What is Cholangiocarcinoma?
What is Cholangiocarcinoma? Cholangiocarcinoma or bile duct cancer is a cancer cell that grows in the bile ducts. The function of the bile duct itself is to collect and drain fluid from the liver and gallbladder to the small intestine, in order to digest fats in the diet.
Cancer of the bile ducts can occur in any part of the bile ducts. Cancer that appears in the bile duct in the liver is called intrahepatic cholangiocarcinoma. These cancers are sometimes classified as liver cancer. While the cancer in the bile ducts outside the liver organ is called cholangiocarcinoma or perihilal cholangiocarcinoma. Cancer of the bile duct can also grow under the bile duct near the small intestine and is referred to as distal cholangiocarcinoma.
This cancer can penetrate the walls of the bile ducts and attack the surrounding organs or tissues. At a more severe level, the cancer can spread to nearby lymph nodes. When the spread of bile duct cancer reaches other organs in the body, then the condition of this disease has entered the most severe stage. The spread usually occurs in the liver, abdominal cavity wall, or lungs. Although the spread can be very rapid, bile duct cancer including rare occur.
Cancer of the bile ducts can still be cured if diagnosed at an early stage. But if it has entered the stadium further, the disease is increasingly difficult to treat. Symptoms of bile duct cancer usually appear or feel when the cancer is large enough and block the bile ducts.
Symptoms of Cholangiocarcinoma
Symptoms that occur in people with cholangiocarcinoma (bile duct cancer) are:
- Fever with temperature reaching 38 degrees Cesus or more.
- Body feels tired.
- Weight loss and and appetite decreased.
- Light colored stools with dark urine.
- The stomach becomes swollen and painful.
- The skin feels very itchy.
- The color of the eyes and skin becomes yellow.
- Nausea and vomiting.
Causes of Cholangiocarcinoma
Most cholangiocarcinoma (bile duct cancer) can develop without any obvious cause. However, this cancer occurs when cells in the bile ducts have mutations in their DNA. As a result, cells grow out of control and form tumors or cancer cells in large quantities.
Although the exact cause is unknown, some conditions may increase the risk of developing bile duct cancer. These conditions include:
- Abnormalities of bile ducts from birth, such as colcedocyst cysts.
- Liver problems, such as chronic liver disease, parasitic infections of the liver, or biliary stones in the liver.
- Exposure to certain chemicals or toxins, such as thorium dioxide (ThO2).
- Elderly people have a higher risk of bile duct cancer.
- Smoking habit.
Diagnosis of Cholangiocarcinoma
The diagnosis procedure of cholangiocarcinoma (bile duct cancer) includes physical examination and a series of tests. Implementation of these tests include:
- Blood test to see the signs of cancer by examining levels of cancer antigen 19-9 in the blood and liver organ functions.
- Scan tests, such as ultrasound, CT scan or MRI to see abnormal conditions that indicate bile duct cancer.
- Endoscopic retrograde cholangiopancreatography (ERCP) or bile duct endoscopy to check the bile ducts to the small intestine.
- Biopsy by taking samples of biliary tract tissue for examination by microscope.
- Percutaneous transhepatic cholangiography (PTC) to see more detailed bile ducts.
Treatment of Cholangiocarcinoma
Handling cholangiocarcinoma (bile duct cancer) aims to overcome the symptoms that arise and cure the cancer, and as much as possible in the early stages of cancer occurs. The main options for treating bile duct cancer are surgery, including:
- Laparoscopy. Here the doctor will make a small incision in the stomach. The purpose of this procedure is to remove as many cancer cells as possible. In cases of cancer that have entered further severity, in addition to the bile ducts, the doctor may also be forced to remove the gallbladder, lymph nodes, and some liver or pancreas that is around the bile ducts.
- Installation of a tube (stent) that can widen the bile duct and hold the channel open. The purpose of this procedure is to open blockages that occur in the bile ducts. Stent installation is done with endoscope tool.
- Liver transplantation by taking the liver of the patient and replacing it with the liver organ from the donor. This action is done to heal the cholangicarcinoma hilar.
- Biliary drainage by bypass surgery to restore fluid delivery from the bile ducts that are impaired due to cancer.
Another option of bile duct cancer treatment is through treatment to kill cancer cells or slow the progression of cancer cells.
- Radiation therapy. This is a therapy using radiation rays and protons that aim to destroy cancer cells by directing radiation beams to the targeted body area. This therapy can also be done by installing radioactive material in the body near the location of the affected cancer. Some of the side effects that are at risk from radiation therapy are diarrhea, the body feels tired, red skin, and hair loss in the treated area. Usually these side effects will disappear once therapy is stopped.
- Chemotherapy, ie therapy by using drugs to kill cancer cells and can be given before a liver transplant. In addition to killing cancer cells, this therapy can also help reduce the symptoms of cancer felt by the patient. Side effects of this therapy can be hair loss, fatigue, and risk of infection.
- Photodynamic therapy. This therapy aims to overcome the symptoms of cancer and inhibit the growth of cancer cells by injecting chemicals into the veins. After that, laser light irradiation will be done in the hope of triggering a chemical reaction that can kill cancer cells.
In addition to surgery and various therapeutic treatments to kill cancer cells, doctors can also provide opioid drugs (eg morphine) to relieve pain. Although proven to be very effective in relieving pain, the effects of these drugs can make cancer sufferers become persistent drowsiness or addiction.
After the treatment is completed, the patient still needs to undergo periodic checks, as well as the scans and laboratory tests to determine the progress of the condition and the side effects of treatment. For several years after treatment is over, doctors will usually recommend routine checkups every six months.