Bile Duct Cancer and Gallbladder Cancer
If you have bile duct cancer or gallbladder cancer, you are in good hands at Mount Sinai; we have extensive experience diagnosing and treating these conditions.
The liver produces a digestive juice called bile. Tiny passageways called bile ducts collect the bile, and they come together just outside the liver to form the main bile duct that enters into the first part of the intestine. The gallbladder is a pouch off the side of the main duct where the bile is stored between meals.
Cancer that develops at any point along the bile ducts is called cholangiocarcinoma. It is becoming more and more common in the United States. There are several types of cholangiocarcinomas:
- Intrahepatic cholangiocarcinomas start from the tiny ducts inside the liver. They usually form in people who don’t have any known liver disease. They often grow into large tumors before we find them because the liver is very adaptable. If one part becomes cancerous, other parts can take over the functioning, without causing symptoms.
- Hilar cholangiocarcinomas start in the larger ducts outside the liver. They typically cause the bile ducts to narrow, which makes the bile back up into the blood. The condition causes yellowing of the skin and eyes, called jaundice. Removing these tumors almost always requires removing part of the liver along with the bile ducts.
- Gallbladder cancer usually results from gallstones causing irritation and inflammation over many years. Tumors that grow in the gallbladder often become quite large before they are detected since they don’t block the bile duct, cause jaundice, or display other symptoms.
- Distal cholangiocarcinomas form in the lower part of the bile duct near where it passes through the pancreas and enters the intestine. These tumors lead to jaundice. Removing these tumors often requires taking out the head of the pancreas and the first part of the intestine (duodenum). This procedure is commonly referred to as a Whipple procedure, named for Allen Whipple, MD, the first surgeon to describe the procedure.
We use several types of treatments for biliary cancers. These include surgery, chemotherapy, radiation, and organ transplantation.
Surgery: Surgical procedures for cholangiocarcinoma and gallbladder cancer are complex. Intrahepatic cholangiocarcinomas and gallbladder cancers are often large and involve nearby structures. Surgery for hilar cholangiocarcinoma usually involves removing part of the liver and part of the bile duct. Then the surgeon connects the small bile duct branches that come out of the remaining liver to the intestine. Our team has had a special interest in surgery for cholangiocarcinoma for many years. We use techniques that we learned from doing thousands of liver transplants to perform procedures involving the reconstruction of blood vessels and bile ducts. Only a few medical centers have this type of expertise.
Chemotherapy and radiation: Chemotherapy plays an important role in treating cholangiocarcinoma and gallbladder cancer. You may receive chemotherapy before surgery (neoadjuvant) and/or after surgery (adjuvant). After surgery, we examine everything we remove under a microscope. If we find cancer cells in the nearby lymph nodes, or if we see microscopic cancer cells at the edge where we cut to remove the cancer, we recommend treatment with chemotherapy. This lowers the chances of the cancer coming back and improves your chances of long-term survival. Drugs that target specific genetic mutations have also been shown to help. For this reason, Mount Sinai performs genomic sequencing on all cholangiocarcinoma patients.
When cholangiocarcinoma is too advanced in the liver for us to remove it but has not spread anywhere else, we often provide radiation treatment as well, to help us control cancer growth longer.
Transplantation: Sometimes we cannot remove hilar cholangiocarcinoma surgically. This is more likely when the cancer is caused by primary sclerosing cholangitis (an autoimmune disease that causes inflammation of the bile ducts). For these patients, we offer liver transplantation, combined with radiation and chemotherapy. Mount Sinai is one of a few centers in the United States to offer this treatment. The United Network for Organ Sharing, the organization that manages the U.S. organ transplant system, allows us to prioritize these patients on the transplant waiting list. We also offer transplants for patients with intrahepatic cholangiocarcinoma that cannot be removed surgically on a case-by-case basis.