Bile Duct Cancer

Bile is an important digestive juice produced by the liver and stored in the gall bladder. The bile duct is a tube that runs from the liver and the gall bladder to the intestines and transports the bile to the intestines for digestion. Bile duct cancer is the development of tumors in the bile duct that blocks the tube and thus prevents the bile from flowing into the small intestine. Then the active ingredient bilirubin present in the bile begins to accumulate in the blood resulting in jaundice. Apart from jaundice, bile duct cancer may also present with the following symptoms:

• Itching of skin
  
• Light colored stools
  
• Dark urine
  
• Loss of appetite
  
• Abdominal pain
  
• weight loss

Risk factors

People with chronic inflammation of the bile duct have an increased risk of developing bile duct cancer. Bile duct stones, ulcerative colitis and an auto immune disease called primary sclerosing cholangitis (PSC) are some of the conditions that cause inflammation of the bile duct and scarring.

Polycystic liver disease, pancreatitis, irritable bowel syndrome and a congenital defect called Caroli's syndrome may also increase a person's bile duct cancer risks. People of Asian and Middle Eastern countries are prone to parasitic infection with a parasite called liver fluke. It is a water-borne parasite that can infect the bile duct and and cause cancer.

Aging and obesity also fall under the risk factors for bile duct cancer.

Diagnosis of bile duct cancer

Blood tests, diagnostic imaging tests and biopsy are the common methods followed to diagnose bile duct cancer. Blood tests are ordered to evaluate the functioning of the liver and gall bladder. Excess bilirubin in the blood indicates that there may be a problem with the gall bladder, liver or bile ducts. Liver function tests may be conducted to test for albumin, alkaline phosphatase, AST, ALT, and GGT.

Further, imaging tests like ultrasound, MRI, CT scan and Cholangiography are advised to reveal the presence of bile duct blockage and tumor through specialized X-ray images. Cholangiography is a highly sophisticated test that specifically looks into the bile duct to detect abnormalities. Different types of procedures are conducted using Cholangiography such as Endoscopic retrograde cholangiopancreatography (ERCP), Magnetic resonance cholangiopancreatography (MRCP) and Percutaneous transhepatic cholangiography (PTC).

Though imaging tests reveal the presence of tumor in the bile duct, it can only be confirmed through biopsy. Biopsy involves obtaining a small sample tissue from the tumor and examining it under a microscope. Biopsy also identifies the type of the tumor.

Treatment of bile duct cancer

1.Surgery
2.Radiation treatment
3.Chemotherapy
4.Palliative care

Surgery for the bile duct cancer is a complicated procedure due to its location in the body. Moreover surgery as a method of treatment is opted depending upon the location of the tumor and the extent of spread of the cancer. The surgical oncologist chooses to perform surgery only if he thinks the tumor can be removed successfully. In some cases the surgery may allow only a partial removal of the tumor, yet the surgeon may go ahead with the operation with the intention of relieving the patient of the symptoms of cancer and improve the quality of life. Few cases require a placement of metallic or a plastic stent to keep the bile duct open.

When the surgery is not the choice of treatment, oncologists opt for radiation therapy and chemotherapy. Very often, surgery is also followed by radiation therapy and chemotherapy to prevent the cancer from recurring.

Gallstones

The gall bladder is a small pear shaped organ on the underside of the liver that is used to store bile. When partially digested food passes from the stomach into the small intestine, the gall bladder expels bile to aid digestion. While gallstones usually form in the gallbladder; they can be found in bile; in the intrahepatic, hepatic, common bile, and cystic ducts. Cholelithiasis as Gallstones are called, often do not cause any symptoms. Gallstones are hard masses formed in the gallbladder or its associated passages. They are often discovered when having a routine x ray, abdominal surgery, or abdominal ultrasound. Cholangiography - radiographic examination of the bile duct is performed after injecting with a special dye to check the condition of Cholangitis - infection or inflammation of the bile ducts. Cholangitis manifests in the form of severe abdominal pain, fever and Jaundice.

