According to the American Cancer Society, ACS, for treatment purposes, bile duct cancers are classified into resectable cancers or non-resectable cancers. According to the National Cancer Institute, NCI, the majority of bile duct cancers are non-resectable at initial findings. End stage bile duct cancer is usually non-resectable with or without spread to distant sites like the lungs or bones. Treatment options are mainly geared towards prolonging life and relieving pain and discomfort.
Surgery
According to the ACS, typically surgeons avoid surgery in end stage bile duct cancer, but it can help to relieve obstructive symptoms. Obstruction of the bile duct, with the symptoms of itching and jaundice, is relieved by placing a drain in the bile duct to ensure continuous drainage of bile. This occurs by using open abdominal surgery, by way of an endoscope passed through the mouth or by passing a needle through the skin and liver to get to the bile duct. If the patient was already undergoing surgery when the cancer was discovered, a biliary bypass could be done during the same surgery.
Radiation Therapy
Radiation therapy with or without chemotherapy can shrink the cancer or slow its spread for a while, says the ACS. External beam radiation also serves this purpose. Internal radiation therapy or brachytherapy can open up a blocked bile duct. Here, radioactive seeds or wires are inserted into the lumen of the bile duct for a time to open up the bile duct and promote the flow of bile. According to the ACS, radiation therapy can also control severe pain from spread of cancer to the liver.
Chemotherapy
Drugs can slow the growth of the cancer or shrink it. Physicians frequently combine chemotherapy with radiation therapy in end stage cancer management. According to American Society of Clinical Oncology, ASCO, drugs used in chemotherapy here include 5-Flourouracil, gemcitabine, doxorubicin and cisplatin.
Photodynamic Therapy
Another way to relieve biliary obstruction in end-stage bile duct cancer includes photodynamic therapy, says the ACS. Here, a light sensitive drug is injected into the blood stream, and then a special light source is introduced into the bile duct to activate the chemical within the bile duct, killing off the cancer cells and creating a passage for drainage of bile.
Other Therapies
Tumors within the liver can be treated with heat therapy or radiofrequency ablation and cryotherapy or freezing. Alcohol injection proves another option mentioned by the ACS, for treating the painful symptoms of liver involvement.
Opioid analgesics like morphine and methadone can also relieve the severe pain seen in end-stage bile duct cancer. The ACS recommends that patients and their families inform the doctor of any form of discomfort or pain so that they can address it as priority in patients with end stage bile duct cancer.
