Cholangiocarcinoma: Causes, Symptoms, Treatment and Cost

A specific kind of cancer known as cholangiocarcinoma develops in the cells of the bile ducts.If left untreated, it may spread to other body areas and develop both within and outside the liver.

Following are the types of Cholangiocarcinoma:

• Intrahepatic Cholangiocarcinoma (ICC): This type of cholangiocarcinoma originates in the cells of the bile ducts located inside the liver.
• Extrahepatic Cholangiocarcinoma (ECC): This type of cholangiocarcinoma starts in the cells of the bile ducts located outside of the liver, such as those in the gallbladder and pancreas.
• Perihilar Cholangiocarcinoma: This type is also known as Klatskin Tumor and is located close to where the right and left hepatic ducts join together near the hilum or center of the liver.
• Distal Cholangiocarcinoma: This type occurs farther down in the biliary tract, close to where it joins with the duodenum or first part of the small intestine.

The most common causes of Cholangiocarcinoma are given below:

• Primary sclerosing cholangitis (PSC): PSC is a chronic inflammatory illness that only affects the bile duct. Those with this illness have a higher risk of developing cholangiocarcinoma.
• Intrahepatic stones: Cholangiocarcinoma risk might be raised by stones that grow in the bile ducts.
• Liver flukes: Certain types of parasitic worms, called liver flukes, may increase the risk of cholangiocarcinoma if they are ingested through contaminated food or water.
• Exposure to certain chemicals: Cholangiocarcinoma risk has been associated with exposure to several industrial chemicals, including vinyl chloride and arsenic.
• Chronic infection with hepatitis B and C viruses: Chronic infection with these viruses can increase a person's risk of developing certain types of liver cancer, including cholangiocarcinoma.

Cholangiocarcinoma signs include:

• Some of the typical early symptoms of cholangiocarcinoma include pain in the upper abdomen, jaundice (yellowing of the skin and whites of the eyes), weariness, weight loss, and itching.
• As the tumor grows, symptoms may include fever and night sweats, abdominal swelling, loss of appetite, back pain near the liver or gallbladder, nausea and vomiting.
• In some cases, patients may experience difficulty swallowing or feel a lump in the area where their liver is located.
• Cholangiocarcinoma can also cause blockage of the bile ducts leading to jaundice and other complications such as pancreatitis.

One can avoid Cholangiocarcinoma by adopting these:

• Avoid Smoking: Cholangiocarcinoma risk is heightened by smoking. Giving up smoking might lower this risk.
• Reduce Alcohol Use: Heavy drinking increases the risk of developing cholangiocarcinoma, particularly in men. Lessening one's alcohol consumption may reduce the danger.
• Eat a Healthy Diet: Low-fat diets rich in fruits, vegetables, whole grains, and other phytochemicals may reduce the risk of cholangiocarcinoma.
• Get Vaccinated: Vaccination against hepatitis B virus (HBV) reduces the risk of developing cholangiocarcinoma in people infected with HBV or at high risk for HBV infection.
• Get Regular Medical Check-Ups: Regular check-ups are important for monitoring the health of those at higher risk for developing cholangiocarcinoma, such as those with primary sclerosing cholangitis or liver cirrhosis caused by chronic hepatitis B or C virus infections, as early detection and treatment can improve outcomes significantly.

Cholangiocarcinoma can be diagnosed by the following:

• Imaging tests: Imaging techniques including computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and ultrasound may be used to identify and diagnose cholangiocarcinoma.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This test uses an endoscope to inject dye into the bile ducts in order to view them more clearly on an X-ray. It can detect growths, stones or blockages that may indicate cholangiocarcinoma.
• Endoscopic Ultrasound: In order to obtain comprehensive views of the bile ducts and surrounding tissue for diagnosis, this technique combines ultrasound imaging with endoscopy.
• Liver Biopsy: A sample of liver tissue is removed during a liver biopsy in order to conduct laboratory tests to verify the existence of cancer cells in the body.
• Blood Tests: Blood tests may be conducted to check for elevated levels of certain proteins or enzymes that could indicate cholangiocarcinoma, such as carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9) and alpha-fetoprotein (AFP).

