Bile duct cancer is often in an advanced stage when it is diagnosed, requiring rapid intervention by a group of specialists experienced in treating the disease. The multidisciplinary team at City of Hope includes medical experts from the departments of General Oncologic Surgery, Medical Oncology and Radiation Oncology.

Surgery
Surgery is the primary treatment used for localized tumors. When applicable, our specialists perform minimally invasive surgery (MIS) with advanced technologies such as laparoscopy and a robotical da Vinci S Surgical System that allows for greater precision. These surgeries feature small incisions and potentially:

    • less blood loss, pain and visible incisions
    • shorter hospital stay and recovery time
    • fewer complications and quicker return to normal activities

One of the following surgical procedures may be used to treat bile duct cancer:

• Bile Duct Removal If the tumor is small and only in the bile duct, the entire bile duct may be removed. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes are removed and viewed under a microscope to see if they contain cancer.
• Partial Hepatectomy Removal of the part of the liver where cancer is found. The part removed may be a wedge of tissue, an entire lobe, or a larger part of the liver, along with some normal tissue around it.
• Whipple Procedure A surgical procedure in which the head of the pancreas, the gallbladder, part of the small intestine, the bile duct and occasionally part of the stomach are removed. Enough of the pancreas is left to produce digestive juices and insulin.
• Surgical Biliary Bypass If the tumor cannot be removed but is blocking the bile system and causing bile to build up in the liver, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be connected with the small intestine to create a new pathway around the blocked area. This procedure helps to relieve jaundice caused by the build-up of bile.
• Stent Placement If the tumor is blocking the bile duct, a stent (a thin tube) may be placed in the duct to drain bile that has built up in the area. The stent may drain to the outside of the body or it may go around the blocked area and drain the bile into the small intestine. The doctor may place the stent during surgery or percutaneous transhepatic cholangiography, or with an endoscope.

Chemotherapy
Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat primary and metastatic bile duct cancer. City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.

As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.

Radiaton
Radiation therapy uses energy beams to kill cancer cells. Specialists in the Department of Radiation Oncology have developed highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing unnecessary exposure of healthy tissues. Therapeutic procedures include:

• Radiation implants (brachytherapy)
• Intraoperative radiation
• Intensity-modulated radiation therapy