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Bile Duct Cancer Treatment

This page describes the different types of treatment for bile duct cancer (cholangiocarcinoma). Which of these treatments a patient receives will depend on whether the cancer can be completely removed with surgery (resectable) or not (unresectable). To learn more, see treatment of resectable and treatment of unresectable bile duct cancer.

Types of treatment

Surgery 

The following types of surgery are used to treat bile duct cancer:

  • Removal of the bile duct: This surgical procedure is done to remove part of the bile duct if the tumor is small and is in the bile duct only. Lymph nodes are removed and tissue from the lymph nodes is viewed under a microscope to see if there is cancer.
  • Partial hepatectomy: This is a surgical procedure to remove the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it.
  • Whipple procedure: During this surgical procedure the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine, and the bile duct are removed. Enough of the pancreas is left to make digestive juices and insulin.

After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back.

The following types of palliative surgery may be done to relieve symptoms caused by a blocked bile duct and improve quality of life:

  • Biliary bypass: If cancer is blocking the bile duct and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the part of the bile duct that is past the blockage or to the small intestine. This type of surgery creates a new pathway around the blocked area.
  • Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains the bile into a bag on the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
  • Percutaneous transhepatic biliary drainage: This procedure is used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If the bile duct is blocked, a stent may be left in the liver to drain bile into the small intestine or a collection bag outside the body. 

Radiation therapy  

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. These are the main ways radiation might be given to treat bile duct cancer:

  • External radiation therapy: A machine outside the body sends radiation toward the area of the body with cancer. Radiation is given in a series of treatments to allow healthy cells to recover and to make radiation more effective. The number of treatments is based on details about the cancer, such as the size and location of the tumor.

    It is not known whether external radiation therapy helps in the treatment of resectable bile duct cancer. In unresectable, metastatic, or recurrent bile duct cancer, new ways to improve the effect of external radiation therapy on cancer cells are being studied:

    • Hyperthermia therapy: Body tissue is exposed to high temperatures to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs. 
    • Radiosensitizers: Drugs called radiosensitizers make cancer cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more cancer cells.
  • Internal radiation therapy: A radioactive substance is sealed in needles, seeds, wires, or catheters that are placed directly into or near the bile duct.

External and internal radiation therapy are used to treat bile duct cancer and may also be used as palliative therapy to relieve symptoms and improve quality of life.

To learn more about radiation therapy and its side effects, see Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects.

Chemotherapy 

Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. There are two main types of chemotherapy used to treat bile duct cancer.

  • Systemic chemotherapy: When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body.

    Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer. The following chemotherapy drugs may be used:

  • Regional chemotherapy: When chemotherapy is placed directly into an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas.

    In unresectable, metastatic, or recurrent bile duct cancer, intra-arterial embolization is being studied. It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in blood vessels near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an artery that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells.

It is not known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer. 

To learn about the different ways chemotherapy works against cancer, what to expect when receiving chemotherapy, and how to manage chemotherapy side effects, see Chemotherapy to Treat Cancer.

Liver transplant 

In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed. 

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following targeted therapies are being studied in patients with bile duct cancer that is locally advanced and cannot be removed by surgery or has spread to other parts of the body:

To learn more about how targeted therapy works against cancer, what to expect when having targeted therapy, and targeted therapy side effects, see Targeted Therapy to Treat Cancer.

Immunotherapy  

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Immune checkpoint inhibitor therapy is a type of immunotherapy. The following immune checkpoint inhibitor may be used to treat bile duct cancer:

To learn more about how immunotherapy works against cancer and immunotherapy side effects, see Immunotherapy to Treat Cancer and Immunotherapy Side Effects.

Clinical trials  

A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be the best treatment choice.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

To learn more about clinical trials, see Clinical Trials Information for Patients and Caregivers.

Treatment of resectable (localized) bile duct cancer

If the cancer has not spread and is in a place where surgery can be safely done, the tumor and some of the tissue around it will be removed. This lowers the chance of the cancer coming back. Chemotherapy with or without radiation therapy may be given after surgery.

Treatment of resectable intrahepatic bile duct cancer may include the following:

  • surgery to remove the cancer, which may include partial hepatectomy with or without embolization before surgery

Treatment of resectable perihilar bile duct cancer may include the following:

  • surgery to remove the cancer, which may include partial hepatectomy
  • stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life

Treatment of resectable distal bile duct cancer may include the following:

  • surgery to remove the cancer, which may include a Whipple procedure
  • stent placement or percutaneous transhepatic biliary drainage as palliative therapy, to relieve jaundice and other symptoms and improve the quality of life 

Adjuvant therapy for resectable bile duct cancer may include the following: 

  • chemotherapy
  • external-beam radiation therapy 
  • a clinical trial of adjuvant therapy

Treatment of unresectable bile duct cancer (including metastatic or recurrent disease)

Most people with bile duct cancer cannot have their cancer completely removed with surgery. This may be the case if the cancer has spread too far, the cancer is in a place that is too difficult to completely remove with surgery, or the patient is not healthy enough for surgery.

Treatment of unresectable bile duct cancer (including metastatic or recurrent disease) may include the following:

  • stent placement or biliary bypass as palliative treatment to relieve symptoms and improve the quality of life
  • external or internal radiation therapy as palliative treatment to relieve symptoms and improve the quality of life
  • combination chemotherapy
  • a clinical trial of various combinations of chemotherapy
  • a clinical trial of immunotherapy in patients with mutations (changes) in certain genes
  • a clinical trial of targeted therapy in patients with mutations in certain genes 
  • Updated:

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