Biliary Tract Cancer

What is bile way cancer ?


Bile duct cancer (Cholegiocarcinoma) is a rare tumor consisting of bile duct wall cells. Although it develops from all parts of the biliary tract, 60% originates from the bifurcation, which is the junction of the right and left main bile ducts.


Biliary Tract Cancer

What causes bile way cancer ?


The most common causes of bile duct cancer are primary sclerosing cholangitis, common duct cyst, hepatitis B-C, ulcerative colitis, hepatolithiasis (liver stone), advanced age, obesity, bilienteric anastomoses, and chronic typhoid carrier in old sources.


How does bile way cancer symptoms ?

Painless jaundice is one of the first detected symptoms in bile duct cancer. This is followed by itching due to the accumulation of bilirubin under the skin. Weight loss up to cachexia occurs in late-stage patients. Symptoms may be accompanied by fever.


How is bile way cancer diagnosed ?


It is very important to diagnose gallbladder cancer at an early stage. In the examination of biliary tract cancer, first of all, liver biliary tract ultrasound is performed. If enlargement of the bile ducts is observed, cross-sectional imaging with computed tomography or magnetic resonance aids in the diagnosis. Sudden termination of the bile ducts can be detected without any mass in the biliary tract. Biopsy or swab can be taken with ERCP (endoscopic retrogrand colongiopancreatography). Evaluation with EUS is also useful, especially in distal cancers. The fact that CA19-9, one of the tumor markers of the patient with clinical jaundice, itching and weight loss, is 100 U/ml also supports the diagnosis. Diagnostic methods; It is determined according to the patient's health status, age, signs of disease and previous test results.


How to treat bile way cancer ?


When the bile duct cancer is diagnosed, more than half of the patients have no chance of surgery. Since it is an insidious disease, it gives late symptoms. The level of cancer of the patients who can be operated determines the type of surgery. While hepatectomy is required for proximal cancers, whipple surgery is usually performed for distal cancers.


Biliary cancer treatment is based on surgical removal of the tumor. It may also be necessary to remove part of the liver during treatment, which consists of a major surgery. Since the diagnosis of gallbladder cancer is usually made at an advanced stage, patients often do not have the chance to undergo surgery. However, cancer that is detected early ensures successful treatment of gallbladder cancer. Some endoscopic procedures, pain treatment, percutaneous drainage (radiological intervention) can be performed to relieve jaundice and pain in patients with advanced disease that cannot be operated.


FREQUENTLY ASKED QUESTIONS ABOUT BILE WAY CANCER


What happens if the bile duct is blocked ?


Jaundice develops primarily due to bile duct obstruction. There is an enlargement of the bile ducts in the liver. Bile duct inflammation (cholangitis) develops with the increase in pressure and bacterial density in the biliary tract. This condition, which is considered as billier sepsis, can be fatal.


What are the stages of bile duct cancer ?


Bile duct cancer is divided into 3 stages.


In the first stage of bile duct cancer, the cancer is within the bile ducts. It is the group that responds best to surgery.

In the second stage, the cancer has invaded the gallbladder, liver, pancreas or part of the portal vein & hepatic artery.

In the third stage, there is cancer metastasis to nearby organs, and in the fourth stage, there is cancer metastasis to distant organs.


What are the types of bile duct cancer ?


Bile duct cancers are diversified according to their location. There are varieties of intrahepatic, hilar and distal. The most common 60% is hilar. Bismuth classification is done specifically for biliary tract cancers in the hilar region.


Type I: Cancer is in the common hepatic duct and distal to the bifurcation.


Type II: Cancer is in the common hepatic duct and has invaded the bifurcation.


Type III: Cancer is in the common hepatic duct and has affected the right or left hepatic duct along with the bifurcation.


Type IV: Cancer involving the bifurcation has affected both the right and left channels as well as the segments opening to these channels.


Can a stent be placed in the bile duct ?


A stent is placed in the biliary tract to reduce jaundice values. The reason for stenting may be a benign stenosis or cancer. In patients who will be operated for bile duct cancer, a stent is placed on the side of the liver segment that will remain in the patient.


What should the patient pay attention to after bile duct cancer surgery ?


They should receive their post-operative chemotherapy (chemical treatment) regularly and follow up closely with their doctor. They should not disrupt control imaging and examinations.


Does gallbladder stone cause cancer ?


The presence of gallstones in more than 90% of patients with gallbladder cancer has been proven by studies. However, although this situation has revealed the opinion that cancer may occur by being affected by gallstones, the opinion that "Gallbladder stones cause cancer" has not gained certainty. Only the close association of gallstones and cancer has created suspicion for years. Cancer is the last among the diseases caused by gallstones. Gallstones cause infection, obstruction in the biliary tract, jaundice and pancreatic inflammation before cancer.


What causes narrowing of the bile ducts ?


The narrowing of the biliary tract is usually caused by the presence of stones in the biliary tract. In addition, it can be caused by previous procedures (surgeries - stenting).


Are polyps in the gallbladder dangerous ?


There is a risk of developing cancer from polyps larger than 10 mm in size and more than one in the gallbladder. It is appropriate to remove the gallbladder with the cholecystectomy (laparoscopic or open) method. Single polyps smaller than 10 mm in size are followed by 6-month ultrasound control.


What deficiencies does the removal of the gallbladder cause in the body ?


Removal of the gallbladder does not have a negative effect on the body. Bile is produced from the liver. After gallbladder surgery, the patient does not have a lack of bile.


Do gallstones cause cancer ?


It can cause cancer due to chronic inflammation. Stones in the gallbladder were observed in 90% of patients who were operated on for gallbladder cancer.

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