Palliative Therapy for Bile Duct Cancer

Palliative care is treatment used to help control or reduce symptoms caused by cancer. It's not meant to cure the cancer.

When are palliative treatments used?

If bile duct cancer has spread too far to be removed by surgery, doctors may focus on palliative treatments. For instance, pain medicines and drugs to control nausea or itching might be used to help you feel better. Chemotherapy and radiation can also be used to relieve problems caused by the tumor(s). Sometimes, surgery or other treatments are used to help you feel better or to help prevent possible problems the cancer might cause. Because bile duct cancers tend to grow and spread quickly, doctors try to use palliative therapies that are less likely to have unpleasant short-term side effects, whenever possible. Your cancer care team will talk with you about the pros and cons of all the treatments that might help you.

Here are some examples of procedures that might be used as part of palliative care for bile duct cancer:

Biliary stent or biliary catheter

If cancer is blocking a bile duct, it can lead to jaundice (yellowing of the skin and eyes) as well as other problems, like infection and liver failure. A small tube or a catheter can be put into the duct to help keep it open.

• A stent is a small metal or plastic tube that's put through the blockage in the duct. It keeps the duct open to allow bile to drain into the small intestine.
• A catheter is a thin, flexible tube that's put in through the skin of the abdomen (belly). One end of the tube is put into a bile duct and the other end is outside the body. This allows the bile to drain into a bag. The bag can be emptied when needed. If you have a catheter, your doctor or nurse will teach you how to care for it.

These procedures can be done as part of a cholangiography procedure such as ERCP or PTC (see Tests for Bile Duct Cancer) or, in some cases, during surgery. They're often done to help prevent or relieve symptoms from more advanced cancers, but they can also be done to help relieve jaundice before potentially curative surgery is done. This helps lower the risk of complications from the surgery.

The stent or catheter might need to be replaced every few months to help reduce the risk of infection and gallbladder inflammation. It will also need to be replaced if it becomes clogged.

Biliary bypass

Another option to allow bile to go into the small intestine and not build up in the liver is a surgery called a biliary bypass. The surgeon creates a bypass around the tumor blocking the bile duct by connecting part of the bile duct before the blockage with a part of the duct that lies past the blockage, or with the intestine itself. There are different biliary bypass operations:

• A choledochojejunostomy joins the common bile duct to the jejunum (the second part of the small intestine).
• A gastrojejunostomy (also known as a gastric bypass) joins the stomach directly to the jejunum.
• A hepaticojejunostomy joins the duct that carries bile from the liver to the jejunum.

The decision on which one to use depends on where the blockage is.

As mentioned in Surgery for Bile Duct Cancer, biliary bypass is more likely to be done if a patient is already having surgery to try to cure the cancer by taking it out, but it turns out the cancer cannot be totally removed. While a bypass is more invasive than placing a stent or catheter, it has some advantages in that it may last longer and infection is less likely to be a problem.

Tumor ablation (radiofrequency ablation,cryosurgery, or alcohol ablation)

Tumors in the liver that can’t be resected can sometimes be destroyed (ablated) by putting a long metal probe through a small hole in the skin and into the tumor. A CT scan or ultrasound is used to guide it to the right place. The tip of the probe is then heated (in radiofrequency ablation) or frozen (in cryotherapy) or an alcohol solution is injected (alcohol ablation) to kill the cancer cells.

Photodynamic therapy (PDT)

For PDT, a light-activated drug is injected into a vein. Over time, the drug tends to collect in cancer cells more than in normal cells. A few days later, an endoscope (a long, flexible tube that can be used to look inside the body) is passed down the throat, through the stomach and intestine, and into the bile ducts. A special laser light on the end of the endoscope is aimed at the tumor. The light turns on the drug, causing the cells to die. PDTcan be helpful for people with bile duct cancer whose tumors can't be removed with surgery.

The drugs used for PDT can also collect in normal cells in the body, making a person very sensitive to sunlight or strong indoor lights. You'll need to stay out of any strong light for several weeks after the injection.