Chemotherapy for bile duct cancer
Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called 
. They circulate throughout the body in the bloodstream.
Chemotherapy is a common treatment for people with bile duct cancer.
When you have chemotherapy
You might have chemotherapy:
- after surgery to remove bile duct cancer
- to control the cancer if it can't be removed, or if it has come back after surgery
Chemotherapy after surgery
Your doctor might suggest you have chemotherapy after surgery to remove bile duct cancer. This is to lower the chance of it coming back.
Chemotherapy to shrink the cancer
Your doctor might recommend you have chemotherapy if you can’t have surgery to remove bile duct cancer. Or if the cancer comes back after having it removed.
Unfortunately, chemotherapy won’t cure bile duct cancer. You usually have it to control the cancer or slow down its growth. This can help to relieve pain and other symptoms.
Your doctor will talk to you about the benefits of chemotherapy and the possible side effects. It is a good opportunity to ask them any questions you might have.
Types of chemotherapy
You may have one chemotherapy drug or a combination of them. This depends on if you are having it after surgery or to control the cancer. The most common chemotherapy drugs for bile duct cancer are:
- capecitabine
- gemcitabine and cisplatin
- a combination called FOLFOX
Capecitabine
Your doctor normally recommends you have capecitabine after surgery to remove bile duct cancer. You usually have it for 6 months.
Gemcitabine and cisplatin
This is a chemotherapy combination. You have if the cancer has spread to an area near the bile ducts (locally advanced bile duct cancer) or if the cancer has spread elsewhere in your body. This is called advanced bile duct cancer. You usually have gemcitabine and cisplatin with an immunotherapy drug called durvalumab.
Gemcitabine and cisplatin is a first line treatment for bile duct cancer. This means it is the first treatment you have after being diagnosed. Or the first treatment you have if the cancer comes back.
If your general health is poor you may have gemcitabine on its own. Or you may have the chemotherapy drug oxaliplatin instead of cisplatin if your kidneys don't work very well.
FOLFOX
This is a combination of the chemotherapy drugs:
- folinic acid
- fluorouracil (5FU)
- oxaliplatin
FOLFOX is a second line treatment for bile duct cancer. This means it is a treatment you have if the first line treatment doesn’t work or the cancer stops responding to it.
You usually have FOLFOX if the cancer doesn't have certain changes (mutations). If it does, you might have an immunotherapy or targeted cancer drug as your second line treatment.
Research into chemotherapy for bile duct cancer
Your doctor may ask you to take part in a clinical trial looking at chemotherapy for bile duct cancer. Or looking at other treatments combined with chemotherapy. Trials are an important way to find out which treatments work best.
Before you start chemotherapy
Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.
You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment.
Your doctors and pharmacists work out your chemotherapy dose based on your:
- blood cell levels
- weight and height
- general health
DPD deficiency
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.
Before each cycle of treatment
You usually have cancer drug treatment in cycles. A cycle means that you have a single cancer drug or a combination of drugs and then have a rest. This gives your body time to recover.
You have blood tests before each cycle of treatment. This is to check your blood cells have recovered from your last treatment before you have more chemotherapy. Sometimes your blood counts are not high enough to have chemotherapy. If this happens, your doctor usually delays your next treatment. They will tell you when to repeat the blood test.
How you have chemotherapy
You have most chemotherapy drugs for bile duct cancer into your bloodstream (intravenously). Capecitabine is a tablet.
Into your bloodstream
You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.
Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment. This means your doctor or nurse won't have to put in a cannula every time you have treatment.
Taking tablets
You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.
Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, not more or less.
Talk to your healthcare team before you stop taking a cancer drug, or if you have missed a dose.
Where you have chemotherapy
You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.
You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.
For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.
Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.
Watch the video below about what happens when you have chemotherapy. It is almost 3 minutes long.
Clare Disney (nurse): Hello, my name is Clare and this is a cancer day unit.
So when you arrive and you’ve reported into with the receptionist, one of the nurses will call you through when your treatment is ready, sit you down and go through all the treatment with you.
Morning, Iris. My name is Clare. I am the nurse who is going to be looking after you today. We’re going to start by putting a cannula in the back of your hand and giving you some anti sickness medication. And then I am going to come back to you and talk through the chemotherapy with you and the possible side effects you may experience throughout your treatment. Is that okay?
Before you have each treatment you’ll need to have a blood test to check your bloods are okay. And you’ll also be reviewed by one of the doctors to make sure you’re fit and well for your treatment. Sometimes you’ll have the blood test taken on the day of your treatment; other times you’ll have it the day before your treatment when you see the doctor.
Each chemotherapy is made up for each individual patient, depending on the type of cancer they have and where it is and depending their height, weight and blood results.
So, depending on where your cancer is some people have their chemotherapy drug, their cancer drug by drip, some will have an injection and other people will have tablets.
So, Iris, your chemotherapy is going to be given to you in what we call cycles and the cycles are given every three weeks for a period of six cycles. So, you will be coming in for approximately five months for your chemotherapy.
Depending on where your cancer is and what type of cancer you have will be dependent on how often you come in for treatment. An example of a treatment cycle would be for you to come in on Day 1, Day 8 and Day 15 then to have a week’s break before you come back again for Day 1 treatment.
Depending on the type of treatment that you are having we will also give you some anti sickness tablets to take alongside your chemotherapy and also some drugs to prevent any reactions if that’s appropriate.
All chemotherapy is given over different time periods so it’s best to check with your nurse about how long you are likely to be in the unit for. This can range from anything up to an hour to an all day treatment slot so please be prepared to bring along some bits to keep you occupied, such as books and music.
So, before you go home it’s important to make sure you have got the tablets you need to go home with your anti sickness medications and any other symptom control tablets that you may require. Also, to make sure that you’ve got the telephone numbers for the oncology unit to phone if you have a temperature or you are experiencing any other symptoms at home that you need to ask advice about.
So, please make sure when you leave the unit that you’ve got all the information you require and if you’ve got any questions at all don’t hesitate to ask the nurse who will be able to answer them for you.
Before your next cycle of treatment you will come in and see the doctor in the clinic room, you’ll have a blood test and an examination to make sure you are fit and well for treatment you will then come back the following day or later on that week for treatment.
Side effects
Common chemotherapy side effects include:
- feeling sick
- loss of appetite
- losing weight
- feeling very tired
- increased risk of getting an infection
- bleeding and bruising easily
- diarrhoea or constipation
- hair loss
Side effects depend on:
- which drugs you have
- how much of each drug you have
- how you react
Tell your treatment team about any side effects that you have.
Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.
When you go home
Chemotherapy for bile duct cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.
