Cholangiocarcinoma

Cholangiocarcinoma, or bile duct cancer, is a serious and potentially life-threatening type of cancer. There are no known single causes of this cancer but many risk factors including liver disease and bile duct deformities. One potential risk factor that is being explored by researchers is asbestos exposure. The inflammation and damage that asbestos fibers cause in the body and that cause cancers like mesothelioma may also trigger bile duct cancer.

What is Cholangiocarcinoma?

Cholangiocarcinoma is cancer of the bile ducts. These are the tubes that connect the liver, small intestines, and gallbladder. The bile ducts transport bile to the intestines from the liver and gallbladder to aid digestion. Bile is a fluid that helps to digest fats. There are small and larger ducts within the liver, called the intrahepatic bile ducts. When these ducts connect and combine with the cystic duct outside the liver, it is called the common bile duct. This moves through the pancreas and into the small intestines.

When cancer arises in any of these ducts it is called cholangiocarcinoma. The primary tumor may grow in the intrahepatic ducts, in the duct just outside the liver, or in the ducts that run through the pancreas and small intestines. These are called, respectively, intrahepatic bile duct cancer, perihilar bile duct cancer, and distal bile duct cancer, but all of these are considered cholangiocarcinoma.

Symptoms and Diagnosis

There are several potential symptoms of any of these types of cholangiocarcinoma, which include jaundice or yellowing of the skin. They also include abdominal pain, weakness, itchy skin, weight loss, fever, fatigue, and white bowel movements.

Diagnosing this cancer begins with a thorough physical examination and blood tests. There are several markers that are often elevated in the blood in someone who has bile duct cancer, including specific antigens. Liver function can also be examined with a blood test, and this can provide a diagnostic clue.

An ultrasound of the abdomen is an imaging test that can help physicians see soft tissues and any tumors that are in the bile ducts. A patient may also undergo a CT or MIR scan, more involved imaging scans that provide a better sense of location and size of tumors.

If bile duct cancer is suspected doctors may need to image the liver and bile ducts more closely. An endoscope inserted through the mouth and esophagus to the stomach and intestines can be used for a closer, less invasive view. A cholangiogram may also be done, which is an image of the bile ducts. Dye must first be injected into the ducts. Then, an X-ray will show the ducts more clearly so that doctors can see if there are any tumors. Finally, doctors may need to biopsy any suspected tumors, which involves removing a small amount of tissue to look for cancer cells under a microscope.

Causes of Cholangiocarcinoma

Exactly what causes this kind of cancer is not fully understood, although ultimately all cancers are caused by damage to DNA in the cells where the tumors first develop. There are some known risk factors for cholangiocarcinoma. These may not cause or ensure someone will have this cancer, but they increase the risk:

• Having a disease called primary sclerosing cholangitis, which is a hardening and scarring of the bile ducts
• Congenital bile duct problems, including being born with cysts or irregular bile ducts
• Contracting a parasite of the liver, which is more common in Southeast Asia and can come from raw and undercooked fish
• Having chronic liver disease
• Being older, as most people diagnosed with cholangiocarcinoma are 50 or older.
• Smoking

Asbestos and Cholangiocarcinoma

More recently studies have found some connections between asbestos exposure and the risk of developing cholangiocarcinoma. One study of thousands of people in northern Europe who have been diagnosed with bile duct cancer discovered that they were more likely than the general population to have been exposed to asbestos in the workplace. There was a connection seen between asbestos and intrahepatic bile duct cancer in particular.

Another study from Italy was smaller but also investigated workers who had been diagnosed with this type of cancer. They were construction workers, and construction is an industry known to have high amounts of asbestos materials. This study again found a significant connection between intrahepatic bile duct cancer and workers exposed to asbestos. The researchers suggested there may be chronic inflammation in the bile ducts triggered by asbestos that ultimately leads to the development of the cancer. This study also noted that the incidence of cholangiocarcinoma has been on the rise worldwide for the last 30 years and that asbestos exposure could explain the trend.

Treatment and Prognosis for Cholangiocarcinoma

How cholangiocarcinoma is treated depends on the individual patient, the location and size of tumors, whether it has metastasized, and the patient’s overall health as well as other factors. In general, options for treatment include surgery to remove as much of the cancer tissue as possible. Chemotherapy may be used to administer drugs that target and kill fast-growing cancer cells. Radiation therapy is also a possibility, which involves aiming a beam of high energy particles at the tumors to kill the cancer cells.

Other treatments that may be used include photodynamic therapy. This is a therapy that causes light-sensitive chemicals to accumulate inside cancer cells. Lasers are then used to activate the chemicals to kill the cells. In some cases a liver transplant may be possible and has the potential to cure the cancer. This is not a common treatment and most people will receive a combination of the other types of treatment.

Avoiding Asbestos and Prevention

Knowing more about what may cause cholangiocarcinoma helps people now avoid the risk factors that could lead to a cancer diagnosis in the future. People today are not nearly as likely to be exposed to asbestos as in the past, but it is still a risk. Avoiding asbestos by being safe in older homes and relying on asbestos professionals to find and abate the material is important, as is being aware of safety regulations in the workplace where exposure is possible. Avoiding asbestos is important for lowering the risk of bile duct cancer, but so is not smoking and avoiding or reducing the risk of liver disease.

Cholangiocarcinoma is a cancer that may be triggered by asbestos, but there are many people who develop it with no known exposure. With any type of cancer, regardless of the cause, it is important to seek a diagnosis and get treated as early as possible. This gives the patient the best possible prognosis. If you have been diagnosed with bile duct cancer and you know you have been exposed to asbestos in the past, talk to an asbestos attorney to find out what your legal options are.