Bile Duct Cancer Treatment - Surgery Success Rate, Recovery

To treat bile duct cancer, different types of doctors work together to create a good and compatible treatment plan for the patient. This team of doctors are generally referred to as a multidisciplinary team. This team also includes varieties of other healthcare professionals like physicians, oncology experts, pharmacists, and dieticians.

The patient's cancer care plan may also include treatments for possible side effects and complications after the therapy. The most common types of treatments used in treating bile duct cancer are Radiation therapy, Surgery, Chemotherapy, Targeted drug therapy, Immunotherapy, and Palliative therapy. The treatment approach used for bile duct cancer depends upon the following factors:

1. The location of the tumour in the bile duct, means whether the tumour is present in the upper or lower part of the bile duct. 
2. The treatment option is also based on the stage of cancer. The primary stage can be cured by surgery, and for the secondary staged cancer, other treatment approaches may be used. In the second stage, cancer has also been spread to the other body parts.
3. It is checked whether or not cancer can be removed by surgery. If surgery cannot remove it, other methods are used to cure it.
4. Whether cancer in the person is diagnosed for the first time or has a history of cancer
5. Presence of other medical conditions like Sclerosing cholangitis (in this disease, there is inflammation in the bile duct)

The various treatment Options for Bile Duct Cancer include: 

Surgery

1. Treating bile duct cancer by surgery means removing the tumours by making an incision. It also includes the removal of some healthy tissues around the tumour. It is done to prevent the further spreading of the tumour.
2. This surgery can be performed either by an oncologist or a hepatobiliary surgeon. The difficulty of the surgery depends upon the location of the surgery.
3. The effectiveness of the surgery may vary due to the size of the tumour and the stage of cancer. If the tumour is in metastatic form (spread to other body parts), then surgery is not the best option that should be used.

Some standard surgical procedures that are used for treating bile duct cancer are:

1. Whipple Procedure: It is performed to manage the extrahepatic bile duct cancer near the pancreas. The procedure is also known as a pancreaticoduodenectomy. It involves the removal of a part of the pancreas, bile duct, small intestine and stomach, gallbladder, and nearby lymph nodes. 
2. Bile Duct Removal: All surgical procedures are done under the influence of general anaesthesia. Therefore, the patient will not feel any pain during the procedure. During this procedure, the surgeon removes the entire bile duct. This option is used only if cancer has not spread outside the bile duct. The lymph nodes (the small bean-like organ that helps the body fight against infections.) may also be removed to check the spread of cancer in it.
3. Partial Hepatectomy: This procedure is used when the cancer is near the liver and some areas of the bile duct. The affected portion of the liver and bile duct is removed by surgery. In most cases, the person's liver returns to its standard shape in size after a few weeks.
4. Liver Transplant: In this, the surgeon completely removes the patient's liver and then replaces it with a donor's liver. This process is rarely used. It is used only when the cancer is detected in an early stage.
5. Palliative Surgery: This treatment is used in cases where cancer has been spread to such an extent that it cannot be obliterated. This surgery prevents complications caused by cancer prognosis, like a blockage in the bile duct due to increased inflammation. Palliative surgery includes the following procedures:
   1. Biliary bypass: During this procedure, the surgeon creates a new route that bypasses the part of the bile duct blocked by cancer. 
   2. Endoscopic Stent Replacement: The surgeon places a stent in the bile duct, which is blocked due to cancer, to keep it open. 
   3. Percutaneous Transhepatic Biliary Drainage: The surgeon locates the area of fluid accumulation in the bile duct through an X-ray. Percutaneous transhepatic biliary drainage is then performed to drain the fluid and relieves pressure.

Radiation Therapy

This method uses high-energy radiation to cure cancer in the bile duct. It is a less used treatment method used in the case of bile duct cancer. During internal radiation therapy, radioactive material is placed in a catheter or other device and implanted near the cancerous tissues.

External Beam Radiation Therapy (EBRT) is a type of therapy in which a machine aims the radiation on a specific part of the organ having tumours, and the tumours get destroyed. Some ways in which External Beam Radiation Therapy (EBRT) can be given are:

1. Three-Dimensional Conformal Radiation Therapy (3D-CRT): A particular computer is used to locate the tumour. Then the radiation beam is shaped according to the tumour and is aimed at the tumour from several directions. It reduces the damage to healthy tissues.
2. Intensity-Modulated Radiation Therapy: It is an advanced version of 3D-CRT. It is the same as 3D-CRT, but the radiation intensity changes continuously.
3. Targeted Drug Therapy: The principle of targeted drug therapy is that it targets the specific part of the cancer cells. A particular type of protein is found in cancerous cells targeted by drugs like pemigatinib and Ivosidenib. Ivosidenib blocks the growth of proteins responsible for the normal development of the cells. Pemigatinib blocks the action of the mutated (changed) proteins that cause the cancer cells to mature into normal cells instead of cancerous cells, decreasing the population of tumour cells. 
4. Immunotherapy: This method is also called Biology therapy. In this treatment method, medicines are used to boost the person's immune system. It helps the body fight against cancer more efficiently by recognising and destroying cancerous cells. Different types of immunotherapy have other side effects caused by the drugs used. 
5. Chemotherapy: In this method, the cancer is treated using medicines that kill the cancerous cells. These drugs are taken either by mouth or given by injections. It can also shrink the tumours to make the surgery possible. In some cases, medicines must be delivered directly to the bile duct. It can be shown in the following ways:
6. Systemic Chemotherapy: It involves the administration of the drug in the blood that travels throughout the body along with the bile duct, which is affected by cancer.
7. Regional Chemotherapy: During regional chemotherapy, the chemotherapeutic drugs are directly administered to the area of the bile duct affected by cancer.
8. Hepatic artery infusion: A pump is implanted in the hepatic artery using a surgical method. This pump injects the chemo(medicine) into the artery that brings the blood to the liver.
9. Trans-arterial chemoembolisation (TACE): This method includes implanting tiny beads of chemo (medicines) in the artery that delivers blood to the tumours. For placing these beads, a catheter is used. These beads block the blood vessel and prevent blood supply to the tumours. At the same time, it also releases medicines that shrink the tumours.

Suggested Reads:

1. Bile Duct Cancer
2. Bile Duct Cancer Symptoms - Starting and Last Stage 4
3. बाइल डक्ट (पित्त वाहिनी) कैंसर - लक्षण, कारण, इलाज और बचाव