Treatment Options Based on the Extent of Bile Duct Cancer
- 3 years ago
Treatment Options Based on the Extent of Bile Duct Cancer
The extent of bile duct cancer is an important factor in deciding on treatment options. Whenever possible, surgery is the main treatment for bile duct cancers. It offers the only realistic chance for a cure. Because of this, doctors generally divide bile duct cancers into:
Resectable cancers, those that doctors believe can be removed completely by surgery, based on the results of imaging tests and other tests.
Unresectable cancers, those that have spread too far or are in too difficult a place to be removed entirely by surgery.
Most bile duct cancers are unresectable by the time they're found.
Resectable bile duct cancers
Most stage 0, I, and II cancers and possibly some stage III cancers are potentially resectable -- it might be possible to completely take out the cancer with surgery. But other factors can impact whether this is a good option, such as where the cancer is and whether the patient is healthy enough to have major surgery.
Surgery to remove the cancer completely is the preferred treatment if it's possible. If surgery is being considered, a staging laparoscopy may be done first. This allows the doctor to look inside the abdomen (belly) for any spread of the cancer that could make it unresectable. (Laparoscopy is described in Tests for Bile Duct Cancer)
Types of surgery
The type of surgery done to remove the cancer depends on the location and extent of the cancer. (See Surgery for bile duct cancer for more details.)
Other treatments that may be used with surgery
If the patient has jaundice (yellowing of the skin and eyes) before surgery, a stent or catheter may be put in the bile duct first. This allows the bile to flow the way it should. It can help relieve symptoms over a few days and might help make a person healthy enough to have the operation.
Radiation therapy and/or chemotherapy (chemo) may be given after surgery to try to lower the risk that the cancer will come back. This is called adjuvant therapy. Doctors aren’t sure how helpful adjuvant therapy is. It's more likely to be used if there’s a higher chance that the cancer wasn’t removed completely (based on looking at and testing the tissue removed during surgery). If it's clear that some cancer was left behind, a second surgery to take out more tissue may also be an option in some cases.
Sometimes it isn’t clear from imaging or other tests whether the cancer can be removed completely. These cancers may be called borderline resectable tumors. Some doctors may recommend treatment with radiation and/or chemo before surgery to try to shrink the tumor. (This is called neoadjuvant treatment.) Then, if the cancer shrinks, surgery can be done to try to remove all of it.
Unresectable bile duct cancers
These cancers cannot be removed with surgery, which includes most stage III and IV cancers. It may also include earlier stage cancers if a person isn’t healthy enough for surgery.
The extent of bile duct cancer is an important factor in deciding on treatment options. Whenever possible, surgery is the main treatment for bile duct cancers. It offers the only realistic chance for a cure. Because of this, doctors generally divide bile duct cancers into:
Resectable cancers, those that doctors believe can be removed completely by surgery, based on the results of imaging tests and other tests.
Unresectable cancers, those that have spread too far or are in too difficult a place to be removed entirely by surgery.
Most bile duct cancers are unresectable by the time they're found.
Resectable bile duct cancers
Most stage 0, I, and II cancers and possibly some stage III cancers are potentially resectable -- it might be possible to completely take out the cancer with surgery. But other factors can impact whether this is a good option, such as where the cancer is and whether the patient is healthy enough to have major surgery.
Surgery to remove the cancer completely is the preferred treatment if it's possible. If surgery is being considered, a staging laparoscopy may be done first. This allows the doctor to look inside the abdomen (belly) for any spread of the cancer that could make it unresectable. (Laparoscopy is described in Tests for Bile Duct Cancer)
Types of surgery
The type of surgery done to remove the cancer depends on the location and extent of the cancer. (See Surgery for bile duct cancer for more details.)
Other treatments that may be used with surgery
If the patient has jaundice (yellowing of the skin and eyes) before surgery, a stent or catheter may be put in the bile duct first. This allows the bile to flow the way it should. It can help relieve symptoms over a few days and might help make a person healthy enough to have the operation.
Radiation therapy and/or chemotherapy (chemo) may be given after surgery to try to lower the risk that the cancer will come back. This is called adjuvant therapy. Doctors aren’t sure how helpful adjuvant therapy is. It's more likely to be used if there’s a higher chance that the cancer wasn’t removed completely (based on looking at and testing the tissue removed during surgery). If it's clear that some cancer was left behind, a second surgery to take out more tissue may also be an option in some cases.
Sometimes it isn’t clear from imaging or other tests whether the cancer can be removed completely. These cancers may be called borderline resectable tumors. Some doctors may recommend treatment with radiation and/or chemo before surgery to try to shrink the tumor. (This is called neoadjuvant treatment.) Then, if the cancer shrinks, surgery can be done to try to remove all of it.
Unresectable bile duct cancers
These cancers cannot be removed with surgery, which includes most stage III and IV cancers. It may also include earlier stage cancers if a person isn’t healthy enough for surgery.