Biliary Tract Cancer is a group of rare and aggressive malignancies that arise from the bile ducts, gallbladder, and ampulla of Vater.
Gallbladder cancer is considered as the most common biliary tract and third gastrointestinal tract cancer.
Tumors spread through blood vessels, lymph nodes, nerves, and ducts to liver/organs.
These cancers are divided into three types:
Cholangiocarcinoma: It is sub-divided as:
Intrahepatic Cholangiocarcinoma: It occurs in the bile ducts within the liver
Perihilar Cholangiocarcinoma: It occur at the junction of the right and left hepatic bile ducts
Distal Cholangiocarcinoma: It occurs in the bile ducts outside the liver near the small intestine
Gallbladder Cancer
Ampullary Cancer
Gallbladder cancer arises from the gallbladder’s epithelial cells. It occurs more in women as compared to men.
Ampullary cancer occurs where the bile duct and pancreatic duct meet and empty into the small intestine at the ampulla of Vater.
Epidemiology
Cholangiocarcinoma incidence rates range from 0.72 to 1.62 per 100000 in the U.S.
Northeast Thailand has the highest disease incidence rate of over 80 per 100000 individuals.
Studies suggests a rise in intrahepatic cholangiocarcinoma incidence due to chronic inflammation and irritation of the biliary tract epithelium over decades.
Incidence of primary sclerosing cholangitis increases with age and is more common in men due to high prevalence.
Anatomy
Pathophysiology
Chronic irritation and inflammation cause similar changes to the biliary tract epithelium as other GI cancers.
Research indicates that 20% of intrahepatic bile duct tumors have mutations in IDH1 and IDH2 genes.
While 13% to 17% cases exhibit fibroblast growth factor receptor gene fusion or translocation.
P53 mutation is present in 40% of perihilar and distal cholangiocarcinoma and 25% of intrahepatic cholangiocarcinoma.
Moving the bed closer to a bathroom or using bedside commodes can prevent falls and reduce effort for patients.
Proper nutrition is of great importance for biliary tract cancer patients, particularly those who are undergoing the treatment.
Alternative pain management approaches like relaxation therapy, an imagery guide, acupuncture, and massage can help sufferers to feel less painful and injured.
Physical activity and exercise can be a good way to improve the strength, endurance and overall wellness of the patients.
Proper awareness about biliary tract cancer should be provided and its related causes with management strategies.
Appointments with an oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Use of Chemotherapy
Gemcitabine/Cisplatin:
Gemcitabine interferes with DNA replication to cause cancer cell death.
While cisplatin induces DNA cross-linking to results in apoptosis.
Use of Targeted Therapy
Infigratinib:
It is an oral FGFR inhibitor used in patients with FGFR2 gene fusions.
Biliary Tract Cancer is a group of rare and aggressive malignancies that arise from the bile ducts, gallbladder, and ampulla of Vater.
Gallbladder cancer is considered as the most common biliary tract and third gastrointestinal tract cancer.
Tumors spread through blood vessels, lymph nodes, nerves, and ducts to liver/organs.
These cancers are divided into three types:
Cholangiocarcinoma: It is sub-divided as:
Intrahepatic Cholangiocarcinoma: It occurs in the bile ducts within the liver
Perihilar Cholangiocarcinoma: It occur at the junction of the right and left hepatic bile ducts
Distal Cholangiocarcinoma: It occurs in the bile ducts outside the liver near the small intestine
Gallbladder Cancer
Ampullary Cancer
Gallbladder cancer arises from the gallbladder’s epithelial cells. It occurs more in women as compared to men.
Ampullary cancer occurs where the bile duct and pancreatic duct meet and empty into the small intestine at the ampulla of Vater.
Cholangiocarcinoma incidence rates range from 0.72 to 1.62 per 100000 in the U.S.
Northeast Thailand has the highest disease incidence rate of over 80 per 100000 individuals.
Studies suggests a rise in intrahepatic cholangiocarcinoma incidence due to chronic inflammation and irritation of the biliary tract epithelium over decades.
Incidence of primary sclerosing cholangitis increases with age and is more common in men due to high prevalence.
Chronic irritation and inflammation cause similar changes to the biliary tract epithelium as other GI cancers.
Research indicates that 20% of intrahepatic bile duct tumors have mutations in IDH1 and IDH2 genes.
While 13% to 17% cases exhibit fibroblast growth factor receptor gene fusion or translocation.
P53 mutation is present in 40% of perihilar and distal cholangiocarcinoma and 25% of intrahepatic cholangiocarcinoma.
Biliary tract cancer has poor prognosis with survival less than 2 years and less than 10% survival rate.
Chemotherapeutic agents treat unresectable tumors, but overall median survival is only one year.
Surgery is potential cure for early cancer and post-surgery survival factors.
Undifferentiated tumors show aggressive behavior and worse outcomes.
Collect details including initial symptoms, progression of symptoms, and medical history to understand clinical history of patient.
Abdominal examination
Full body assessment
Chronic symptoms are:
Jaundice
Abdominal Pain
Weight Loss and Fatigue
Nausea and Anorexia
Acute symptoms are:
Biliary Obstruction
Severe Abdominal Pain
Pruritus
Severe right upper quadrant pain
Acute Biliary Colic
Severe abdominal distention
Hepatocellular carcinoma
Gallbladder adenomas
Metastatic liver cancer
Gallbladder adenomyomatosis
Surgical resection is the sole cure for localized bile duct tumors. Evaluate the patient physically and radiologically before surgery.
Surgical exploration via laparoscopy may be needed for staging tumor before resecting cholangiocarcinoma.
Post-surgery monitoring for biliary tract issues using post-treatment CT imaging
Late-stage diagnosis in metastatic or recurrent bile duct cancers or unfit for surgery.
