The function of the bile ducts is to transport bile produced by the liver to the duodenum and small intestine, aiding in digestion of food. Many people may not know that the bile ducts are divided into intrahepatic bile ducts and extrahepatic bile ducts. The intrahepatic bile ducts are smaller and branch-like, while the extrahepatic bile duct is commonly referred to as the common bile duct.
Q2. What are the types of bile duct cancer?
The bile ducts are divided into intrahepatic and extrahepatic parts; therefore, the bile duct cancer is also classified into intrahepatic cholangiocarcinoma and extrahepatic cholangiocarcinoma, depending on the location of the tumour.
Q3. Which groups are more commonly affected by bile duct cancer?
Three groups of people are more prone to developing bile duct cancer.
The first group is people of Southern Chinese origin. In the past, due to limited public health condition, they were more likely to consume contaminated food containing parasites, such as Clonorchis sinensis (Chinese liver fluke), which lives in the bile ducts and causes recurrent inflammation. Chronic inflammation may eventually lead to bile duct cancer.
The second group includes Individuals with congenital bile duct cysts. The bile duct abnormalities lead to bile accumulation and a prolonged state of inflammation, which can increase the risk of developing bile duct cancer.
The third group is patients with primary sclerosing cholangitis (PSC). They are at an increased risk of developing cholangiocarcinoma. This condition, more commonly seen in older adults, involves chronic inflammation of the bile ducts, which can cause unhealthy changes in the cells and increase the risk of cancer.
Q4. What are the symptoms of bile duct cancer?
Bile duct cancer typically does not cause pain, especially in its early stages. Since cholangitis (bile duct inflammation) often occurs without bacterial infection, most patients may observe symptoms like yellowing of the eyes (jaundice) and dark urine before discovering they have bile duct cancer. Early detection usually relies on regular health check-ups.
Q5. How can bile duct cancer be detected early?
Early detection of bile duct cancer is very important. It is crucial to have regular health check-ups, including liver function tests. If liver enzymes or bilirubin levels are abnormally high, it could indicate that a tumour is obstructing the bile duct. Additionally, testing for tumour markers such as CA19-9 and CEA is also important. A sudden rise in these markers warrants further investigation to confirm whether there is a problem with the bile ducts.
Q6. How is bile duct cancer treated at different stages?
In early-stage bile duct cancer, the cancer is confined to the bile ducts, either intrahepatic or extrahepatic, and has not spread to other areas. In such cases, surgical removal of the affected portion of the liver and nearby lymph nodes can effectively manage the disease. If the cancer has spread to other areas, such as the peritoneum or lungs, chemotherapy and targeted therapy may be needed in combination with surgery as supportive treatments.
Q7. What treatment options are available if surgery is not suitable?
Some patients may not be suitable for surgery due to advanced age, poor cardiopulmonary function, or extensive tumour spread. If the tumour is blocking the bile duct, there are alternative methods to relieve the situation. For example, endoscopy can be used to place a metal stent to widen and unblock the narrowed ducts. This approach can be complemented with mild chemotherapy to improve the patient's quality of life, potentially allowing them to live comfortably for an extended period.
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