Surgical Procedures: Surgery and Staging for Bile Duct Cancer (Cholangiocarcinoma)

Autor: OncoLink Team
Última Vez Revisión: 7 de junio de 2019

Cancerous cells in the bile duct it is called cholangiocarcinoma. There are two types: intrahepatic and extrahepatic. Intrahepatic bile duct cancer forms in the bile ducts of the liver. Extrahepatic bile duct cancer forms outside of the liver, in either the perihilar or distal extrahepatic bile duct.

What is staging and how is it performed?

Staging is a way to find out how far the cancer has spread in your body. Your provider will have you get a few tests to figure out the stage of your cancer. These tests may include: 

Physical Exam: This is a general exam to look at your body and to talk about your past health issues. 

Imaging: Radiology tests can look inside your body to look at the cancer and determine if it has spread. These tests can include:

  • CAT scan (CT scan).
  • Magnetic Resonance Imaging (MRI).
  • Ultrasound.
  • MRCP (magnetic resonance cholangiopancreatography).

Laboratory Tests: Certain blood tests may be done,such as liver function tests to evaluate bilirubin and alkaline phosphatase levels, Carcinoembryonic antigen (CEA) and CA 19-9 tumor marker testing.

Procedures: These may include:

  • Laparoscopy: Many small incisions (cuts) are made in the belly. The surgeon will place a laparoscope (thin, lighted tube) with tools on the end of it into the belly to obtain a biopsy. 
  • Percutaneous transhepatic cholangiography (PTC): A needle is used under x-ray guidance (with dye) to evaluate the liver and bile ducts. Biopsies may be obtained and in cases of duct blockages, a stent may be placed.
  • Endoscopic retrograde cholangiopancreatography (ERCP): A lighted tube with a camera (endoscope) is placed through the mouth and into the small intestine under x –ray guidance (with dye) to evaluate the bile ducts. Biopsies may be obtained and in cases of duct blockages, a stent may be placed.

Cholangiocarcinoma spreads to other parts of the body through the tissue, lymph and blood systems. Cholangiocarcinoma is assigned a stage from 1 to 4, based on how extensive the cancer is, how far it has spread, and what treatment course will be recommended. When planning treatment for cholangiocarcinoma, the tumors are further described as resectable (localized) or unresectable. Those with localized disease may undergo surgery to remove the tumor in its entirety, whereas unresectable cancers are unable to be fully removed surgically.    

In some cases surgery is used to treat cholangiocarcinoma. 

Surgical Procedures for Cholangiocarcinoma 

  • Bile duct removal: In cases of small, confined cancers (within the bile duct only), full or partial bile duct removal may be recommended. In some cases, evaluation and removal of lymph nodes and lymph tissue may be done during the procedure.
  • Partial hepatectomy: The removal of a wedge shaped piece of liver tissue, removal of an entire liver lobe, or a larger portion of the liver, with an area of normal appearing surrounding tissue.
  • Whipple procedure: A standard Whipple is the removal of the pancreatic head (and at times the body), gallbladder, bile duct and a part of both the stomach (pylorus), small intestine (duodenum), and nearby lymph nodes. 
  • Laparoscopy: Many small incisions (cuts) are made in the belly. The surgeon will place a laparoscope (thin, lighted tube) with tools on the end of it into the belly to obtain a biopsy. 
  • Biliary bypass: For those with a blockage in the bile duct from a tumor, a biliary bypass procedure may be done. This procedure involves creating a bypass around the tumor to another organ, such as the gallbladder.
  • Stent placement: This is the placement of a tube, called a stent, into the bile duct to keep it open and functioning.

Your surgeon will discuss with you if your cancer is resectable (surgically removable) or unresectable (likely unable to be removed surgically), which will determine the surgical procedure recommended.

In certain cases, it may be recommended that in addition to a partial hepatectomy, part of the pancreas and small intestine be removed or that patients undergo a liver transplant. If this is an option, your healthcare team will discuss this with you.

What are the risks associated with cholangiocarcinoma surgery?

As with any surgery, there are risks and possible side effects. These can be:

  • Reaction to anesthesia. (Anesthesia is the medication you are given to help you sleep through the surgery, not remember it and manage pain. Reactions can include wheezing, rash, swelling and low blood pressure.)
  • Bleeding.
  • Blood clots.
  • Infection.
  • Pneumonia.
  • Bile leaking into the abdominal cavity.
  • Liver failure.
  • Nutritional problems may occur in some cases.

Before surgery, your surgeon will talk to you about any other risks based on your health and the specific surgery you are having.

What is recovery like?

Recovery from surgery to treat cholangiocarcinoma will depend on the extent of the procedure performed. You may need to stay in the hospital.

You will be told how to care for your surgical incisions and will be given any other instructions before leaving the hospital.

Your medical team will discuss with you the medications you will be taking, such as those for pain, blood clot, infection, constipation prevention and/or other conditions.

Your healthcare provider will discuss your particular activity restrictions, depending on the surgery you have had.

How can I care for myself?

You may need a family member or friend to help you with your daily tasks until you are feeling better. It may take some time before your team tells you that it is ok to go back to your normal activity.

Be sure to take your prescribed medications as directed to prevent pain, infection and/or constipation. Call your team with any new or worsening symptoms.

There are ways to manage constipation after your surgery. You can change your diet, drink more fluids, and take over-the-counter medications. Talk with your care team before taking any medications for constipation. 

Taking deep breaths and resting can help manage pain, keep your lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to do deep breathing and relaxation exercises a few times a day in the first week, or when you notice you are extra tense.

  • Example of a relaxation exercise: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.

This article contains general information. Please be sure to talk to your care team about your specific plan and recovery.

Referencias

NIH. Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Patient Version. July 5, 2018. Found at: https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq 

ACS. Surgery for Bile Duct Cancer. July 3, 2018. Found at: https://www.cancer.org/cancer/bile-duct-cancer/treating/surgery.html 

Palabras clave

Haga clic en cualquiera de estos términos para más artículos relacionados

Preguntas frecuentes


A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
X
Y
Z
#
 
A
B
C
E
F
G
H
K
L
M
N
O
P
R
S
T
U
V
 
 
Manténgase informado con las última información de OncoLink!   Suscribirse a los boletines electronico de OncoLink
Ver nuestros archivos de boletines