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| Cholangiocarcinoma, Causes, Diagnosis, Treatment, Prevention, Complications |
Bile duct cancer or cholangiocarcinoma is a cancer that occurs in the bile ducts. This bile duct cancer will cause symptoms of jaundice, although at first it does not cause symptoms.
Cholangiocarcinoma is a rare disease and usually affects people over the age of 50. The cause is unknown, but this condition is known to be more at risk for people with bile duct disorders and people with liver disease.
Types of Cholangiocarcinoma
Based on the location of the appearance of cancer, cholangiocarcinoma can be divided into three types, namely:
- Intrahepatic cholangiocarcinoma, which is cancer of the bile ducts in the liver
- Distal cholangiocarcinoma, which is cancer that arises in the bile ducts near the small intestine
- Klatskin tumor, which is cancer that arises in the bile ducts that will come out of the liver
Causes of Cholangiocarcinoma
Cholangiocarcinoma occurs due to changes or gene mutations in the tissues that make up the bile duct. Mutations in this gene cause the tissue to grow abnormally. However, the cause of the change in the gene itself is not known for certain.
Although the cause is unknown, there are several conditions that increase a person's risk of developing cholangicarcinoma, including:
- Bile duct disorders from birth, such as bile duct cysts
- Liver disease, such as hepatitis B, cirrhosis, or a parasitic infection of the liver
- Primary sclerosing cholangitis (PSC), which is an autoimmune disease that causes narrowing of the bile ducts
- Age 50 years and over
- Smoking habit
- Chronic diseases, such as diabetes
- Obesity
Symptoms of Cholangiocarcinoma
Early-stage cholangiocarcinoma usually causes no symptoms. New symptoms appear when the cancer tissue has enlarged.
Patients with bile duct cancer may experience different symptoms, depending on the initial location of the cancer. In general, the symptoms of this disease include:
- Symptoms of jaundice, such as yellowish skin and eyes, itching, dark urine, and pale stools
- Stomach pain that can spread to the back
- Fever
- Weak
- Weight loss
When to go to the doctor
Immediately consult a doctor if you experience symptoms of bile duct cancer, such as jaundice, to get the right treatment.
In addition, make regular check-ups with your doctor if you have diabetes or hepatitis B, so that treatment and disease progression can be monitored. Both of these chronic diseases are thought to be at risk of causing bile duct cancer.
If you are at risk of developing hepatitis B, for example because you work as a medical officer, then you need to consult a doctor to get the hepatitis B vaccine.
Cholangiocarcinoma diagnosis
To diagnose cholangiocarcinoma, the doctor will ask the patient's symptoms and medical history, followed by a physical examination.
If the patient is suspected of having bile duct cancer, the doctor will perform further examinations to confirm the diagnosis, including:
- Scan with ultrasound, CT scan, or MRI, to see abnormal conditions of the bile ducts
- Endoscopic retrograde cholangiopancreatography (ERCP) or a combination of endoscopy with X-rays of the bile ducts, to examine the bile ducts in more detail
- Percutaneous transhepatic cholangiography (PTC), to see the bile ducts in more detail with the catheterization method
- Biopsy, by taking a sample of bile duct tissue for examination in the laboratory
- Blood tests, to check levels of tumor markers CA 19-9 and liver function
Cholangiocarcinoma stage
After establishing a diagnosis, the doctor will determine the stage of bile duct cancer suffered by the patient to determine treatment. The staging of bile duct cancer is as follows:
Stage 1
At this stage, the cancer tissue is still small and is only found in certain parts of the bile duct.
Stage 2
At this stage, the cancerous tissue has begun to enlarge and can spread to the tissues around the bile duct.
Stage 3
At this stage, the cancer tissue has spread to the lymph nodes around the cancer.
Stage 4
At this stage, the cancer tissue has spread to other organs (metastasize).
Cholangiocarcinoma Treatment
Treatment of bile duct cancer aims to overcome the symptoms that arise and cure the cancer. Cholangiocarcinoma that is diagnosed and treated early has a greater chance of recovery. The following are some treatment options for treating cholagiocarcinoma:
Operation
The main method of treatment of cholangiocarcinoma is surgery. Some of the types of surgery that patients can undergo are:
- Laparoscopy
- Laparoscopy is a surgical method performed using a laparoscope to remove as much cancerous tissue as possible.
- biliary drainage
- This method is performed with bypass surgery to restore fluid drainage from the bile ducts that have been disrupted by cancer.
- Installation of rings (stents)
- This surgery aims to maintain the flow of bile by widening the bile ducts that are narrowed by cancer.
- Liver transplant
- Liver transplant is done by taking the patient's liver and replacing it with liver from a donor. This procedure is performed on cholangiocarcinoma located in the liver.
If the cancer has entered an advanced stage and has spread to surrounding tissues, surgery is performed not only to remove the cancerous tissue, but also part of the gallbladder and duct, pancreas, and part of the intestine. This procedure is known as Whipple surgery.
Radiotherapy
To help kill cancer cells that are not surgically removed, patients may undergo radiotherapy. Radiotherapy is done with high-energy light technology to kill cancer cells.
Chemotherapy
Chemotherapy can also be done to kill cancer cells through drugs, such as cisplatin, fluorouracil, gemcitabine, or oxaliplatin. Radiotherapy and chemotherapy can be combined to increase the effectiveness of cancer treatment, especially if the cancer has spread.
Supporting drugs
The doctor will also give drugs to relieve the patient's symptoms, such as morphine to relieve pain.
After treatment, patients still need to have regular check-ups through scans and laboratory tests, so that the development of the condition and side effects of treatment can be monitored.
If the cancer is declared calm, the doctor will recommend regular checkups every 6 months, for several years after treatment is complete.
Cholangiocarcinoma complications
Several complications can arise in cholangiocarcinoma due to blockage of the bile duct by cancer tissue. These complications include:
- Bile tract infection
- Cirrhosis
Cholangiocarcinoma Prevention
Because the cause is not known with certainty, bile duct cancer is difficult to prevent. However, there are several efforts that can be made to reduce the risk of developing cholangiocarcinoma, namely:
- Get the hepatitis B vaccination to prevent hepatitis B
- Undergo regular blood sugar control with a doctor if you have diabetes
- Quit smoking
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