Tests, Treatments & Therapies for Extrahepatic Bile Duct Cancer

At the University of Colorado Cancer Center, we use the most minimally invasive approach possible for both diagnosis and treatment of extrahepatic bile duct cancer. We recognize that both work-up and management requires a multidisciplinary approach with numerous specialists working closely together.

We use both standard treatments and those being tested in clinical trials. You might consider participating in a trial, which are designed to improve current treatments or get information on new treatments. If a new treatment is proven better than the standard treatment, the new treatment may become the standard treatment.

Staging and Detection Tests

Once a cancer has been diagnosed, it is very important for doctors to find out where the cancer may have spread (the “stage” of the cancer) to determine the best possible treatment plan for you. To find out, doctors use staging tests, which include:

  • Different types of scans
  • Different ways to take tissue samples to look for tumor cells microscopically (biopsy tests)

Scans and other tests may also be used:

  • In a “surveillance program” looking for any signs of relapse after treatment
  • In a “screening program” to detect cancer early in individuals at high-risk
  • To monitor responses to treatment

Tests that may be used include:

Liver function tests – A blood sample is checked to measure the amounts of certain substances released into the blood by the liver.

Biopsy – The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer.

Types of scans and procedures include:

ERCP (endoscopic retrograde cholangiopancreatography) – A thin, lighted tube, called an endoscope is passed through the mouth and stomach, down into the first part of the small intestine. After injecting dye through the catheter into the ducts, the doctor takes X-rays to see if the ducts are narrowed or blocked by a tumor or other condition.

PTC (percutaneous transhepatic cholangiography) – A dye is injected through a thin needle inserted through the skin into the liver. The dye makes the bile ducts show up on X-rays so the doctor can if the ducts are narrowed or blocked by a tumor or other condition.

Ultrasound – High-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

CT scan (computed tomography) – An X-ray procedure that creates detailed, highly accurate cross-sectional body images.

PET scan (positron emission tomography) – An imaging test used to light up cancer in different parts of the body. You get an injection of a short-lived radioactive substance before having the scan. Cancerous tissue will build up more of the substance and appear brighter than normal tissue on the PET images. Other non-cancerous tissues, such as areas of inflammation, can also sometimes “light up.”

Treatment & Therapy for Extrahepatic bile duct Cancers

Surgery

People with bile duct surgery usually need surgery as a first step to remove the tumor. A surgical oncologist-a doctor who specializes in cancer operations-will perform the operation.

Removal of the bile duct – If the cancer is found at a very early stage, surgeons can remove the tumor, bile duct and nearby lymph nodes. Then they reconstruct a new duct by sewing a piece of intestine to the liver.

Partial hepatectomy – If the tumor has spread to the liver, surgeons can remove the involved part of the liver, the bile duct and lymph nodes near the tumor. Then they reconstruct a new duct by sewing a piece of intestine to the liver.

Whipple procedure – Surgeons remove the bile duct, the head of the pancreas, the gallbladder, and parts of the small intestine and stomach, then reconstruct the digestive system to allow you to eat a regular diet.

Surgical biliary bypass – If the tumor is blocking the duct, but it can’t be removed, surgeons will create a new pathway around the blocked area.

Stent placement – If the tumor is blocking the bile duct, a thin tube called a stent may be placed in the duct to drain bile that has built up in the area.

Radiation Therapy (“Radiotherapy”):

Radiation therapy involves using X-rays and other types of medical radiation aimed at specific parts of the body to:

  • Kill cancer cells
  • Prevent cancer cells from developing or recurring
  • Improve many of the symptoms caused by cancer

Radiation therapy can be:

  • Used before surgery to make the operation easier (this is called “neoadjuvant” treatment)
  • Used after surgery to reduce the chances of the cancer coming back (this is called “adjuvant treatment”)
  • Almost as effective as surgery in people who are not fit enough for an operation
  • Better than surgery when used together with chemotherapy for certain cancers (this is called “chemo-radiotherapy”)

Chemotherapy and other drug-based treatments:

Anti-cancer drug treatments – Chemotherapy-and new “targeted therapies”-involve using drugs that kill, slow down or damage cancer cells. Many new drugs are being developed. View current extrahepatic bile duct cancer clinical trials available at UCCC.

Anti-cancer drug treatments may involve:

  • Single drugs or combinations of drugs
  • Intravenous injections or tablets/capsules
  • Taking the drugs in repeating patterns, called “cycles”, that usually last three to four weeks
  • Taking some drugs every day or only on a few days within the cycles
  • Taking other medicines to reduce or eliminate side effects associated with chemotherapy
  • Taking targeted therapies, often with very little side effects, on their own or in combination with standard chemotherapy
  • Access to new drugs or vaccines on their own, or added into standard treatments, in clinical trials

Chemotherapy and targeted therapies can:

  • Be given before surgery to make the operation easier
  • Be given in combination with radiotherapy to make both treatments more effective
  • Be given after surgery to reduce the chances of cancer coming back
  • Successfully control advanced cancer and many cancer-related symptoms

Clinical Trials

The goal of clinical research is to improve treatment outcomes and reduce treatment side effects or long-term toxicities. Clinical trials provide the latest treatments because they evaluate:

  • New drugs
  • New combinations of therapies
  • New treatment delivery methods

Because we’re the Rocky Mountain region's only National Cancer Institute (NCI)-designated Comprehensive Cancer Center—one of only 39 in the United States—your treatment will always include the latest and most comprehensive care options.

Learn more about clinical trials at UCCC.

Other types of treatments being tested in clinical trials include:

Biologic therapy (biotherapy or immunotherapy) – 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.

Hyperthermia therapy – A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells. It can also make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.

Radiosensitizers – Drugs that make tumor cells more sensitive to radiation therapy.