Understanding biliary cancer and who’s at risk

Instances of biliary cancer are increasing at a steady rate. We asked Neil Sharma, medical director, GI Oncology and President of the Parkview Cancer Institute, what we need to know about this somewhat rare form of the disease.

Defining biliary cancer

Biliary cancer (also known as Cholangiocarcinoma) is cancer that forms in the cells lining the bile duct system. The bile ducts connect the liver to the gallbladder and move bile, a substance that helps breakdown fats, to the small intestine. The cancer can be intrahepatic (inside the liver) or extrahepatic (outside the liver).

Occurrence

While relatively uncommon, approximately 8,000 people in the United States are diagnosed with this disease each year, and those numbers are increasing. It is the second most common primary liver malignancy.

Signs and symptoms

Biliary cancer can present in symptoms such as jaundice, nausea, itching, light-colored, greasy stools, weight loss, dark urine, abdominal pain or a liver mass detected on imaging.

Diagnosis

A physician will order a CT/MRI, labs, biopsy and cholangioscopy (a procedure that provides a clearer view of the bile duct) to confirm the diagnosis and determine the stage of the cancer.

Risk factors

While generally the cause of biliary cancer is unknown, the following risk factors seem to correlated with a higher risk of the disease:

  • Primary Sclerosing Cholangitis (PSC) – A chronic disease that slowly damages the bile duct system
  • Long standing intrahepatic (in the liver) bile duct stones
  • Parasitic infections of the liver
  • Being over age 65
  • Cirrhosis
  • A history of Hepatitis C or B infection
  • Chemical exposures
  • Choledochocele –  A rare abnormality of cystic or diverticular dilation of a portion of the bile duct
  • Inflammatory bowel disease
  • Being of Hispanic descent  
  • Non-alcoholic fatty liver disease
  • Obesity
  • Family history
  • Diabetes
  • Alcohol abuse
Reducing risk

While you can’t control risk factors like age and bile duct abnormalities, there are things you can do that might help lower your risk.

Getting to and staying at a healthy weight is one important way to reduce the risk of all types of cancer. The American Cancer Society recommends that people try to stay at a healthy weight throughout life by being active and eating a healthy diet, with a focus on plant foods.

Other steps to reduce the risk of bile duct cancer include:

  • Getting vaccinated against the hepatitis B virus (HBV) to prevent infection and the cirrhosis it can cause.
  • Taking precautions to avoid blood-borne or sexually transmitted infections like HBV and other viruses (like hepatitis C virus) to help prevent cirrhosis.
  • Treating hepatitis infections (such as B and C) to help prevent cirrhosis.
  • Limiting alcohol consumption. 
  • Quitting smoking.

Once a stage has been identified, you and your physician can begin developing a treatment plan, which could include surgery, immunotherapy and/or radiation, among other methods.

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