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Biliary tract cancer, also known as cholangiocellular carcinoma, is the name given to cancers of the bile ducts that carry bile from the liver to the small intestine.
Other cancers related to the biliary tract are pancreatic cancer, gallbladder cancer and ampulla vatery cancers. Cholangiocellular carcinoma is a very rare type of adenocarcinoma.
It is detected in 1 or 2 people out of every 100,000 people in Western society. However, as a result of new studies, it has been determined that the incidence of cholangiocellular cancer has increased gradually in recent years.
The biliary tract system starts from thin ducts called ducts that collect bile from the liver. Ducts unite to form two main canals, right and left. Bile ducts inside the liver are called intrahepatic bile ducts.
The right and left bile ducts combine in the structure called the hilus, in which the vessels that provide blood flow to the liver are located, forming the main bile duct. The gallbladder is connected to the main bile duct through a duct called the cystic duct.
As the main bile duct passes through the pancreas, it joins with the pancreatic duct and opens into the first part of the small intestine, which is called the duodenum.
Bile duct cancers are classified according to their localization in the biliary system called the biliary tree. The vast majority of cancers are adenocarcinomas. Bile duct adenocarcinomas arise from mucus-secreting cells in the ducts.
The general name of bile duct adenocarcinomas is cholangiocellular carcinoma. The Latin meaning of cholangio is related to the biliary tract.
Biliary tract cancers are called intrahepatic when they originate from the bile ducts in the liver, and extrahepatic cholangiocellular carcinoma if they originate from the extrahepatic bile ducts.
Note. All bile duct tumors are carcinogenic. When benign (noncancerous) bile duct tumors are mentioned, biliary hamartoma and adenoma come to mind.
Bile ducts are like an internet network that collects bile produced from the liver. Bile flows through these ducts into the right and left main bile ducts. These ducts combine to form the common bile duct. Bile from the main bile duct is stored in the gallbladder through the cystic duct. With the meal, the gallbladder contracts and bile flows back into the main bile duct via the cystic duct. The main bile duct transfers bile to the small intestine.
Intrahepatic biliary tract cancers are cancers of the intrahepatic biliary tract. This localization accounts for only 10% of all bile duct cancers.
Intrahepatic cholangiocellular cancers are not the same cancer as hepatocellular carcinoma that develops from liver cells. However, in some cases, two cancers can be found at the same time.
The development of these cancers is quite common in patients with inflammatory bowel diseases and definite liver diseases. For this reason, people with these diseases are called risk factors. However, having these diseases does not necessarily mean that this cancer will develop, or vice versa, it does not mean that people who do not have these diseases will not get this cancer. The point that should be taken out from here is that people with these diseases should be under close doctor follow-up.
Possible bile duct manifestations of extrahepatic bile duct cancers are pain and jaundice.
In cases where the following complaints are present, extrahepatic biliary tract cancer should be suspected and a doctor should be consulted when necessary.
The following tests are used for the diagnosis and treatment of extrahepatic biliary tract cancer.
Physical Examination and Self-Familial History: Some tests are performed to detect general health problems and findings. Disease-related findings (such as swelling and jaundice) are sought. The patient is questioned if he has general health problems, habits, the disease he has been exposed to before, or whether he has any treatment.
Evaluation of Ultrasound: Ultrasonography is the conversion of findings called echo, obtained as a result of reflection of high-energy sound waves from tissues at different rates, into images in computer environment. These echoes, which are obtained differently from the tissues, are called sonograms. Images can also be printed for future consideration.
Computerized Tomography (CT Scan): The procedure provides detailed images of tissues with the help of x-rays from different angles. These images are converted into pictures in computer environment. Intravenous contrast agents can also be injected for better and more detailed imaging of tissues and for more detailed detection of possible disease.
Magnetic Resonance Imaging (MRI) : It is a computer-assisted procedure that provides detailed imaging of the inner parts of the body by means of magnetic radio waves. This process is also called nuclear magnetic resonance imaging (NMRI). With the help of the injected contrast agent, the liver, biliary tract and gall bladder can be evaluated in detail. This process is called MRCP (magnetic resonance cholangiopancreaticography). The dye can be injected intravenously to create detailed images of the proximal gallbladder veins. This procedure is called MRA (magnetic resonance angiography).
ERCP (endoscopic retrograde cholangiography):It is a procedure that uses X-ray rays to view the duct system that carries bile from the liver to the gallbladder, from the gallbladder to the main biliary tract and small intestine.
Sometimes gallbladder cancer narrows or clogs these ducts, causing jaundice by slowing or obstructing bile flow. The endoscope (thin light tube) comes to the first part of the small intestine by passing through the mouth, esophagus and stomach. A thin catheter (a small tube) is passed through the endoscope into the bile ducts.
The dye is injected into the channels through the catheter, and the image is obtained with the help of X-ray rays. If these channels are blocked by the tumor, the thin tube can be inserted into the channel to remove the obstruction. The stent is placed to keep the canal open while tissue samples can be taken. However, in a short time, the tumor causes occlusion of the stent.
PTC (Percutaneous Transhepatic Cholangiography): It is the process of imaging the liver and bile ducts with the help of X-ray. A thin needle is inserted through the skin under the ribs into the liver. The dye is injected into the liver or biliary tract and X-rays are taken. If there is a blockage, the bile is conveyed through a thin flexible tube (stent), sometimes to a bag outside the body and sometimes to the small intestine.
Biopsy: The tissue samples taken are examined under a microscope by the pathologist due to the possibility of cancer. Tissue samples can be made under x-ray or ultrasonography under local anesthesia with the help of a thin long needle. This is called a fine needle aspiration biopsy. The biopsy can also be taken during PTK or ERCP. A biopsy can also be done after the tumor is removed after surgery.
Liver Function Tests: It is a procedure based on measuring the amount of certain substances released by the liver in blood sampling. High detection of any of these substances in the blood may be a marker of biliary tract cancer.
