Mr Charles Imber offers expert abdominal surgery. The operations that he performs can treat a variety of conditions that affect the organs inside the abdomen (pancreas, gallbladder, liver, spleen, small and large intestine) or the abdominal wall (hernias).
If you know what condition you want to find out more about, use the search option below. Alternatively, browse our database using the menu on the right.
Bile duct cancer
Cancers that form in the bile duct are termed cholangiocarcinomas and are relatively rare. About 1,200 people will be diagnosed with bile duct cancer in any 12-month period in the UK. Cholangiocarcinomas produce few symptoms in the early stages and sadly are often diagnosed at a late stage when they have already started to spread.
What does a healthy pancreas do?
Although this type of cancer is rare, there are well-established risk factors. People are more likely to develop bile duct cancer after the age of 65 and if they have:
- A history of bile duct cysts, also called choledochal cysts.
- Chronic gallbladder problems caused by gallstones and have had frequent bouts of gallbladder inflammation (cholecystitis).
- Bile duct cancer in the family.
- Chronic bile duct problems, including bile duct inflammation or blockages.
- Repeated infection of the bile duct by liver flukes (common in Asia).
- A history of primary sclerosing cholangitis (PSC), a condition in which the bile duct becomes narrow because of scar tissue.
- A history of ulcerative colitis, a type of inflammatory bowel disease.
Why is early diagnosis crucial?
Cancer that develops in the bile duct can be very aggressive and is likely to spread to other tissue. It often spreads to the gallbladder, but can invade tissue of the liver and/or the intestine.
Detecting bile duct cancer early can mean it can be treated before it has spread resulting in a higher chance of survival.
Bile duct cancer in its early stages rarely causes any definite symptoms; if it is caught early, it is usually because it is detected during investigation or treatment for gallstones.
Stages of bile duct cancer
When bile duct cancer is detected, investigations are then performed to find out how far it has advanced.
- Stage 1A: The bile duct cancer is still inside the tissue of the bile duct and has not spread through to the outer wall.
- Stage 1B: The cancer has reached the outer wall.
- Stage 2A: The tumour is invading the gallbladder, liver or pancreas.
- Stage 2B: The cancer has invaded the organs mentioned above in stage 2A and has reached some of the nearby lymph nodes.
- Stage 3: The cancer has spread more widely throughout the abdomen, including the blood vessels and lymph nodes.
- Stage 4: There has been further spread to tissue beyond the abdomen.
Symptons
- Jaundice due to a blocked bile duct: This causes the skin and the whites of the eyes to look yellow. It also leads to itchy skin, dark urine and pale stools.
- Nausea and vomiting.
- Bloating and pain in the abdomen, particularly in the upper right-hand side that goes through to the back.
- Loss of appetite.
- Loss of weight.
- Fever and chills.
- Tiredness.
Diagnosis
- Tests to detect the level of bilirubin in the blood.
- CT scanning and ultrasound scanning of the abdomen.
- ERCP or MRCP: Imaging of the bile duct via endoscopy or MRI scanning.
- Percutaneous transhepatic cholangiography (PTCA).
- Biopsy to draw off a sample of fluid and cells from the bile duct.
Treatments
- Surgery to remove the cancer. Small tumours are removed by taking away the bile duct and joining the smaller ducts from the liver directly to the intestine.
- For large tumours surgery may involve liver resection and liver transplant.
- Chemotherapy using gemcitabine and cisplatin.
- Radiotherapy.
- Endoscopy to open the bile duct and to position a stent to prevent jaundice if the cancer has spread too far to be removed by surgery.