25 year trends in cancer incidence and mortality among adults aged 35-69 years in the UK, 1993-2018: retrospective secondary analysis

Chemotherapy For Bile Duct Cancer (Cholangiocarcinoma)

Chemotherapy is a drug or a combination of drugs that kills cancer cells wherever they are in the body. You may receive chemotherapy before surgery to shrink a bile duct tumor. This is called neoadjuvant therapy. If you receive chemotherapy after surgery to destroy and cancer cells that may remain, it is called adjuvant therapy.

The standard chemotherapy drugs for bile duct cancer are gemcitabine (Gemzar®) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU), oxaliplatin (Eloxatin®), and capecitabine (Xeloda®). We will carefully tailor your treatment to make sure that it's as effective as possible while helping maintain your quality of life.

If you have bile duct cancer that has spread, you may receive chemotherapy as the main treatment if surgery is not an option. Research has suggested that the combination of gemcitabine and cisplatin can lengthen the lives of people with bile duct cancer that cannot be removed by surgery.

Chemotherapy is also occasionally given to relieve symptoms due to bile duct cancer, such as a tumor that is pressing on a nerve and causing pain.

Chemotherapy with Hepatic Arterial Infusion

MSK researchers are evaluating the potential of a new chemotherapy technique called hepatic arterial infusion (HAI) in the treatment of bile duct cancer. HAI involves delivering a high dose of chemotherapy drugs directly to the liver through a tiny pump implanted under the skin in the lower belly. The chemotherapy passes from the liver into the bile ducts. HAI therapy may be used to shrink tumors before surgery.

Targeted Therapies for Bile Duct Cancer

Targeted therapies block specific changes in cancer cells that help them grow and survive or disrupt their blood supply. MSK is currently investigating several targeted therapies for bile duct cancer.

Ivosidenib blocks an abnormal form of a protein called IDH1. Abnormal IDH1 causes too much of a substance called 2-HG to be produced. Scientists believe that too much 2-HG can fuel the growth of bile duct cancer.

Two other targeted therapies, pemigatinib (INCB054828) and infigratinib (BGJ398) help reduce the production of the abnormal form of a protein called FGFR2 in cancer cells. MSK is testing these targeted therapies in certain people with bile duct cancer whose tumors carry mutations in FGFR2 and several other specific genes.

Bile Duct Cancer

Bile duct cancer is also called cholangiocarcinoma. It is a rare type of cancer that starts in the bile ducts.

The bile ducts are small tubes that connect the liver and gallbladder to the small bowel. They carry a fluid called bile. This helps to break down fat from the food we eat making it easier to digest.  

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: 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: 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: 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: 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 appointmentsif you need more teststhe distance you need to travel to and from hospitalYou 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.

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