When gallstones move from the gallbladder into the cystic duct of common bile duct (Choledocholithiasis), it can lead to a severe cramping pain in the upper right abdomen which can radiate to the right shoulder as a result of the blocked bile flow. This can last from a few minutes to a few hours. Cholesterol gallstones are more often noticed in women who are obese, on HRT or with elevated blood triglyceride. Black pigment gallstones are usually formed when there is increased destruction of RBC. Others who are likely to suffer gallstones are those suffering liver cirrhosis and biliary tract infections or sickle cell anemia. Gallstones can form when the gallbladder does not empty bile properly. Blood tests to check bilirubin, liver function test and pancreatic enzymes are often ordered. In cases of severe painful episodes, Cholecystectomy is performed.

Gallbladder diet

People suffering from gall bladder disease should follow a low fat diet for healthy living. The bile from the gall bladder is necessary for proper digestion of fats. When there is no bile or not enough bile is produced by the gall bladder, fat from food cannot be properly digested and makes one feel ill or causes diarrhea. Hence a long-term dietary therapy is strongly recommended for people who have had gall bladder surgery. If your gall bladder is diseased, a low fat diet reduces stimulation of the organ and allows your gall bladder adequate rest. This eating plan also helps to prevent painful spasms of the bile duct.

Cholecystectomy

Cholecystectomy or Gallbladder removal surgery is now commonly carried out by laparoscopic method. This has greatly reduced recovery time over the traditional open surgery. Laparoscopic Cholecystectomy is performed with special tools inserted through small incisions made on the abdomen. A tiny video camera is also inserted to aid the process. Typically Cholecystectomy is resorted in cases where the patient suffers gallstones in the gallbladder or bile duct. Severe Pancreatitis or Cholecystitis (Severe pain coupled with rigidity in the upper right abdomen owing to the infection or inflammation of the gallbladder) are other reasons for resorting to a Cholecystectomy. Some patients and conditions are not suitable for a laparoscopic Cholecystectomy and in these cases, the surgeon opts for the open incision method. Cholecystotomy is a surgical procedure where the gallbladder is opened for removal of the gallstones and the excess bile is drained - but the gallbladder itself is not removed. The actual surgical incision into the gallbladder is called as Cholelithotomy.

Cholecystectomy complications

With laparoscopic Cholecystectomy, a patient can leave the hospital within a couple of days. While this is a relatively simple procedure, the possible complications include blood clots, bile leakage, injury to bile duct and infection. Sometimes, a gallstone might still remain within the bile duct and might get pushed into the central bile duct. In case of injury to bile duct, complex corrective surgery has to be done. For gallstones still remaining in the bile duct, an endoscopic retrograde cholangiopancreatography (ERCP) is conducted. After laparoscopic cholecystectomy, patients might experience bloating and diarrhea. Some patients notice indigestion and abdominal pain. Jaundice might be noticed in a few.

Diet after gallbladder removal

After gallbladder removal surgery, many a patient suffers diarrhea for a few months till the bile flow is regulated. Remember that there is no gallbladder to store the bile and release it when necessary. Now, in the absence of a gallbladder, the bile flows directly into the small intestine. Here it is used for the digestion of fats. But some of it might flow into the large intestine causing irritation and resulting in diarrhea. Unregulated bile supply might lead to improper digestion of fat. It is not surprising to note that the fat content of the stool is higher in those who have had gallbladder surgery. A low fat diet must be followed after gall bladder removal. Fluids and high fiber diet help in preventing constipation or diarrhea post gall bladder surgery. The patient may experience burping and feeling of fullness coupled with gas.

• Eating smaller meals at more frequent intervals helps.
  
• Add new foods slowly and watch out for any symptoms.
  
• Pack in lean protein, poultry, fish and low-fat dairy into your meals.
  
• Caffeine tends to worsen abdominal gas and diarrhea in some patients after Cholecystectomy.
  
• Limit your intake of sweets, cake, cookies and chocolate bars. They might result in intestinal distress.
  

Opt for whole grains and generous servings of fruits and vegetables.Ensure that low fat dairy products are used post gall bladder surgery. Avoid convenience foods and fast foods, as they tend to pack in hidden fats. Limit the use of oil to about 2-3 tsp. a day.