Surgical Procedures: Surgery and Staging for Bile Duct Cancer (Cholangiocarcinoma)
When there are malignant (cancerous) cells that form within the bile duct it is called cholangiocarcinoma. There are two forms of the disease; intrahepatic and extrahepatic bile duct cancer. Intrahepatic bile duct cancer forms within the bile ducts of the liver, whereas 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?
Once a diagnosis of cholangiocarcinoma has been made or if there is suspicion that the disease is present, your healthcare provider will typically obtain additional testing to determine the stage of cancer, which may include:
Physical Exam: This is a general physical exam, as well as, an evaluation of your medical history and symptoms.
Radiologic Imaging: Imaging such as a CAT scan (CT scan), magnetic resonance imaging (MRI), ultrasound and/or MRCP (magnetic resonance cholangiopancreatography) may be used to further evaluate the extent of your cancer.
Blood Testing: Certain blood tests, such as liver function tests to evaluate bilirubin and alkaline phosphatase levels, Carcinoembryonic antigen (CEA) and CA 19-9 tumor marker testing, and other blood work may be recommended during the workup and treatment phases.
Surgical Procedures Used in the Diagnosis and Treatment of Cholangiocarcinoma
During the diagnostic evaluation of cholangiocarcinoma, certain surgical procedures may be recommended during this evaluative phase such as:
- Laparoscopy: During a laparoscopy, the abdominal cavity is surgically accessed using a lighted tube with a camera (laparoscope) to evaluate for the presence of cancer and/or any abnormal findings. Biopsies may be obtained during the procedure.
- Percutaneous transhepatic cholangiography (PTC): During this procedure, 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): During an 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.
It may be recommended that those with cholangiocarcinoma undergo surgery. The surgical procedure recommended will depend on several factors and your surgeon will discuss with you in detail the recommended procedure, based on your unique situation.
Some common surgical procedures to treat cholangiocarcinoma include:
- 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: This procedure involves 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: Learn more about a Whipple procedure on OncoLink.
- Laparoscopy: During a laparoscopy, the abdominal cavity is surgically accessed using a lighted tube with a camera (laparoscope) to evaluate for the presence of cancer and/or any abnormal findings. Biopsies may be obtained during the procedure and if possible, tumors may be removed.
- Biliary bypass: For those with a blockage in the bile duct from a tumor, the surgeon may recommend doing a biliary bypass procedure. This procedure involves creating a bypass around the tumor to another organ, such as the gallbladder.
- Stent placement:This procedure places a tube, called a stent, into the bile duct to keep it open and functioning.
Note: 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 Surgery to Treat Cholangiocarcinoma?
As with any surgical procedure, there are risks and side effects associated with undergoing surgery to treat cholangiocarcinoma. Risks and side effects associated with surgery may include:
- Reaction to anesthesia
- Blood clots
- Bile leaking into the abdominal cavity
- Liver failure
- Nutritional problems may occur in some cases
- Death (rare)
Other risk factors are determined based on your health status and procedure being performed. Speak with your surgeon about the specific risk factors present in your case.
What is Recovery Like?
Recovery from surgery to treat cholangiocarcinoma will depend on the extent and type of the procedure performed. A hospital stay may be required.
You will be instructed on how to care for your surgical incisions and will be given any other instructions prior to 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?
Depending on the extent of your surgery, you may need a family member or friend to help you with your daily tasks until you are feeling better and your medical team gives you the go ahead to resume normal activity.
Be sure to take your medications as directed to prevent pain, infection or other conditions and call your medical team with any concerning symptoms.
If constipation is present, speak with your healthcare team about recommendations to offer relief.
Deep breathing and relaxation are important to help with pain, keep lungs healthy after anesthesia, and promote good drainage of lymphatic fluid. Try to perform deep breathing and relaxation exercises several times a day in the first week, or whenever you notice you are particularly tense. Speak with your healthcare team to see if deep breathing and relaxation exercises are appropriate for you.
- A simple exercise to do on your own: While sitting, close your eyes and take 5-10 slow deep breaths. Relax your muscles. Slowly roll your head and shoulders.
- Find more relaxation exercises on OncoLink.
This hand-out provides general information only. Please be sure to discuss the specifics of your surgical plan and recovery with your surgeon.
NIH. Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®)–Patient Version (December 22, 2016) Retrieved from https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq on March 21, 2017
ACS. Surgery for Bile Duct Cancer (January 20, 2016) Retrieved from https://www.cancer.org/cancer/bile-duct-cancer/treating/surgery.html on March 22, 2017