Cholangiocarcinoma

Cholangiocarcinoma

Bile duct cancer or cholangiocarcinoma is a cancer that occurs in the bile duct ( bile duct ) . This bile duct cancer will cause symptoms of jaundice, although at first it does not cause symptoms.

Cholangiocarcinoma is a rare disease and usually affects people over the age of 50. The cause is unknown, but this condition is known to be more at risk for people with bile duct disorders and people with liver disease.

 

Type C holangiocarcinoma

Based on the location of the appearance of cancer, cholangiocarcinoma can be divided into three types, namely:

  • Intrahepatic cholangiocarcinoma, which is cancer of the bile ducts in the liver
  • Distal cholangiocarcinoma, which is cancer that appears in the bile duct close to the small intestine
  • Klatskin tumor, which is cancer that appears in the bile duct that will come out of the liver

Causes of Cholangiocarcinoma

Cholangiocarcinoma occurs due to changes or gene mutations in the tissues that make up the bile duct. Mutations in this gene cause the tissue to grow abnormally. However, the cause of the change in the gene itself is not known for certain.

Although the cause is unknown, there are several conditions that increase a person's risk of developing cholangicarcinoma, including:

  • Bile duct disorders from birth, such as bile duct cysts
  • Liver disease , such as hepatitis B, cirrhosis , or a parasitic infection of the liver
  • Primary sclerosing cholangitis (PSC), an autoimmune disease that causes narrowing of the bile ducts
  • Age 50 years and over
  • Smoking habit
  • Chronic diseases, such as diabetes
  • Obesity

Symptoms of Cholangiocarcinoma

Early-stage cholangiocarcinoma usually causes no symptoms. New symptoms appear when the cancerous tissue has enlarged.

Bile duct cancer sufferers can feel different symptoms, depending on the initial location of the cancer. In general, the symptoms of this disease include:

  • Symptoms of jaundice , such as yellowish skin and eyes, itching, dark urine, and pale stools
  • Abdominal pain that may spread to the back
  • Fever
  • Weak
  • Weight loss

When to go to the doctor

Immediately consult a doctor if you experience symptoms of bile duct cancer, such as jaundice, in order to get the right treatment.

In addition, do routine checks with your doctor if you have diabetes or hepatitis B , so that treatment and disease progress can be monitored. These two chronic diseases are thought to be at risk of causing bile duct cancer.

If you are at risk of getting hepatitis B, for example because you work as a medical officer, then you need to consult a doctor to get the hepatitis B vaccine .

Cholangiocarcinoma diagnosis

To diagnose cholangiocarcinoma, the doctor will ask about the patient's symptoms and medical history, followed by a physical examination.

If the patient is suspected of having bile duct cancer, the doctor will carry out further tests to confirm the diagnosis, including:

  • Scan with ultrasound , CT scan, or MRI, to see abnormal conditions of the bile ducts
  • Endoscopic retrograde cholangiopancreatography (ERCP) or a combination of endoscopy with X-rays of the bile ducts, to examine the bile ducts in more detail
  • Percutaneous transhepatic cholangiography (PTC), to see the bile ducts in more detail with the catheterization method
  • Biopsy, by taking a tissue sample of the bile ducts for examination in the laboratory
  • Blood tests, to check levels of tumor markers CA 19-9 and liver function

Stage Cholangiocarcinoma _

After establishing the diagnosis, the doctor will determine the stage of bile duct cancer suffered by the patient to determine treatment. The division of bile duct cancer stages is as follows:

  • Stage 1
    At this stage, the cancer tissue is still small and is only found in certain parts of the bile duct.
  • Stage 2
    At this stage, the cancerous tissue has begun to enlarge and can spread to the tissues around the bile duct.
  • Stage 3
    At this stage, cancer tissue has spread to the lymph nodes around the cancer.
  • Stage 4
    At this stage, the cancer tissue has spread to other organs ( metastasis ).

Treatment of Cholangiocarcinoma

Treatment of bile duct cancer aims to overcome the symptoms that arise and cure the cancer. Cholangiocarcinoma that is diagnosed and treated early has a greater chance of recovery. The following are several treatment options for treating cholagiocarcinoma:

Operation

The main method of treatment of cholangiocarcinoma is surgery. Some of the types of surgery that patients can undergo are:

  • Laparoscopy
    Laparoscopic is a surgical method that is performed using a laparoscope, to remove as much cancer tissue as possible.
  • Biliary drainage
    This method is performed by bypass surgery to restore fluid drainage from the bile ducts that have been disrupted by cancer.
  • Placement of the ring (stent)
    This operation aims to maintain the flow of bile by widening the bile ducts that are narrowed due to cancer.
  • Liver transplant Liver transplantation is done by taking the patient's liver and replacing it with a liver from a donor. This action is performed on cholangiocarcinoma which is located in the liver.

If the cancer has entered an advanced stage and has spread to surrounding tissues, surgery is performed not only to remove the cancerous tissue, but also part of the bladder and bile ducts, pancreas and part of the intestine. This procedure is called the Whipple operation .

Radiotherapy

To help kill cancer cells that are not removed through surgery, patients can undergo radiotherapy . Radiotherapy is carried out using high-energy beam technology to kill cancer cells.

Chemotherapy

Chemotherapy can also be done to kill cancer cells through drugs, such as cisplatin , fluorouracil, gemcitabine , or oxaliplatin . Radiotherapy and chemotherapy can be combined to increase the effectiveness of cancer treatment, especially if the cancer has spread.

Supporting drugs

The doctor will also give drugs to relieve the patient's symptoms, such as morphine to relieve pain.

After treatment, patients still need to have regular check-ups through scans and laboratory tests, so that the development of the condition and side effects of treatment can be monitored.

If the cancer is declared calm, the doctor will recommend regular checkups every 6 months, for several years after treatment is complete.

Cholangiocarcinoma complications

Several complications can arise in cholangiocarcinoma due to blockage of the bile duct by cancer tissue. These complications include:

  • Bile duct infection
  • Cirrhosis

Cholangiocarcinoma Prevention

Because the cause is not known with certainty, bile duct cancer is difficult to prevent. However, there are several efforts that can be made to reduce the risk of developing cholangiocarcinoma, namely:

  • Get hepatitis B vaccination to prevent hepatitis B
  • Undergo regular blood sugar control with a doctor if you have diabetes
  • Quit smoking
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