Biliary Cancer (Cholangiocarcinoma)

Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.

Overview

Biliary cancer (cholangiocarcinoma) is a rare but aggressive type of cancer, the surgical treatment of which requires great experience and specialization in order to achieve optimal oncological outcome to avoid dangerous and unwanted complications.

Dr. Konstantinidis and his Surgical Team have operated on a large number of patients with biliary cancer achieving high success rates, even in cases previously considered inoperable.

In addition, they are pioneers in the treatment of biliary cancer worldwide by performing innovative surgeries using the robotic system da Vinci Xi – a state of the art robotic surgery technology in the world – at Athens Medical Center.

What is Biliary Cancer?

Also known as cholangiocarcinoma, biliary cancer is a type of malignancy that develops in the system of ducts that connect the liver, the gallbladder, and the small intestine, allowing for the circulation of bile.

It is not a common type of cancer, however it is considered aggressive and usually does not show symptoms in its early stages.

What are the Bile Ducts?

The bile ducts are a network of ducts that connect the liver, the gallbladder, and the small intestine.

This network begins in the liver, where many small ducts collect bile and join to form the right and left hepatic ducts, which lead out of the liver.

The two ducts join outside the liver and form the common hepatic duct. The cystic duct connects the gallbladder to the common hepatic duct.

The connection of cystic duct and the common hepatic duct constitute the common bile duct.

Bile from the liver passes through the hepatic ducts, the common hepatic duct and the cystic duct and is stored in the gallbladder.

During digestion, bile released from the gallbladder and through the cystic duct passes through the common bile duct to the small intestine.

Which are the types of Biliary Cancer?

Biliary cancer is generally categorized into two groups:

  • Intrahepatic cholangiocarcinoma. This type of cancer forms in the cells of the bile ducts inside the liver. Only a small number of bile ducts are intrahepatic.
  • Extrahepatic cholangiocarcinoma. This type of cancer forms in the bile ducts outside the liver and is divided into the following types:
    • Hilar cholangiocarcinoma (Klatskin tumor): A type of cancer that develops in the anatomical position where the right and / or left hepatic ducts join to form the common hepatic duct
    • Gallbladder cancer (peripheral or central): A type of cancer that develops along the bile duct.

What are the symptoms of Biliary Cancer?

Biliary cancer usually has no symptoms until it is already advanced.

The symptoms of biliary cancer vary depending on the location of the tumor and include the following:

  • feeling unwell and loss of appetite
  • jaundice (yellowing of the skin and whites of the eyes)
  • weight loss for no apparent reason
  • pain in the stomach area, usually on the right side, below the ribs
  • high fever and chills

What are the risk factors for Biliary Cancer?

Risk factors for developing biliary cancer include:

  • age (biliary cancer mainly affects people over the age of 65)
  • obesity
  • smoking
  • history of gallstones
  • infections, especially chronic ulcerative colitis and hepatitis B and C, which affect the liver
  • liver diseases
  • primary sclerosing cholangitis
  • cysts in the bile ducts

Biliary cancer affects women more often than men.

How is Biliary Cancer diagnosed?

When diagnosing biliary cancer, it is important to determine its subtype (intrahepatic, extrahepatic), as each has its own specific characteristics and requires specific tests.

In general, the best diagnostic tool is magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP).

In particular, the following tests and procedures may be used to diagnose biliary cancer:

  • history taking and physical examination
  • liver function tests: a blood sample is tested to measure the amount of bilirubin and alkaline phosphatase released into the bloodstream by the liver
  • laboratory tests: they include testing of tissue samples, blood, urine, or other substances in the body, such as carcinoembryonic antigen (CEA) and CA 19-9
  • endoscopic ultrasound (EUS)
  • computed tomography (CT) with or without dye intake
  • magnetic resonance imaging (MRI)
  • magnetic resonance cholangiopancreatography (MRCP)
  • biopsy, including Percutaneous Transhepatic Cholangiography (PTC) and Endoscopic Retrograde Cholangiopancreatography (ERCP)

How is Biliary Cancer treated?

Appropriate treatment for biliary cancer is determined after consultation of the Oncology Board, a multi-disciplinary team of physicians who assess all available data, each through the prism of their own specialty.

The Oncology Board examines the diagnostic data, the general health state of the patient, the condition of affected organs, as well as various pieces of information about the tumor and accordingly determines a treatment plan suitable for each patient specifically.

If the cancer is detected early, then surgery to remove it is usually the first step, followed by additional treatment, such as chemotherapy and/or radiation therapy.

Surgery may involve removing part of the liver, the biliary tract (tree) and the gallbladder.

If the tumor cannot be removed surgically, it is usually treated with chemotherapy, sometimes radiation, as well as other treatment modalities, which have been developed.

What type of surgery should I choose?

The type of surgery chosen for each case depends on the location of the tumor in the bile duct and the extent of the disease (stage).

The following types of surgery are used to treat biliary cancer:

  • Removal of the common bile duct: It refers to the removal of part of the common bile duct if the tumor is small and limited to it. The lymph nodes are removed as well and tissue from the lymph nodes is examined for signs of cancer in a lab.
  • Partial hepatectomy: It refers to the removal of a portion of the liver that has been affected by cancer.
  • Whipple’s procedure: It involves the removal of the head of the pancreas, the gallbladder, part of the stomach, part of the small intestine (duodenum) and the common bile duct.

In intrahepatic cancers, if the tumor blocks the common bile duct, a procedure may be performed to place a thin stent to facilitate bile drainage to the small intestine.

Removal of bile ducts can be performed with open surgery, laparoscopically or by using the robotic system, which is the most modern approach.

Why us

Why Dr. Konstantinidis?

Dr. Konstantinidis and his Surgical Team constitute a reference point in Greece for the treatment of biliary cancer, being the only ones applying Robotic Surgery.

Robotic Surgery offers unique benefits in the treatment of biliary cancer by dramatically reducing the risk of postoperative complications.

Dr. Konstantinidis and his Surgical Team collaborate with leading specialists in all relevant medical specialties, such as Radiologists, Gastroenterologists, etc., in order to determine a treatment plan based on the specificity, needs and goals of each patient.