Intrahepatic cholangiocarcinoma

Overview

Intrahepatic cholangiocarcinoma is a cancer that develops in the cells within the bile ducts; both inside and outside the liver. The terms cholangiocarinoma and bile duct cancer are often used to refer to the same condition. This condition occurs slightly more often in males than females and usually affects people who are between 50-70 years old.

Symptoms

The list of signs and symptoms mentioned in various sources for Intrahepatic cholangiocarcinoma includes the symptoms listed below:

  • Abdominal pain
  • Palpable abdominal mass
  • Jaundice
  • Weight loss
  • Anorexia
  • weakness and itching
  • fever

Diagnosis

When you see your physician you will have a routine examination. Your doctor will ask you questions about your general health and your family history of cancer and liver disease. You will also be asked about your lifestyle and habits, including drinking and smoking.

Your physician may order the following tests:

  • Blood work. Blood tests may include a complete blood count, hematocrit, platelet count, liver function tests, Carcinoembriogenic antigen (CEA) and Carbohydrate antigen 19-9 (CA19-9), which may be elevated in patients with bile duct cancer.
  • Abdominal ultrasound. This test helps the doctor see the tumor.
  • CT scan. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver.
  • MRI. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver.  A doctor will determine whether to do a CT scan, an MRI or both.
    Endoscopy. Endoscopy is visual instrument that allows your physician to see the inside of the esophagus, stomach and beginning of the lower intestine without surgery.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP). Endoscopic retrograde cholangiopancreatography is an endoscopic procedure that involves the use of fiberoptic endoscopes. You will be lightly sedated and your doctor will insert an endoscope through the mouth, down the esophagus, and into the stomach and small bowel.  A smaller tube or catheter is passed through the endoscope and into the bile ducts.  Dye is injected into the ducts, and the doctor takes X-rays that can show whether a tumor is present in the bile ducts.
  • Percutaneous (through the skin) Transhepatic (through the liver) Cholangiogram.  In this procedure, a thin needle is inserted through the skin and into the bile ducts. A dye is injected through the needle so that a contrast image will show up on X-rays. By looking at the X-rays, the doctor may be able to see whether there is a tumor in the bile ducts.

Treatment

Treatment for bile duct cancer may include a combination of the following:

    • Surgery to remove the bile duct, and sometimes part of the liver 
    • Chemotherapy
    • Radiation
    • Stent placement. A stent is a tube that allows the bile, which is made by the liver, to drain more easily into the intestine if a tumor is blocking the bile duct.
  • Surgical Therapy
    Removing biliary tract tumors surgically is the treatment of choice in cholangiocarcinoma as it is the only therapeutic option that offers the potential for cure. Surgical approaches have become increasingly sophisticated over the last decade. It has become apparent that curative treatment depends on expertise that often involves the removal of a major section of the liver. The objective is complete removal of the bile duct and tumor.