The following are a few Cholangiocarcinoma complications:

• Obstruction of the bile ducts: Cholangiocarcinoma can cause the narrowing or blockage of the bile duct, resulting in jaundice, abdominal pain, and dark urine.
• Spread to other organs: Cholangiocarcinoma can spread to nearby lymph nodes and other organs, such as the lungs and liver.
• Weight loss: Due to a reduced appetite and food absorption, advanced cholangiocarcinoma often manifests as weight loss.
• Fatigue: Fatigue is a common symptom of advanced cholangiocarcinoma due to anemia, which occurs when cancer cells interfere with normal blood cell production in the bone marrow.
• Itching: Itching is a common symptom of advanced cholangiocarcinoma due to high levels of bilirubin in the blood caused by bile duct blockage.

These natural treatments for cholangiocarcinoma are effective:

• Intake of bitter gourd juice mixed with honey on an empty stomach is beneficial for Cholangiocarcinoma.
• Consume equal amounts of dried ginger powder and rock salt before meals to reduce the symptoms of Cholangiocarcinoma.
• Turmeric, when taken orally in small doses, helps to reduce inflammation associated with Cholangiocarcinoma.
• Consume warm, unrefined sesame oil with the juice of five black peppercorns twice daily to reduce pain caused by Cholangiocarcinoma.
• A paste made from two tablespoons of coriander seeds and a glass of water can be taken daily to reduce nausea associated with Cholangiocarcinoma.
• Make a decoction from three tablespoons of fenugreek seeds and one cup of water, which can be consumed twice daily for relief from abdominal discomfort caused by Cholangiocarcinoma.

Some foods may help the patients of Cholangiocarcinoma:

• Fruits and vegetables: Antioxidants, vitamins, and minerals found in abundance in fruits and vegetables may help strengthen the immune system and combat cancer cells. Cholangiocarcinoma patients are advised to consume a lot of fruits and vegetables.
• Lean meats: Lean meats such as chicken, turkey, and fish are also beneficial for Cholangiocarcinoma patients as they provide valuable protein for tissue repair.
• Healthy fats: Avocados, almonds, olives, and olive oil are examples of foods high in healthy fats that may help lower inflammation and enhance general health.
• Whole grains: Whole grains are packed with fiber that can help keep the digestive system running smoothly and reduce the risk of cancer growth.

The following foods should be avoided by the patients of Cholangiocarcinoma:

• Processed foods: These are high in salt, sugar, fat, and preservatives, which can increase inflammation and make it harder for the body to fight off cancer cells.
• Fried foods: Fried meals include a lot of bad fats, which may cause inflammation and hinder the body's ability to fight off cancer cells.
• Refined grains: Refined grains have had the majority of their nutrients removed during processing, so they may not provide enough nutritional benefits.
• Red meat: Red meat has been linked to an increased risk of certain cancers, including cholangiocarcinoma.
• Alcohol: Alcohol has been linked to an increased risk of certain cancers, including cholangiocarcinoma.

Treatments for cholangiocarcinoma may include:

• Surgical resection: The most frequent method of treating cholangiocarcinoma includes removing all or a portion of the bile ducts that are damaged. The aim is to minimize tumor removal while maintaining healthy bile duct function.
• Liver resection: This procedure involves removing a portion of the liver that contains the cancerous tumor, which can help reduce symptoms and improve survival rates.
• Whipple procedure: This operation is used to remove part of the pancreas, along with other surrounding organs and tissues that may be affected by cancer.
• Biliary bypass surgery: This procedure creates an alternate pathway for bile to travel from the liver to the small intestine, helping to reduce blockage caused by a tumor in the biliary tree.
• Stent placement: A stent may be placed in a blocked bile duct to relieve pressure and help bile flow more freely through it.
• Radiation therapy: Radiation therapy may be used to shrink tumors that are difficult to surgically remove or have spread beyond one area of the body.

