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Prognosis and survival for bile duct cancer
If you have bile duct cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history and the type, stage and characteristics of your cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
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. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic factors for bile duct cancer.
Removal of the tumour with surgery
Complete removal of the tumour with surgery offers the best chance for long-term survival for people with bile duct cancer. But for most people, the tumour cannot be completely removed. This is because bile duct cancer is not usually found in its early stages, and many people are not diagnosed until their cancer is too advanced for removal with surgery.
If a tumour can be completely removed with surgery (is resectable), you will have a more favourable prognosis.
People with a tumour that cannot be removed with surgery (is unresectable) and who have symptoms like weight loss, nausea, buildup of fluid in the abdomen (ascites) and a poor performance status usually have a poor prognosis.
Margins in surgery
Margin is the area of healthy tissue surrounding a tumour that is removed along with the tumour during surgery. If cancer cells are found at the edges (outer margins) of this tissue, it is called a positive surgical margin and the prognosis is less favourable. If cancer cells are not found there, it is called a negative margin and the prognosis is better.
The stage of bile duct cancer is an important factor in determining the outcome. Tumours that are in the early stages when the cancer is found have the most favourable outcome. Tumours that are in later stages (they have spread into nearby lymph nodes or organs far from the bile ducts) have a less favourable prognosis.
Location of the tumour
Tumours in the distal 3rd of the bile duct (the 3rd closest to the small intestine) have a favourable prognosis, especially if they can be completely removed with surgery. Tumours in the distal part of the bile duct (close to the small intestine) may be easier to remove with surgery than those closer to or in the liver.
Type of tumour
Some types of bile duct tumours have better outcomes than others. Intraductal papillary adenocarcinoma has a more favourable prognosis than other types of bile duct cancers.
Bile duct cancers that are low grade and slow growing have a more favourable prognosis than high-grade cancers.
Perineural invasion means that the cancer has grown along the nerves. Bile duct cancers with perineural invasion are associated with a less favourable prognosis.
Intrahepatic bile duct tumours that have grown into the blood vessels in the liver have a poor prognosis.
Intrahepatic bile duct tumours that have spread along the bile ducts have a poor prognosis.
The measure of how well a person is able to perform ordinary tasks and carry out daily activities.
Examples of scales used to evaluate performance status include the Eastern Cooperative Oncology Group (ECOG), World Health Organization (WHO) and the Karnofsky performance status scale.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
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