the test that diagnosed your cancer (an ERPC). You have a drug to relax you and then your doctor gently puts a tube (the endoscope) down your throat. The doctor can see the blockage and stretches it to open the bile duct. They then put in the stent.
Occasionally, people need to have the stent put in through the skin of the tummy (abdomen). This is the same as having a PTC test. First, you have something to make you drowsy and a local anaesthetic. Your doctor puts a needle through the skin of the right side of your tummy. The needle has a guide wire attached. The doctor finds the blockage in the bile duct and puts the stent onto the guide wire to feed it into the blockage.
You may have some soreness after you have had a stent put in. You can take mild painkillers to control it, such as paracetamol. You are also at risk of infection afterwards. So you will need to take antibiotics before and after you have the stent.
You can also have a stent put in during an operation. This isn’t done very often. Your surgeon cuts the bile duct above the blockage and rejoins it to the small bowel. You can find more information about surgery to relieve symptoms in the treating gallbladder cancer section of CancerHelp UK.
You may also have chemotherapy and radiotherapy to help relieve your symptoms. We need more research to find out how well these treatments work. Researchers are trying to find out which chemotherapy drugs are best for bile duct cancer.
Doctors are researching new treatments for bile duct cancer, such as chemotherapy. The BILCAP trial is for people who have had surgery for early bile duct cancer. This study is looking at whether taking the chemotherapy drug capecitabine lowers the risk of the cancer coming back.
Researchers are looking into a treatment called photodynamic therapy (PDT). This uses light to destroy cancer cells. Researchers are looking into how well it works for advanced bile duct cancer. In 2005, the National Institute for Health and Clinical Excellence (NICE) said that photodynamic therapy on its own didn't seem to help. A trial called PHOTOSTENT 02 is testing whether having photodynamic therapy as well as a stent is better than just having a stent.
To have PDT, you have an injection of a light sensitive drug. After about 2 days, the drug circulates around your body. Your doctor uses an endoscopy tube to shine a laser light onto the tumour. This activates the drug, which then destroys the cancer cells.
You can find out about trials for bile duct cancer on the clinical trials database in the trials and research section of CancerHelp UK. Choose 'bile duct and gallbladder cancer' from the dropdown list of cancer types.
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