Biliary cancer - the cause, symptoms and treatment

Biliary cancer is a rare, rarely mentioned cancer that is still quietly destroying the health of thousands of people around the world. Therefore, people do not pay much attention to this type of disease, from which the subjective is not detected early. However, bile sugar is very dangerous with a life span of only 6-9 months.

1. What is cholangiocarcinoma?

Cholangiocarcinoma (cholangiocarcinoma) is a cancer that forms in the system of ducts that carry bile from the liver to the small intestine. The bile ducts are divided into two main types: biliary tract cancer in the liver and beyond the liver.

Cholangiocarcinoma is a malignant disease of the biliary tract system, which can arise from hepatic bile ducts or extrahepatic biliary tract, including the confluence of biliary-pancreatic balls.

2. Types of cholangiocarcinoma

According to anatomical location, biliary cancer is divided into 3 groups:

1. Biliary tract cancer in the liver.
2. Cancer of the bile ducts in the navel.
3. Cancer of the bile ducts outside the liver.

In which, biliary tract cancer in the umbilical cord is the most common type and the most common type of cholangiocarcinoma in the liver. Although the same is biliary cancer, each group has a difference in prognosis as well as treatment method.

Cholangiocarcinoma of the hepatic umbilical cord forms at the junction of the bile ducts, the confluent position of the right liver tube and left hepatic tube to form a common liver tube. Extrahepatic biliary tract cancer is a tumor that is located from the upper margin of the pancreas to the confluent position of the pancreatic-pancreas ball (Vater ball).

Approximately 95% of cholangiomas are tubular carcinoma, characterized by rapid progression, late detection at the inoperable stage.

Symptoms of biliary tract cancer

Jaundice

Jaundice is a consequence of biliary obstruction caused by tumors.

This is the most common symptom, most often expressed when exposed to sunlight. Jaundice is a consequence of biliary obstruction caused by tumors. Bile salts reverse from the bile into the liver sinuses, entering the blood and depositing in the skin. Jaundice is often poor in the color of fecal stools and dark colored urine (like liquid water).

Gold eyes

The expression in the sclera of the eye is dark yellow. This sign may appear before or simultaneously with jaundice.

Itching

Pruritus is often accompanied by jaundice but many cases appear before jaundice. Pruritus levels often increase at night and hardly respond to dermatological medications. Pruritus is caused by bile acids deposited in the skin, stimulating sensory nerve receptors.

Skinny weight loss

About 30-50% of cases lose weight at the time of diagnosis. This is a consequence of the process of digestive disorders (loss of appetite, loss of appetite, bloating) due to the absence of excreted bile.

Abdominal pain in the liver

The disease is at an early stage, the symptoms are often vague, unclear. When abdominal pain is more often due to complications of biliary obstruction.

Gan big

Hepatomegaly is the result of cholestasis. Approximately 25% of cases may palpate the liver below the ribs with soft density.

Light color / greasy color

If the cancer tumor prevents the release of bile and pancreatic fluid into the intestine, the decline in fat digestibility. Undigested fats can make the stool unusually pale.

Dark urine

When the concentration of bilirubin in the blood is high, it can also appear in the urine and turn it into a dark yellow color.

Nausea and vomiting

These are not common symptoms of bile duct cancer, but can occur if you have a biliary tract infection caused by obstruction of the bile ducts. They are often seen with fever.

Risk factors for biliary tract cancer

The cause of cholangiocarcinoma is still unclear, but it has identified high risk factors of the disease such as primary cholangitis, infection and chronic biliary tract parasites (eg liver fluke).

Biliary stones are one of the causes of biliary tract cancer.

In developing countries, the weakest risk is biliary stones and chronic biliary tract infections.

Unlike hepatocellular carcinoma (HCC), there is no clear evidence of viral hepatitis and cirrhosis of biliary tract carcinoma.

In addition, exposure to chemicals has been shown to increase the risk of cholangiocarcinoma formation, which is common in people working in the chemical industry or exposed to prolonged chemicals.

Congenital congenital diseases including bile duct cysts, hepatic biliary cysts, alpha 1 –antitrypsin deficiency metabolic disorders are also a risk factor for disease.

Prognosis of disease

The incidence of cholangiocarcinoma is highest in the age group of 60-70 years. In the age of 60 years or older, the rate of biliary cancer in women is 2.5 times higher than that of men and under 40 years old, the rate of women is 1.5 times higher than men.

In the first stage, biliary tract cancer progresses slowly, going through stages of hyperplasia, dysplasia, infiltration of the basal membrane cells and then entering the surrounding gland tissue such as liver, portal vein, lymphatic, regional lymph nodes.

Although there have been many advances in medicine in general and cancer treatment in particular, including from diagnostic imaging, surgery, radiotherapy or supportive treatment, the prognosis of biliary cancer is still very good. bad.

Because it is difficult to diagnose early, at the time of detection of the disease, about 90% of cases cannot apply radical treatment measures. Therefore, the average life span of biliary cancer is only about 6-9 months.

Diagnosis of biliary tract cancer

Based on the symptoms of warning of clinical biliary tract cancer, it is possible to provide a diagnosis and appropriate treatment regimen for each patient. Your doctor may order you to perform some medical tests or procedures necessary to make a final diagnosis.

