Gallbladder and bile duct cancer usually surface with many vague symptoms. Maybe stomach pain or weight loss brought you into the hospital. Maybe you went in for a routine gallbladder surgery, but your doctor found something much more complex and unexpected.
Navigating a bile duct cancer diagnosis can feel a little like walking in the dark. Theodore Sunki Hong, MD, a radiation oncologist at Mass General Cancer Center, sheds some light on what to expect. Dr. Hong specializes in diagnosing and treating gallbladder and bile duct cancers as director of the Gastrointestinal Service in the Department of Radiation Oncology.
Bile duct cancers develop when cells grow out of control in the bile duct, or biliary system. This system of thin tubes drains bile (a fluid that helps your body digest fat) from the liver to the gallbladder and small intestine.
“The biliary system is like a tree, where all the little branches are up in the liver,” explains Dr. Hong. “As bile flows from the liver, it goes into bigger and bigger branches until coming to the right and left bile ducts. Then the branches join up with a tube from the gallbladder, forming a common bile duct that empties into the intestine.”
The gallbladder stores bile and releases it into the common bile duct every time you eat. Cancer can form anywhere in this network of bile ducts or in the gallbladder.
Bile duct cancers, also called cholangiocarcinoma, are named for where they occur. The types of bile duct cancers include:
Intrahepatic cholangiocarcinoma (inside the liver)
Extrahepatic cholangiocarcinoma (outside the liver), which includes common bile duct cancer and perihilar bile duct cancer (Klatskin tumors)
Gallbladder cancer (in the gallbladder)
Cancer can spread, or metastasize, from the gallbladder or bile ducts to other parts of the body. Most often, it spreads to the liver, abdominal lymph nodes, abdominal cavity (the space surrounding organs in the belly), lungs, or bones.
“Compared to other metastatic cancers, bile duct cancers are generally on the more aggressive end, even when they’re removed,” says Dr. Hong. “The cancer has often spread by the time you’ve found it.”
Recognizing gallbladder and bile duct cancer symptoms can be hard. You likely won’t have obvious signs of cancer, but rather vague symptoms such as:
Abdominal (belly) discomfort
Feeling full early
Food intolerances, especially to fatty foods
Jaundice (a yellow tint to your skin or eyes)
Light-colored, floating stool
Unexplained weight loss
“It’s really sort of a silent disease, and that’s the reason why, more often than not, it presents at a very late stage (Stage 3 or Stage 4),” says Dr. Hong.
Gallbladder and bile duct cancers are usually discovered when you see a doctor for an entirely different health concern. Since these cancers happen so rarely, no screening tests exist to catch them early.
If your doctor suspects cancer, you may get a:
Computed tomography (CT) scan, imaging using a series of x-rays
Magnetic resonance imaging (MRI) scan, imaging using a strong magnetic field and radio waves
Positron emission tomography (PET) scan, imaging using a safe radioactive sugar
Biopsy, procedure to get a tissue sample
These tests help spot cancer in the biliary system and throughout your body to confirm a diagnosis. If imaging shows a blockage in your biliary system, you may get an endoscopic retrograde cholangiopancreatogram (ERCP). This procedure allows your doctor to take tissue samples and open up a blocked bile duct with stents (tubes that widen and support the duct).
Your treatment plan depends on whether the cancer can be removed with surgery. Surgery may not be possible if cancer has spread or involves critical blood vessels. Sometimes surgery would take too much of a toll on your body—most bile duct cancer surgeries are major operations.
You may need additional treatment before or after surgery. Interventional radiology cancer treatments help make the tumor smaller or treat remaining cancer cells.
“It’s really important to go to a high-volume center with a lot of expertise, not just in doing surgery but in managing the complications and complexities of the situation,” says Dr. Hong. “These tumors are in such difficult locations and management is so complicated. Care needs to be individualized based on your anatomy and your cancer journey.”
He highlights that your care team should include specialists from:
“With our surgical expertise at Mass General Cancer Center, we’re able to do potentially curative operations,” says Dr. Hong. “How you feel and how you eat afterward highly depends on the operation.”
Even when tumors can’t be removed or when cancer has spread, you still have treatment options. Cancer medications, including chemotherapy, immunotherapy, and targeted therapy, attack cancer cells in your body.
“Mass General played a pivotal role in identifying and developing targeted therapies for IDH1 and FGFR mutations that tend to occur in intrahepatic bile duct cancer,” says Dr. Hong. “Those were huge breakthroughs that provided different types of therapies where none existed before.”
In addition to cancer medications, you have access to radiation therapies. Mass General also pioneered an advanced procedure called high-dose ablative radiation. This therapy, which treats intrahepatic bile duct cancer, shrinks tumors while limiting radiation exposure to surrounding tissue. Proton radiation therapy similarly targets cancer cells with less damage to healthy tissue.
Bile duct cancers are very challenging, high-risk cancers. Treatment can potentially cure some forms of the disease. Researchers continue to search for better therapies to bring hope.
“When cancer is very advanced, a health care system that does a lot of research in this is more likely to have novel clinical trials that may be beneficial,” says Dr. Hong.
He notes that Mass General Cancer Center is a national leader in bile duct cancer treatment and research. You can find clinical trials that offer the latest therapies, working to optimize cancer medications, radiation, and surgery.