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Prognosis and survival for extrahepatic bile duct cancer
People with extrahepatic bile duct cancer may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person's medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor's best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for extrahepatic bile duct cancer.
Surgical removal of the tumour
Surgery offers the best chance for long-term survival for people with extrahepatic bile duct cancer. However, tumours can only be completely removed in a small number of people. This is because extrahepatic bile duct cancer often doesn't cause any symptoms in its early stages, and many people are not diagnosed until their cancer is advanced.
- Tumours that can be completely removed by surgery (resectable) have a more favourable prognosis.
- Tumours that cannot be removed by surgery (unresectable) have a poorer prognosis.
- People with unresectable bile duct cancers and symptoms like weight loss, nausea, buildup of fluid in the abdomen (ascites) and a poor performance statusperformance statusThe measure of how well a person is able to perform ordinary tasks and carry out daily activities. usually have a poor prognosis.
The stage of extrahepatic bile cancer is an important factor in determining the outcome.
- Tumours that are confined to the bile duct have the most favourable outcome.
- Tumours that have spread into nearby lymph nodes have a less favourable prognosis.
Location of the tumour
Tumours located in the distal third of the bile duct (the third closest to the small intestine) have a favourable prognosis, especially if they can be completely removed by surgery. Tumours in the distal part of the bile duct can be easier to remove with surgery than those higher up the bile duct, closer to the liver.
Type of tumour
Some types of extrahepatic bile duct tumours have better outcomes than others.
- Papillary adenocarcinoma of the bile duct has a slightly more favourable prognosis than other types of extrahepatic bile duct cancers.
- Small cell carcinoma and undifferentiated carcinoma of the bile duct often have a poorer prognosis. This is because they are often high-grade tumours.
Extrahepatic bile duct cancers that are slow growing (low grade) have a more favourable prognosis than high-grade cancers.
Perineural invasion means that the cancer has grown along the nerves. Extrahepatic bile duct cancers with perineural invasion are associated with a less favourable prognosis.