Treatments for unresectable bile duct cancer

Unresectable means that the cancer cannot be completely removed with surgery. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Most stage 3 and all stage 4 bile duct tumours cannot be completely removed with surgery. This is because the cancer has spread too far outside the bile duct or it is in a place that makes it too difficult to remove with surgery. For example:

• Cancer is in the liver and it cannot be completely removed.
• Cancer is in the blood vessels of the liver (vascular invasion) and it cannot be completely removed.
• The cancer has spread (metastasized) to other places.

The following are treatment options for unresectable bile duct cancer.

If you are not well enough to have surgery or if the doctor thinks that the cancer cannot be completely removed with surgery, then treatment may be given to relieve these symptoms of bile duct cancer:

• jaundice
• pain and inflammation of the bile ducts (cholangitis)
• pain in the abdomen

Palliative surgery or procedures may include:

• placing a small wire or plastic tube (stent) to keep the bile duct open and allow the flow of bile
• 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 bile duct cancer if they are well enough to cope with this treatment.

Radiation therapy uses high-energy rays or particles, such as x-rays or gamma rays, to damage or destroy cancer cells. Bile duct cancer is usually treated with external beam radiation therapy. A machine directs radiation through the skin to the tumour and some of the tissue around it.

External beam radiation therapy may be given in the same time period as chemotherapy to treat advanced unresectable bile duct cancer.

For some people who have an unresectable perihilar bile duct cancer that has spread to the liver, removal of the liver (complete hepatectomy) and a liver transplant may be an option. During a liver transplant, the diseased liver is removed and replaced with a healthy liver from an organ donor. A liver transplant is done only if the cancer has not spread beyond the liver to other organs or lymph nodes.

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). They include chemoembolization, embolization, radiofrequency ablation and microwave ablation.

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.

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