Treatments for bile duct cancer
If you have bile duct cancer, your healthcare team will create a treatment plan just for you. It will be based on your health and specific information about the cancer. When deciding which treatments to offer for bile duct cancer, your healthcare team will consider:
- whether the tumour can be completely removed with surgery (is resectable) or cannot be completely removed (is unresectable)
- the stage of your cancer
- your overall health
In the early stages of bile duct cancer, complete removal of the tumour with surgery is the only treatment that offers a chance for a cure. But usually in an advanced stage, the cancer cannot be fully removed with surgery. Chemotherapy and chemoradiation may be given to slow down the spread of cancer and prolong life. Palliative treatment may also be used to relieve symptoms. Intrahepatic bile duct cancers are treated more like liver cancer.
You may be offered the following treatments for bile duct cancer.
Surgery is the most effective treatment for bile duct cancer. The type of surgery depends on the location, size and spread of cancer in your body. If your bile duct cancer is found early, in stage I or stage II, then it is usually possible to completely remove the cancer with surgery. In stage III cancer, it may still be possible to remove the tumour along with the lymph nodes where the cancer has spread. But often, bile duct cancer is found at an advanced stage and cannot be completely removed with surgery. In stage III cancer where the tumour cannot be fully removed with surgery and in stage IV cancer, you may need a different kind of surgery to remove a blockage of bile flow.
Surgery may include removing the part of the bile duct with the cancer and some nearby tissue. Surgery may include:
- removal of a part or all of the liver (hepatectomy) for bile duct cancers near the liver or in the liver
- Whipple procedure (pancreaticoduodenectomy) for distal bile duct tumours
- liver transplant
- removal of nearby lymph nodes
Palliative surgery or procedures may be done to relieve symptoms of advanced bile duct cancer. If the tumour is blocking the bile duct, surgery is done to place a stent in the bile duct or to make a bypass. This will allow the bile to flow, and it will treat or prevent jaundice due to the blockage.
Chemotherapy is used to relieve symptoms of bile duct cancer that cannot be removed with surgery. Chemotherapy is sometimes given after surgery to kill any cancer cells that remain (called adjuvant therapy).
Chemoradiation may be an option for some people. Chemotherapy and radiation therapy are given in the same time period after surgery to kill any cancer cells that remain or to treat advanced cancer. In chemoradiation for bile duct cancer, radiation therapy is combined with 5-fluorouracil (Adrucil, 5-FU).
Locoregional therapies are treatments given close to or directly into the tumour. These may be used in intrahepatic bile duct cancer that cannot be fully removed with surgery (is unresectable). These therapies include chemoembolization, embolization, radiofrequency ablation and microwave ablation.
If you can’t have or don’t want cancer treatment
You may want to consider a type of care to make you feel better without treating the cancer itself. This may be because the cancer treatments don’t work anymore, they’re not likely to improve your condition or they may cause side effects that are hard to cope with. There may also be other reasons why you can’t have or don’t want cancer treatment.
Talk to your healthcare team. They can help you choose care and treatment for advanced cancer.
Follow-up after treatment is an important part of cancer care. You will need to have regular follow-up visits, especially if you have had surgery. These visits allow your healthcare team to monitor your progress and recovery from treatment.
Some clinical trials in Canada are open to people with bile duct cancer. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.
Questions to ask about treatment
To make the decisions that are right for you, ask your healthcare team questions about treatment.
A surgical procedure to remove all or part of the pancreas along with part of the stomach, the duodenum, the gallbladder and part of the bile duct. The remaining bile duct is attached to the small intestine.
Also called pancreaticoduodenectomy.
A procedure to reduce or block the main blood supply to a tumour and deliver chemotherapy drugs directly to the tumour.
Chemoembolization uses a synthetic blood vessel blocker mixed with chemotherapy drugs.
A procedure that blocks or slows down the blood supply to tissues or an organ.
Embolization can be used to block the flow of blood to a tumour so the cancer cells die.
A procedure that removes or destroys cells, tissues or organs.
Ablation may be done by surgery, radiation, chemicals, heat, high-frequency electrical current, radiofrequency waves, lasers or other methods.