Treatment options for bile duct cancer

A team of doctors and other health professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The treatment you have depends on:

• where in the bile ducts the cancer is
• how big it is and whether it has spread (the stage)
• if it is near important blood vessels
• if your doctor can remove the cancer completely with an operation
• how well your liver works
• your general health and level of fitness
• if the cancer cells have any gene changes (mutations)

Your doctor will discuss the treatment, the benefits and the possible side effects with you. 

Deciding which treatment you need

The MDT look at your test and scan results to see if they can remove (resect) the cancer or not. The cancer can be:

• resectable - this means you can have an operation to try and remove it
• unresectable - this means that surgery to remove the cancer is not possible

Your doctor might not be able to remove the cancer if it has grown into organs near the bile ducts (locally advanced). Or if it has grown into the main blood vessels of the liver.

Unfortunately, they will not usually be able to remove the cancer if it has spread elsewhere in the body. This is called advanced bile duct cancer.

Treatment for resectable bile duct cancer

Resectable bile duct cancer is normally only in the bile ducts or has grown just outside them. Generally, early stage bile duct cancers are resectable.

Your surgeon will try to remove the cancer and an area of tissue around it that doesn’t contain any cancer cells. This area is called the margin.

The type of surgery you have depends on where the bile duct cancer is. Surgery for bile duct cancer is a major operation. Your surgeon will only suggest it if you are fit enough to cope with the operation.

You might have chemotherapy after surgery. Chemotherapy uses anti cancer drugs to destroy cancer cells. These drugs are also called cytotoxic drugs . Chemotherapy helps to lower the chance of the cancer coming back.

Treatment for unresectable bile duct cancer

If you can't have surgery to remove the cancer you usually have:

• chemotherapy
• targeted cancer drugs
• immunotherapy

These can help control the growth of the cancer, relieve symptoms and hopefully help people to live longer.

You normally have a combination of chemotherapy and immunotherapy drugs as your first line treatment. A first line treatment is the first treatment you have after being diagnosed with cancer.

Your doctor might offer you further treatment if the first line treatment isn't working or the cancer starts to grow again. This is called second line treatment.

It might be a:

• different combination of chemotherapy drugs

• targeted cancer drug or immunotherapy

Which second line treatment you have depends on whether the cancer has any gene changes (mutations) or not.

You might also have other treatments to help control your symptoms.

Treatment to control symptoms of bile duct cancer

Bile duct cancer can cause symptoms such as:

• weight loss

• pain in the tummy (abdomen)

• yellowing of the skin and eyes - this is called jaundice

You usually see the symptom control team (palliative care team). They help to manage your symptoms. You might have different treatments depending on the type of symptoms you have. This might include painkillers and anti sickness medicines.

Radiotherapy

Some people may have radiotherapy to help control the symptoms of advanced bile duct cancer. 

Treatment to open a blocked bile duct

Bile duct cancer can block the bile ducts and cause jaundice. Your doctor usually puts a tube called a stent in your bile duct to open it. This means the bile can flow again.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments such as chemotherapy. But you can still have medicines to help control symptoms such as sickness or pain.

This is a very difficult decision to make. Talk this through with your family and doctor or nurse. Your doctor or nurse will explain what will happen, and what treatments you might have to control the symptoms. They can also refer you to the symptom control team to give you support at home.

Getting a second opinion

You might feel you would like an opinion from a second doctor before deciding about your treatment. If so, you can ask your specialist doctor or your GP to refer you to another doctor specialising in liver and bile duct cancers.

There are advantages and disadvantages of getting a second opinion. It might help to think about why you would like a second opinion before you speak to your doctor.