Chemotherapy for advanced or unresectable tumors benefits from gemcitabine alone or combined with cisplatin based on clinical trials.
Recent studies recommend targeted therapies for patients with unresectable tumors due to emerging data on molecular treatments.
Cholangiocarcinoma can have fibroblast growth factor receptor gene fusion. Inhibitors may improve survival in unresectable tumors.
Bevacizumab tested with GEMOX and erlotinib in combination shows promising anti-cancer potential.
Oncology, Medical
Moving the bed closer to a bathroom or using bedside commodes can prevent falls and reduce effort for patients.
Proper nutrition is of great importance for biliary tract cancer patients, particularly those who are undergoing the treatment.
Alternative pain management approaches like relaxation therapy, an imagery guide, acupuncture, and massage can help sufferers to feel less painful and injured.
Physical activity and exercise can be a good way to improve the strength, endurance and overall wellness of the patients.
Proper awareness about biliary tract cancer should be provided and its related causes with management strategies.
Appointments with an oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Oncology, Medical
Gemcitabine/Cisplatin:
Gemcitabine interferes with DNA replication to cause cancer cell death.
While cisplatin induces DNA cross-linking to results in apoptosis.
Oncology, Medical
Infigratinib:
It is an oral FGFR inhibitor used in patients with FGFR2 gene fusions.
Biliary Tract Cancer is a group of rare and aggressive malignancies that arise from the bile ducts, gallbladder, and ampulla of Vater.
Gallbladder cancer is considered as the most common biliary tract and third gastrointestinal tract cancer.
Tumors spread through blood vessels, lymph nodes, nerves, and ducts to liver/organs.
These cancers are divided into three types:
Cholangiocarcinoma: It is sub-divided as:
Intrahepatic Cholangiocarcinoma: It occurs in the bile ducts within the liver
Perihilar Cholangiocarcinoma: It occur at the junction of the right and left hepatic bile ducts
Distal Cholangiocarcinoma: It occurs in the bile ducts outside the liver near the small intestine
Gallbladder Cancer
Ampullary Cancer
Gallbladder cancer arises from the gallbladder’s epithelial cells. It occurs more in women as compared to men.
Ampullary cancer occurs where the bile duct and pancreatic duct meet and empty into the small intestine at the ampulla of Vater.
Cholangiocarcinoma incidence rates range from 0.72 to 1.62 per 100000 in the U.S.
Northeast Thailand has the highest disease incidence rate of over 80 per 100000 individuals.
Studies suggests a rise in intrahepatic cholangiocarcinoma incidence due to chronic inflammation and irritation of the biliary tract epithelium over decades.
Incidence of primary sclerosing cholangitis increases with age and is more common in men due to high prevalence.
Chronic irritation and inflammation cause similar changes to the biliary tract epithelium as other GI cancers.
Research indicates that 20% of intrahepatic bile duct tumors have mutations in IDH1 and IDH2 genes.
While 13% to 17% cases exhibit fibroblast growth factor receptor gene fusion or translocation.
P53 mutation is present in 40% of perihilar and distal cholangiocarcinoma and 25% of intrahepatic cholangiocarcinoma.
Biliary tract cancer has poor prognosis with survival less than 2 years and less than 10% survival rate.
Chemotherapeutic agents treat unresectable tumors, but overall median survival is only one year.
Surgery is potential cure for early cancer and post-surgery survival factors.
Undifferentiated tumors show aggressive behavior and worse outcomes.
Collect details including initial symptoms, progression of symptoms, and medical history to understand clinical history of patient.
Abdominal examination
Full body assessment
Chronic symptoms are:
Jaundice
Abdominal Pain
Weight Loss and Fatigue
Nausea and Anorexia
Acute symptoms are:
Biliary Obstruction
Severe Abdominal Pain
Pruritus
Severe right upper quadrant pain
Acute Biliary Colic
Severe abdominal distention
Hepatocellular carcinoma
Gallbladder adenomas
Metastatic liver cancer
Gallbladder adenomyomatosis
Surgical resection is the sole cure for localized bile duct tumors. Evaluate the patient physically and radiologically before surgery.
Surgical exploration via laparoscopy may be needed for staging tumor before resecting cholangiocarcinoma.
Post-surgery monitoring for biliary tract issues using post-treatment CT imaging
Late-stage diagnosis in metastatic or recurrent bile duct cancers or unfit for surgery.
Chemotherapy for advanced or unresectable tumors benefits from gemcitabine alone or combined with cisplatin based on clinical trials.
Recent studies recommend targeted therapies for patients with unresectable tumors due to emerging data on molecular treatments.
Cholangiocarcinoma can have fibroblast growth factor receptor gene fusion. Inhibitors may improve survival in unresectable tumors.
Bevacizumab tested with GEMOX and erlotinib in combination shows promising anti-cancer potential.
Oncology, Medical
Moving the bed closer to a bathroom or using bedside commodes can prevent falls and reduce effort for patients.
Proper nutrition is of great importance for biliary tract cancer patients, particularly those who are undergoing the treatment.
Alternative pain management approaches like relaxation therapy, an imagery guide, acupuncture, and massage can help sufferers to feel less painful and injured.
Physical activity and exercise can be a good way to improve the strength, endurance and overall wellness of the patients.
Proper awareness about biliary tract cancer should be provided and its related causes with management strategies.
Appointments with an oncologist and preventing recurrence of disorder is an ongoing life-long effort.
Oncology, Medical
Gemcitabine/Cisplatin:
Gemcitabine interferes with DNA replication to cause cancer cell death.
While cisplatin induces DNA cross-linking to results in apoptosis.
Oncology, Medical
Infigratinib:
It is an oral FGFR inhibitor used in patients with FGFR2 gene fusions.
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