It is recommended to consult an oncologist who specializes in gastrointestinal cancers, such as hepatobiliary cancers.

The finest cholangiocarcinoma treatments, including surgery, chemotherapy, radiation therapy, and targeted medication therapy, will be offered by the oncologist.

They could also suggest other experts and medical personnel to you if you need further assistance and care.

Medicines recommended to the patients of Cholangiocarcinoma:

• Targeted Therapies: These medications go against certain chemicals or metabolic processes that contribute to the development of cancer cells. Examples include small molecule inhibitors and monoclonal antibodies, such as nab-paclitaxel (Abraxane) and ramucirumab (Cyramza).
• Chemotherapy: These drugs attack rapidly dividing cells, including cancer cells. Examples include gemcitabine (Gemzar) and cisplatin.
• Immunotherapy: These drugs help activate the immune system to fight cancer cells. Examples include nivolumab (Opdivo) and pembrolizumab (Keytruda).
• Hormone Therapy: These drugs target hormones involved in the growth of some types of cancers, such as cholangiocarcinoma. Examples include aromatase inhibitors, such as letrozole (Femara).
• Other Therapies: This includes other medications that can help manage symptoms associated with cholangiocarcinoma, including steroids to reduce inflammation, pain relievers to manage pain, and anti-nausea medications to reduce nausea and vomiting.

The stage and severity of cholangiocarcinoma determine how long it takes to recover:

• Generally speaking, recovery times can range from a few weeks to several months, depending on the type of treatment received.
• Depending on how bad the cancer is and how far along it is when it is discovered, healing may take longer in certain situations.
• Surgery may be required in some cases, which can add additional time to the recovery process.
• Additionally, certain treatments such as chemotherapy and radiation may also add to the length of time it takes to recover from Cholangiocarcinoma.

Cholangiocarcinoma treatment outcomes are influenced by the size and stage of the disease, the patient's general health, and other factors. In some cases, treatment may be able to cure the disease, while in other cases, it may only be able to slow its progression or reduce symptoms. For some patients, the results of treatment can be permanent; however, for others, further treatment or monitoring may be needed to prevent a recurrence.

Patients are advised following after the treatment of Cholangiocarcinoma:

• After treatment, regular follow-up visits are essential to detect any recurrence of the cancer or side effects of treatment.
• Patients should have regular physical examinations, blood tests, imaging tests such as CT scans or MRI scans, and liver function tests to monitor their health and ensure that any new signs or symptoms are addressed promptly.
• It is important to attend all follow-up visits so that any changes in health can be caught early and treated effectively.
• Patients should also follow a healthy diet with plenty of fresh fruits and vegetables, limit red meat consumption, stop smoking if they smoke, exercise regularly, and manage stress levels to maintain overall health while managing their cholangiocarcinoma diagnosis.

The cost of treating cholangiocarcinoma in India varies depending on the stage of cancer, type of treatment, and other factors:

• Treatments like chemotherapy and radiation therapy often range in price from Rs. 30,000 to Rs. 5 lakhs.
• Depending on the intricacy of the operation, surgery for cholangiocarcinoma might cost anywhere from Rs. 1 million to Rs. 10 lakhs or more.
• Additionally, post-operative care can cost around Rs. 20,000 to Rs. 50,000 per month or more depending on the intensity of the care required.

Common side effects of Cholangiocarcinoma treatments are given below:

• Surgery: Pain, scarring, infection, bleeding, fatigue, nerve damage.
• Radiation therapy: Fatigue, skin irritation or burning, hair loss, dry mouth or throat swelling.
• Chemotherapy: Hair loss, nausea, and vomiting, fatigue, increased risk of infection.
• Targeted therapy: high blood pressure, rash or itchy skin changes, diarrhea, and elevated blood sugar levels.

If you have any Cholangiocarcinoma symptoms, you should see a doctor right away. These symptoms might result in consequences including 'obstruction of the bile ducts, spread to other organs,' for which the length of the treatment course will depend on how severe the condition is.