Gallstones and tumors are one of the most common diseases of the biliary tract. Biliary tract cancer is the 5th most common cancer that can develop in the digestive system. Because the body can survive when the gallbladder does not function, its symptoms are usually noticed when gallbladder cancer is very advanced. Gallbladder cancer is mostly seen in people aged 60 and over and can progress very quickly if precautions are not taken, so early diagnosis is important in gallbladder cancer as in all other cancers.
What is Bile Tract Cancer?
Bile duct cancer (cholangiocarcinoma) is a tumor composed of bile duct wall cells. Its incidence is low. 60% originates from the bifurcation, which is the junction of the right and left main bile ducts, and can develop anywhere in the biliary tract.
What Causes Biliary Tract Cancer?
Primary sclerosing cholangitis, common duct cyst, hepatitis B-C, ulcerative colitis, hepatolithiasis (liver stone), advanced age, obesity, bilienteric anastomoses and chronic typhoid carrier in old sources are among the most common causes of biliary tract cancer.
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What are the symptoms of Biliary Tract Cancer?
Painless jaundice in bile duct cancer is one of the first detected symptoms. This is followed by itching due to the accumulation of bilirubin under the skin. Weight loss up to cachexia occurs in late-stage patients, and symptoms may be accompanied by fever.
How is Biliary Tract Cancer Diagnosed?
It is very important to diagnose gallbladder cancer at an early stage. In the examination of bile duct cancer, liver biliary tract ultrasound is performed first, and if enlargement of the biliary tract is observed, cross-sectional imaging with computed tomography or magnetic resonance helps the diagnosis. Sudden termination of the bile ducts can be determined without any mass in the biliary tract. Biopsy or swab can be taken with ERCP (endoscopic retrogrand colongiopancreatography), which is especially useful in the evaluation with endoscopic ultrasound in distal cancers. clinical jaundice, pruritus and weight loss, tumor marker CA19-9 being 100 U/ml supports the diagnosis. Diagnostic methods are made according to the patient’s health status, age, disease symptoms and previous test results.
How is Biliary Tract Cancer Treated?
Since bile duct cancer is an insidious disease, it gives late symptoms and when the diagnosis is made, more than half of the patients have no chance of surgery. The level of cancers determines the type of surgery, hepatectomy is required for proximal ones. For distal cancers, whipple surgery is usually performed.
Biliary cancer treatment is based on surgical removal of the tumor. It may also be necessary to remove part of the liver during treatment, which consists of a large-scale operation. Since the diagnosis of gallbladder cancer is usually made at an advanced stage, patients often do not have the chance to undergo surgery. However, cancer that is detected early enables successful treatment of gallbladder cancer. Some endoscopic procedures, pain treatment, percutaneous drainage (radiological intervention) can be applied to relieve jaundice and pain in patients with advanced stages that cannot be operated.
What are the Stages of Bile Tract Cancer?
Bile duct cancer is divided into 3 stages.
- In the first stage of bile duct cancer, the cancer is within the bile ducts. It is the group that responds best to surgery.
- In the second stage, the cancer has invaded the gallbladder, liver, pancreas or part of the portal vein & hepatic artery.
- In the third stage, there is cancer metastasis to nearby organs, and in the fourth stage, there is cancer metastasis to distant organs.
What are the Types of Bile Tract Cancer?
Bile duct cancers are classified according to their location. There are varieties of intrahepatic, hilar and distal. The hilar region is most common. Bismuth classification is done specifically for biliary tract cancers in the hilar region.
Type I: Cancer is in the common hepatic duct and distal to the bifurcation.
Type II: Cancer is in the common hepatic duct and has invaded the bifurcation.
Type III: Cancer is in the common hepatic duct and has affected the right or left hepatic duct along with the bifurcation.
Type IV: Cancer involving the bifurcation has affected both the right and left channels as well as the segments opening to these channels.
Frequently asked Questions
Jaundice develops primarily due to bile duct obstruction. There is an enlargement of the bile ducts in the liver and biliary tract inflammation (cholangitis) is observed with the increase in pressure and bacterial density in the biliary tract. this is considered Billier sepsis and can be fatal.
A stent is placed in the biliary tract to reduce jaundice values. The reason for stenting may be a benign stenosis or the possibility of cancer. In those who will be operated on due to bile duct cancer, a stent is placed on the side of the liver segment that will remain in the patient.
They should take their post-operative chemotherapy (chemical treatment) regularly and should be in close contact with their doctor and should not disrupt their control imaging and examinations.
The narrowing of the biliary tract is usually due to the presence of stones in the biliary tract. In addition, it is possible to result from previous procedures (operations – stenting).
There is a risk of developing cancer from polyps larger than 10 mm in size and more than one in the gallbladder. It is appropriate to remove the gallbladder by cholecystectomy (laparoscopic or open) technique. Single polyps smaller than 10 mm in size are monitored with 6-month ultrasound control.
Removal of the gallbladder does not have a negative effect on the body. Bile is produced from the liver. After the gallbladder operation, there is no bile deficiency in the patient.
Chronic inflammation can cause cancer. Stones in the gallbladder were also observed in 90 percent of the patients who were operated for gallbladder cancer.
