Tumors of the bile ducts

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Romuald Lipko, the leader of Budka Suflera, died at the age of 69. The musician suffered from a tumor of the bile ducts of the liver. In July 2019, he said in an interview with Super Express that the disease had been stopped. Unfortunately, the composer lost the fight against cancer. Biliary tumors can include the gallbladder and bile ducts. As in other organs, also here we can distinguish primary or secondary neoplasms – as a result of displacement (penetration) from the neighborhood. The cause of neoplasms is not entirely clear, but it is suspected that gallstone disease is a factor contributing to neoplastic changes.

Biliary tract – definition

The bile ducts are the ducts responsible for the discharge of bile into the liver and gastrointestinal tract. The biliary tract begins in the liver, and after exiting the liver, they form the space needed to store bile, i.e. the gallbladder. The bile ducts run successively through the pancreas to the mouth of the gastrointestinal tract near the duodenum. Among the bile ducts, we distinguish the following:

1. intrahepatic (running through the liver parenchyma);
2. extrahepatic.

Cancer causes of the bile ducts

They are not fully defined. There are suspicions that the formation of bile duct neoplasms is influenced by gallstones. Primary biliary tumors are relatively rare.

Factors increasing the risk of cancer of the bile ducts

Although the causes of the disease are not fully understood, there are certain factors that increase the risk of developing bile duct cancer. The risk occurs in the case of:

1. intrahepatic urolithiasis,
2. parasitic infection,
3. inflammation of the large intestine (ulcerative),
4. biliary cysts,
5. primary sclerosing cholangitis,
6. obesity,
7. genetic conditions,
8. Caroli’s disease, characterized by a large number of intrahepatic biliary cysts.

Symptoms of bile duct neoplasms

At first, the disease may be completely asymptomatic, but only as the neoplastic lesion grows, they become noticeable. Symptoms of biliary neoplasms formation and development are uncharacteristic, resembling chronic inflammation or cirrhosis of the liver, or inflammation or cholelithiasis. They are accompanied by:

1. weight loss,
2. increasing mechanical jaundice (characterized by yellowing of the whites of the eyes and skin, additionally the urine is dark in color),
3. nausea,
4. vomiting,
5. pain located in the right hypochondrium,
6. lack of appetite
7. fever with chills may appear
8. faster fatigue.

Due to the fact that these symptoms occur in other non-cancerous diseases, it is necessary to consult a doctor and make an appropriate diagnosis.

Diagnosis of bile duct neoplasms

The symptoms described above are helpful in establishing a XNUMX% diagnosis, but most of all the examination:

1. abdominal ultrasound – considered the basic examination performed in the assessment of the gallbladder and bile ducts. Thanks to the ultrasound examination, the position of the bile ducts, their width and changes along their course are determined. This test may highlight a situation where the cancer has spread to the liver;
2. magnetic resonance imaging – a test that helps to assess the extent of liver infiltration by a bile duct cancer;
3. Abdominal CT scan (computed tomography) – is more accurate than ultrasound, as it helps to assess the size, location and nature of changes in the bile ducts;
4. ERCP (endoscopic retrograde cholangiopancreatography) – an examination performed with an endoscope inserted through the patient’s mouth into the duodenum. The patient is administered a contrast agent, and then X-rays are taken. Thanks to the images taken, it is possible to determine the level of the narrowing of the bile ducts caused by the tumor. In addition, ERCP testing allows to determine whether the liver has been infiltrating the tumor;
5. Magnetic resonance cholangiopancreatography – also allows you to accurately assess the pancreatic duct, and importantly, this method combines two techniques: magnetic resonance and ERCP.

Treatment of neoplasms of the bile ducts

Treatment of this type of ailments is not the easiest task. As with most cancers, relatively early diagnosis increases the chances of successful treatment. Surgical removal of the tumor is considered the most important method, while radiation is used less. As for chemotherapy, it is not necessary and is useful in the treatment of this type of cancer.

Depending on the advancement of the process and ailments, the following are used:

1. surgical treatment – involves excision of the tumor, and the procedure itself is relatively complicated and carries a high risk of complications. This is because next to each other there are many organs important for the body that during the procedure (depending on the case) should be left (if they are not affected by the tumor) or cut out. This is especially true of the portal vein which carries blood from the lower extremities and abdomen to the heart and finally the pancreas; pancreas; liver and duodenum. Unfortunately, not every patient can undergo surgery, it depends on the general condition and comorbidities, which in some cases may preclude surgery. In this case, bile drainage should be ensured to prevent jaundice. For this purpose, a stent is used, i.e. a rigid tube that is inserted into the narrowed bile duct. This method is called endoscopic biliary decompression;
2. palliative surgery – is performed when radical surgery is impossible. It consists in eliminating some symptoms and improving the condition of the patient and his life without removing the disease. It may be the aforementioned endoscopic stent placement or surgical anastomosis of a fragment of the bile ducts with the intestine, which also allows bile to flow into the gastrointestinal tract bypassing the section obstructed by the tumor;
3. radiation therapy.

How to prevent bile duct cancer?

Prevention of biliary neoplasms consists of:

1. effective elimination of urolithiasis (ignoring urolithiasis can lead to the development of a follicle tumor),
2. elimination of inflammation of the bladder and bile ducts,
3. proper nutrition,
4. care for human natural environment free from contamination and degradation.

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