February is Bile Duct Awareness Month. If you are like me, you probably don’t know where the bile ducts are, let alone the signs and symptoms of this rare cancer. I sat down with Dr. Steven Cohen to get up-to-speed. Dr. Cohen is Chief of Medical Oncology, Sidney Kimmel Cancer Center at Abington-Jefferson Health and Vice-Chair of Medical Oncology at Thomas Jefferson University.
Where are our bile ducts?
The bile ducts are tubes which carry bile from the liver to the intestine. Several conditions can cause blockage of the bile ducts which results in jaundice (yellowing of the eyes or skin). This could include benign conditions such as gallstones or gallbladder inflammation, or malignant conditions such as cancers of the biliary system (bile ducts or gallbladder) or pancreas.
What are the risk factors for bile duct cancer?
Risk factors for bile duct cancers can include gallstones and chronic inflammation, autoimmune diseases, chronic hepatitis, or less common infections. There is an increased risk as we age, as well as in people with chronic inflammatory bowel disease. Bile duct cancer can also be increased in people with family histories of this cancer or other related malignancies
What are the symptoms or warning signs of bile duct cancer?
Cancers of the bile ducts can often present with jaundice due to a tumor blocking the flow of bile. Tumors that begin in the gallbladder or in the bile ducts within the liver can cause pain in the right side of the abdomen, nausea, or decreased appetite and unintentional weight loss. If the tumor spreads or metastasizes to other parts of the body, it can cause symptoms in the affected organ such as more diffuse abdominal pain or pain in the chest.
What would patients consider when choosing a cancer center or physician to treat bile duct cancer?
Cancers of the bile ducts are relatively rare, with less than 10,000 cases a year. This compares to approximately 150,000 cases of colorectal cancer a year. As a relatively rare tumor, it is important to have a treatment team with experience in management.
For localized tumors, surgery is often an initial consideration. However, due to the location of these tumors near (or in) the liver, pancreas, and small intestine, receiving an opinion and treatment at a center with experience is critical in determining if surgery is the proper approach and to have it performed safely.
For tumors which are inoperable either due to local extension or distant spread, systemic chemotherapy is often recommended. There are an increasing number of clinical trials which can be considered for these tumors, with some dependent on particular gene features found with molecular profiling.
Finally, radiation therapy can be utilized for localized tumors which due to their location are not able to be surgically removed.
Given the rarity of this tumor type and nuances of management, receiving an opinion with a high volume experienced center and provider is particularly important.