Bile duct cancer is also known as cholangiocarcinoma, and it occurs in the thin pipes (bile ducts) which carry bile between the liver and the Gallbladder and it works its way to the small intestine. It is difficult to treat and progressive and is usually detected late.
Best hospitals for bile duct cancer in India
Artemis Hospital, Gurgaon
Medanta-The Medicity, Gurgaon
Fortis Memorial Research Institute, Gurgaon
Max Hospital, Saket
Bile duct cancer treatment in India
Surgery (Curing Alternative on Early Stage)
When early detection is made and when the tumor has not spread, surgery could occur.
Bile Duct Resection-removal of the affected part of the bile duct.
Hepatectomy -part of the liver is removed (in the case of intrahepatic tumors).
A Whipple Procedure (Pancreaticoduodenectomy) can be done in the case of distal bile duct cancer.
Liver Transplant- in some cases with unresectable perihilar cholangiocarcinoma.
Guidance can be a worst-case treatment but very few patients can receive the care.
Liver Transplant
Taken into consideration when the patients have perihilar bile duct cancer that is not removable surgically.
Most often used with chemoradiation prior to transplant in order to enhance results.
Chemotherapy
Was used after surgery as adjuvant, before surgery as neoadjuvant, or in advanced disease.
Combinations of chemotherapy: Gemcitabine with Cisplatin (standard first-line).
Alternative treatment: 5-FU, Capecitabine, Oxaliplatin.
Radiation Therapy
External Beam Radiation (EBRT): the rays are directed on the tumor.
Brachytherapy: insertion of toxic radioactive matter into the hepatic ducts.
Locally treated, used during palliation, or as part of chemotherapy.
HER2-directed treatment- of HER2-positive patients.
Immunotherapy
Checkpoint inhibitors (Pembrolizumab, Nivolumab, Durvalumab) -Any tumor which is either MSI-H/dMMR or PD-L1 positive.
Is also used together with chemotherapy in advanced stages.
Supportive and Palliative Treatments
In advanced or unresectable disease
Biliary Stenting / Bypass Surgery –Treats jaundice and improves the quality of life.
Pain and supportive care.
Alimentary supplements in order to keep strong.
Bile duct cancer surgery in India
Aim of surgery
The only potentially curative treatment of the bile duct disease is surgery. It is provided, on condition that it is not, so to speak, strictly exact.
The cancer is localized (has not spread so much).
Major surgery is possible due to the general health and the liver function of the patient.
Due to late diagnoses of the cancer of the bile ducts, only 20-30 percent of the patients can undergo surgery.
Types of Surgery
When you have cancer of the bile duct, surgery is usually used together with other treatments.
Biliary Removal
Resection of the affected part of the bile duct.
The other bile ducts are joined again to the small intestines.
Only for small and localized tumors.
Liver Resection (Hepatectomy)
Surgical removal of a portion of the liver as well as of the biliary duct.
May contain regional lymph nodes
Application intrahepatical cholangiocarcinoma or when tumor extends to the liver.
Whipple Surgery (Pancreaticoduodenectomy)
Excision of the distal bile duct, some part of the pancreas, gall-bladder, part of the stomach and small intestine.
In very small bile duct tumors (close to pancreas).
Surgery that can be curative when there is no spread of the cancer but major.
Liver Transplant
To surgically remove patients with perihilar bile duct cancer (Klatskin tumor) whose cancer cannot be removed.
Usually needs pretreatment with chemoradiation to manage disease.
In limited areas.
Top bile duct cancer specialists in India
Dr. Giriraj Bora
Dr. Arvinder Singh Soin
Dr. Adarsh Chaudhary
Dr. Vinod Raina
Dr. Amit Javed
Dr. Subhash Gupta
Advanced bile duct cancer care in India
This is the brief detail on the advanced care of Bile Duct Cancer (Cholangiocarcinoma) Treatment when the cancer is not removable or when it becomes spread:
Bile Duct Cancer Challenges in Advanced Medical scenarios
Resulting to late diagnosis because of vague symptoms.
Surgery is normally out of the question
Objective: to prolong survival, symptom control and quality of life.
Systemic Therapies
Chemotherapy (Adjuvant Standard)
Gemcitabine + cisplatin: most frequently used, leads to increased survival rate, compared to gemcitabine on its own.
In some cases stacked with the addition of Durvalumab (immunotherapy) as of new clinical research trials.
Second-line Chemotherapy
On a regimen of FOLFOX chemotherapy (5-FU, leucovorin, oxaliplatin).
Capecitabine-based regimens.
Personalized Treatment
It is vital to profile the tumor at the molecular level. Highly aggressive bile duct cancer cancers can possess mutations that can be targeted
MSI-H (Microsatellite Instability-high) is present in tumor.
MMR-(Mismatch Repair Deficient).
Between 10-3% and 90-2% of the PD-L1 expression.
Radiation Therapy
External Beam Radiation (EBRT) → it checks the proliferation of the tumor, reduces pain, and assists in local disease.
Internal radiation according to stents.
It is highly used as palliative as opposed to curative.
Supportive and Palliative Care
To alleviate symptoms and quality of life:
Biliary stenting or drainage - alleviates the jaundice itch caused by the biliary system talking bile ducts.
Pain management - opioids, nerve blocks.
Nutritional therapy --> controlling weight loss and hepatic management.
Psychological & palliative care support
Clinical Trials
New drugs (new immunotherapies, vaccines, CAR-T therapies) are under experimental trials.
Patients with bile duct cancer that has advanced might be helped to enroll to trials at specialized cancer instances.
Affordable bile duct cancer treatment in India by GetWellGo
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