1. Blood chemistry test . Blood chemistry tests measure alkaline bilirubin and alkaline phosphatase levels and check for liver function. If your test results indicate high levels of these substances in your blood, it may indicate that your bile duct is not working properly.
2. Tests (CEA and CA19-9) : Biliary cancer can cause high levels of carcininochromicine antigen (CEA) and CA19-9 in the blood. However, a person can develop bile duct cancer even when there are levels of these antigens in the normal range of these tumor markers. Besides, there are bile-related diseases such as cholecystitis, biliary inflammation . sometimes the content of these substances increases.

Besides biochemical biochemical tests other tests can be done to provide more information about bile duct cancer. Include:

1. Biopsy: Other tests may suggest that cancer is present, but only performing a biopsy from a cell taken directly from the new bile can confirm a benign or malignant tumor.
2. Ultrasound : In ultrasound, the doctor can see the actual tumor. To see the bile duct, the doctor may use an endoscopic ultrasound instead. Ultrasound images will provide the doctor with information about bile ducts such as location, volume, size and extent of tumor damage.

Magnetic resonance imaging shows the exact bile duct cancer.

1. Magnetic resonance imaging (MRI) . MRI uses magnetic fields rather than X-rays to produce detailed images of the body. MRI for bile ducts is called MRI cholangioscopy. A contrast can be given before MRI creates a clearer picture of the biliary tract. Help the doctor determine the tumor and the tumor site has spread and affects the lymphatic system and other organs in the body.
2. Abdominal endoscopy . In laparoscopy, the doctor observes bile ducts, gallbladder and liver through a bright tube. Some endoscopic scanners can help a doctor sample tissue by using small tubes to help with the test, biopsy looking for the presence of cancer cells.

Stages of biliary tract cancer

Cholangiocarcinoma often confuses the symptoms of liver cancer. Through the test results, the doctor will make a diagnosis about the condition, nature and stage of the disease. Since then give the prognosis of treatment for each patient.

1. Stage 0 : Cancer occurs in the inner lining of the bile duct. This is the stage of tumor formation, it is developing and there is no sign of spreading into the lining and bile duct wall.
2. Stage IA : Cancer is in the bile duct wall, but not fully developed. It has no sign of spreading to surrounding lymph nodes or further locations in the body.
3. Stage IB : The cancer has been deeply ingested and developed through the bile duct wall, but has not spread anywhere else.
4. Phase IIA . From the bile duct wall, cancer tumors begin to invade nearby structures, such as the liver, pancreas, or gallbladder. Or it may have spread to smaller branches of the liver or venous artery, but not yet spread to larger vessels. It has not spread to lymph nodes or other body sites.
5. Phase IIB . Cancer develops and spreads in the bile ducts and spreads to lymph nodes but not to the lymphatic system. It may or may not spread to nearby structures.
6. Phase III . Cancer enters the main vein or artery or part of the small intestine, gallbladder, colon, or stomach. It can spread to lymph nodes but does not spread to distant locations in the body.
7. Stage IV . Cancer has spread to other locations such as bone, lungs, liver .

Treatments for biliary tract cancer

During the consultation of treatments based on the development stage, possible side effects, physical . doctors will develop appropriate treatments for each patient. There are a number of methods currently being used in the treatment of bile cancer:

1. Surgery: The location and sensitivity of the biliary tract often makes surgery difficult. The effectiveness of surgery may be limited by tumor size and metastasis. Common surgical treatment options for biliary cancer include:
2. Surgery to remove the bile duct : remove the entire organ. This is a treatment option if the tumor does not spread beyond the bile duct. This surgery may also include removal of lymph nodes to check for cancer.
3. Partial surgery . If the location of the cancer is close to the liver, the doctor may have surgery to remove part of the liver. The rest of the liver can maintain the activity of liver function. In some cases, if you respond well to care and recovery therapies, your liver will return to normal size within a few weeks.
4. Whipple Procedure : is an extensive surgery that may be recommended if the cancer is located near the pancreas. The doctor will remove part or all of the pancreas and part of the small intestine, bile duct and stomach. However, this is a complicated surgery, a relatively high level of risk. You should consider if you need to use this method.
5. Liver transplantation : Surgery to remove the liver is called resection of the whole liver. Surgeon then donated human liver transplant. However, bile duct cancer tends to recur very quickly after transplantation. So this method is rarely used.

Surgery in the treatment of biliary tract cancer.

1. Radiation therapy: Radiation therapy with high-energy X-rays or other particles to destroy cancer cells. However, this method is rarely used during the treatment of biliary tract cancer. It is often used by doctors to control symptoms and pain when the disease progresses. Side effects of radiation therapy may include fatigue, mild skin reactions, nausea . Most side effects will disappear immediately after treatment is complete.
2. Chemotherapy : Chemotherapy is the use of drugs to kill cancer cells, usually by blocking the ability of cancer cells to grow and divide. Research has shown that the combination of cisplatin (Platinol) and gemcitabine (Gemzar) can prolong the lives of patients with bile duct cancer that cannot perform surgery. Other drugs that have been used to treat bile duct cancer include fluorouracil (5-FU, Adrucil), capecitabine (Xeloda), paclitaxel (Taxol). In addition, chemotherapy may also be given after surgery to help prevent recurrence.