Hilar Cholangiocarcinoma

Diagnosis

Diagnosis of cholangiocarcinoma, or bile duct cancer, involves several tests and imaging studies that help confirm the presence of cancer and determine its stage.

Common diagnostic steps include:

• Liver function tests to measure liver enzyme levels and identify possible liver damage or bile duct blockage.

• Tumor marker test to check the level of carbohydrate antigen (CA) 19-9 in the blood. High levels may suggest bile duct cancer, but can also appear in other bile duct diseases.

• Endoscopic retrograde cholangiopancreatography (ERCP), a procedure that uses a flexible tube with a camera to examine the bile ducts and inject dye for better imaging.

• Imaging tests such as ultrasound, CT scan, MRI, or magnetic resonance cholangiopancreatography (MRCP). MRCP is a noninvasive alternative to ERCP that creates 3D images without dye.

• Biopsy, which involves removing a small tissue sample for microscopic examination. This can be done during ERCP or with a fine-needle aspiration guided by ultrasound or CT imaging.

The method used to collect the biopsy sample can affect future treatment options. For instance, fine-needle aspiration may make a person ineligible for liver transplantation.

Once the diagnosis is confirmed, additional imaging tests help determine the stage of the cancer, which guides treatment planning and prognosis.

Treatment

Treatment for cholangiocarcinoma depends on the cancer’s location, stage, and the person’s overall health. Options may include surgery, medication, or targeted therapies.

• Surgery involves removing as much of the cancer as possible. In some cases, this may include removing parts of the liver, pancreas, or lymph nodes.

• Liver transplant may be an option for people with early-stage hilar cholangiocarcinoma. It can potentially cure the disease, but there is a risk of recurrence.

• Chemotherapy uses drugs to destroy cancer cells. It can be used before a liver transplant or to slow disease progression in advanced cases.

• Radiation therapy employs high-energy beams such as X-rays or protons to kill cancer cells. It may be delivered externally or internally through brachytherapy.

• Targeted drug therapy focuses on specific abnormalities within cancer cells, helping block their growth and survival.

• Immunotherapy strengthens the immune system to recognize and destroy cancer cells. It may be used in advanced stages when other treatments are less effective.

• Radiofrequency ablation heats and destroys cancer cells using electric currents guided by imaging.

• Photodynamic therapy injects a light-sensitive chemical that reacts to laser light to kill cancer cells. This can relieve symptoms and slow cancer growth.

• Biliary drainage helps restore bile flow and relieve symptoms. This may involve inserting stents, bypass surgery, or tubes to drain bile.

Because cholangiocarcinoma is challenging to treat, it is essential to consult experienced specialists and consider a second opinion when needed.

Clinical Trials

Clinical trials offer access to new and experimental treatments that may improve outcomes. They are carefully monitored to ensure safety and effectiveness. While trials cannot guarantee a cure, they may provide access to promising therapies not yet widely available.

Discuss with your doctor whether a clinical trial might be suitable for your condition.

Supportive (Palliative) Care

Palliative care focuses on relieving pain and improving quality of life for people with serious illnesses. It can be provided alongside treatments such as surgery or chemotherapy.

A multidisciplinary team of doctors, nurses, and other healthcare professionals works together to manage symptoms and offer emotional and practical support. Palliative care can help people with cholangiocarcinoma feel better and may even extend survival.