Supportive care for bile duct cancer

Supportive care helps people meet the physical, practical, emotional and spiritual challenges of bile duct cancer. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from bile duct cancer and adjusting to life after treatment is different for each person, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for bile duct cancer may have the following concerns.

Pain can happen with bile duct cancer or its treatment. People may experience pain because the tumour grows into surrounding nerves and organs, such as the liver, gallbladder, pancreas or small intestine. The tumour can also block the bile duct and prevent bile from draining properly.

The amount of pain often increases as the cancer advances.

Pain may be treated in many ways:

• Radiation therapy may be helpful for people with advanced bile duct cancer. It may help to shrink tumours that are pressing on nerves or other organs.
• Palliative surgery or procedures are used to relieve pain and restore the flow of bile if a tumour blocks the bile duct. This may include a biliary bypass or inserting a biliary stent or catheter.
• Pain-relieving medicine may be needed, especially with advanced bile duct cancer.
• An alcohol injection may be used to help relieve pain. Alcohol is injected into or around the nerves (nerve block) that carry sensations of pain from the bile duct and abdomen area to the brain. The alcohol helps deaden the nerves and relieve pain.

Jaundice causes yellowing of the skin and whites of the eyes, dark yellow urine, severe itching (pruritus) and pale-coloured stool. It can happen with extrahepatic bile duct cancer. When a bile duct tumour blocks the bile duct or spreads to the liver, then bile cannot drain properly. As bile builds up in the blood and the skin, it causes jaundice.

 Surgery or other procedures may be used to relieve an obstruction in the biliary tract:

• inserting a small metal or plastic tube (stent) to keep the bile duct open
• inserting a biliary drainage tube (catheter) to help drain bile
• doing a biliary bypass to create a route for bile to drain around the blockage

Itching may be relieved by:

• anti-itch medicines, including oral antihistamines
• cholestyramine (Questran), a drug that binds with bile salts in the body so they can be excreted
• creams or lotions applied to the skin (topical), including corticosteroid cream, calamine lotion or antihistamine cream
• using mild soap and applying moisturizing lotions after a bath
• using an oil or oatmeal bath mixture
• not wearing wool clothing or synthetic fabrics that can irritate the skin
• wearing loose-fitting clothing
• keeping the environment humid and cool

As bile duct cancer progresses, people can lose their appetite, and loss of appetite can cause a person to lose weight. Jaundice may cause changes in taste, which can also affect a person’s appetite. Nausea and vomiting can also affect appetite.

Eating small amounts of high-calorie foods, having smaller, more frequent meals and taking nutritional supplements can be helpful. Antinausea drugs can be used to control nausea and vomiting. Cold foods may be easier to eat, and using plastic cutlery can help if foods have a metallic taste. The doctor may order medicines to help increase appetite.

Cholangitis is inflammation of the bile duct. It can happen when a tumour grows and blocks a biliary stent. Cholangitis can cause fever, chills and other signs of infection. The bile duct has to be cleared and drained, so a blocked stent is often removed and replaced, if possible. Antibiotics may be taken to treat infection.

A liver abscess is a pus-filled area in the liver that causes swelling. A liver abscess can occur if the bile ducts become blocked. Fever, chills, constant pain and jaundice that comes back may indicate a liver abscess. The doctor may need to drain the abscess and may prescribe antibiotics.

Liver failure can happen when the bile ducts are blocked. You may have jaundice, abnormal liver function tests, bleeding or abdominal pain or swelling. Doctors may try to relieve the blockage. Supportive measures are used to make the person as comfortable as possible.

People with a biliary stent or catheter need to know the symptoms that may indicate that the stent or catheter has become blocked. These symptoms include changes in stool or urine colour, jaundice, itching and nausea. These should be reported to the doctor.

If a biliary catheter drains the bile into a bag outside the body, the person is taught how to take care of the catheter and the skin around it and how to drain the bag.

People with advanced bile duct cancer are offered palliative care. This focuses on making the person as comfortable as possible, relieving symptoms, providing support and improving or maintaining the person’s quality of life.

See a list of questions to ask your doctor about supportive care after treatment.