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Bile duct cancer

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Treatment of unresectable extrahepatic bile duct cancer

The following are treatment options for unresectable extrahepatic bile duct cancer. The types of treatments given are based on the unique needs of the person with cancer.

Unresectable extrahepatic bile duct cancer cannot be completely removed by surgery. It includes stage III and IV perihilar bile duct tumours and stage III and IV distal bile duct tumours. Unresectable extrahepatic bile duct cancer has spread too far outside the bile duct or the cancer is in a place that makes it too difficult to remove with surgery, for example:

  • Cancer is in the liver and a liver resection cannot remove it all.
  • Cancer is in the hepatic artery or portal vein (vascular invasion) and cannot be completely removed.
  • The cancer has spread to several places (metastatic disease).

Palliative surgery or procedures

If the person with extrahepatic bile duct cancer is not well enough to have an operation or doctors think that the cancer cannot be removed by surgery, then treatment is aimed at relieving signs and symptoms, such as:

  • jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow. – occurs when cancer blocks the bile duct and stops the flow of bile
  • pain and inflammation of the bile ducts (cholangitis) – caused by a tumour blocking the bile duct
  • abdominal pain – caused by cancer in the liver or other organs or structures in the abdomen

Palliative surgery or procedures may include:

  • placing a small wire or plastic tube (stent) to keep the bile duct open and drain the liver
  • inserting a tube (catheter) to help drain bile
  • doing a biliary bypass to change the flow of bile


Chemotherapy is used for people with unresectable or metastatic extrahepatic bile duct cancer if they are well enough to tolerate this treatment. Chemotherapy drugs called radiosensitizers may also be combined with radiation therapy to make the cancer cells more sensitive to the effects of radiation.

Radiation therapy

External beam radiation therapy may be offered for some cases of unresectable extrahepatic bile duct cancer.

Brachytherapy may also be offered in some situations for unresectable extrahepatic bile duct cancer to shrink the tumour and improve bile drainage. It may be used in combination with external beam radiation therapy.

Liver transplant

When a perihilar bile duct cancer cannot be completely removed but has not spread outside the liver, a liver transplant may be an option for a select number of people. However, it is rarely done.

Clinical trials

People with extrahepatic bile duct cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.


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