Bile Duct Cancer Treatment

About Bile Duct Cancer

At Penn Medicine's Abramson Cancer Center, patients with bile duct cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Cholangiocarcinoma is a rare cancer involving the bile ducts. Bile ducts are the structures within the gastrointestinal tract that carry bile. Bile is the digestive fluid excreted by the liver, which flows via the bile ducts into the intestine.

There are two types of cholangiocarcinomas:

  • Intrahepatic: cancer that arises from within the liver
  • Extrahepatic: cancer that arises from outside of the liver and distal bile ducts

Cholangiocarcinomas can be further classified based on the tissue from which they arise. Most cholangiocarcinomas are adenocarcinomas, meaning they arise from glandular tissue.

Bile duct cancer is rare, accounting for about 3 percent of all gastrointestinal cancers.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Bile Duct Cancer

Diagnosing Bile Duct Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options for treating bile duct cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for every patient with bile duct cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing cancer and are actively researching better and more precise ways to detect bile duct cancer.

An accurate diagnosis is an important step in planning cancer treatment, so it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment available.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse to help them make an appointment with the right physician. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more Diagnosing Bile Duct Cancer

Bile Duct Cancer Treatment

Following the diagnosis and staging of bile duct cancer, cancer specialists at Penn Medicine’s Abramson Cancer Center develop a personalized treatment plan. Penn’s treatment options for bile duct cancer include:

  • Surgery
    • Bile duct resection
    • Partial hepatectomy
    • Whipple procedure
    • Surgical biliary bypass
    • Endoscopic stent placement
  • Radiation therapy
    • 3-D conformal radiation
    • Intensity-modulated radiation therapy (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
    • Brachytherapy
  • Chemotherapy and biologic therapies
  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.


Surgery for Bile Duct Cancer

A subset of patients with bile duct cancer may be candidates for curative surgery. Unfortunately, most cases of bile duct cancer are not operable.

Bile Duct Resection

In a bile duct resection, some or all of the bile duct may be removed if the tumor is small. A new duct is made by connecting the duct openings in the liver to the intestine. Lymph nodes may be removed to check for cancer.

Partial Hepatectomy

A partial hepatectomy removes the part of the liver near the bile duct where cancer is present. The part may be a wedge, an entire lobe, or a larger part of the liver along with some surrounding tissue.

Whipple procedure

A Whipple procedure, or pancreaticoduodenectomy, is a complex procedure in which the gallbladder, common bile duct, part of the duodenum, and the head of the pancreas are removed. Enough of the pancreas is left to continue to produce digestive enzymes. Studies have confirmed that the success of the procedure is linked to the experience of the surgeon performing the procedure.

Surgical Biliary Bypass

If a tumor is blocking the small intestine and bile is building up in the liver, a biliary bypass may be performed. The gallbladder or bile duct is cut and sewn directly to the small intestine to create a new pathway around the blockage. This procedure is not designed to cure bile duct cancer, only relieve symptoms.

Endoscopic Stent Placement

If the tumor is blocking the bile duct, a stent may be placed employing ERCP or interventional radiology to drain bile that builds up in the area. This procedure is not designed to cure bile duct cancer, only relieve symptoms.

Radiation Therapy for Bile Duct Cancer

Radiation oncologists at Penn Medicine are recognized for techniques that target radiation precisely to the disease site while sparing nearby tissue.

Proton therapy at Penn Medicine is now being used to treat upper gastrointestinal cancers and recurrent tumors in the digestive tract. Penn Medicine is one of the only facilities in the country treating gastrointestinal cancers in this way.

Radiation therapy uses high-energy radiation to kill cancer cells. A radiation therapy schedule usually consists of a specific number of treatments given over an extended period of time.

3-D Conformal Radiation Therapy

The imaging technology used by radiation oncologists at Penn Medicine helps shape the radiation treatment beam to the shape of the tumor. Conformal radiation therapy gives doctors more control when treating tumors.

Special computers use CT imaging scans to create 3-D maps of the location of the cancer in the body. The system permits the delivery of radiation from several directions, and the beams can then be shaped, or conformed, to match the shape of the cancer. Conformal radiation therapy limits radiation exposure to nearby healthy tissue as well as the tissue in the beam's path.

Intensity-Modulated Radiation Therapy (IMRT)

IMRT is an advanced type of radiation therapy that uses a computer-controlled device, called a linear accelerator, to deliver precise doses of radiation to tumors or specific areas within the tumors. Radiation therapy, including IMRT, may stop cancer cells from dividing and growing, thus slowing or stopping tumor growth.

Using 4-D computed tomography (CT) images along with computerized dose calculations, IMRT allows for the radiation dose to conform more precisely to the shape of the tumor by controlling, or modulating, the intensity of the radiation beam while tracking any movement of the tumor. The therapy allows higher radiation doses to be delivered to areas within the tumor while minimizing the dose to the surrounding area.

Volumetric-Modulated Arc Therapy (VMAT)

VMAT is a type of specialized intensity modulated radiation therapy, or IMRT. VMAT delivers radiation by rotating the radiation machine, through one or more arcs while radiation is continuously delivered.

VMAT allows Penn radiation oncologists to treat complex cancers while minimizing exposure to surrounding healthy tissue. VMAT shortens radiation delivery time, and offers patient more comfort because it does not require patients to lie completely still for long periods of time.

Penn radiation oncologists use RapidArc™ radiotherapy technology to treat hard to reach tumors.

Proton Therapy

Penn Medicine is the only health care facility in the country that is using proton therapy to treat recurrent gastrointestinal tumors and tumors in the upper digestive tract in clinical trials.

Penn Medicine's Roberts Proton Therapy Center is the largest and most advanced facility in the world for this precise form of cancer radiation. Patients have access to one of the most sophisticated weapons against cancer, seamlessly integrated with the full range of oncology services available at Penn Medicine. Proton therapy is external beam radiotherapy in which protons are directed at a tumor.

The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation. The result is a better chance for curing cancer with fewer harmful side effects.

Proton therapy, like all forms of radiation therapy, works by aiming the energized particles, in this case protons, onto the target tumor. The particles damage the DNA of cells, ultimately causing their death. Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation.

Brachytherapy

Radiation oncologists at Penn Medicine use both internal and external forms of radiation therapy to treat cancer. Brachytherapy is an internal therapy in which the radiation source is placed inside the body.

Brachytherapy for bile duct cancer involves placing radioactive wires inside tubes in small sealed holders in the body. The implants are left in the body for only a short time. This allows the doctor to give a high dose of radiation to a smaller area than is possible with external radiation treatment.

Chemotherapy and Biologic Therapies for Bile Duct Cancer

Penn Medicine specializes in a team approach to treatment with multidisciplinary care and innovative approaches that use chemotherapy to target tumors prior to and after surgery.

Chemotherapy can also be delivered to potentially enhance the effectiveness of radiation therapy.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. It is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy is usually delivered intravenously through an IV, or orally by pill.

Biologic therapy

Biologic therapy, also called targeted therapy, uses the patients' own immune system to target cancer cells. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer, and are delivered orally by pill or intravenously. This type of cancer treatment is also called immunotherapy.

Clinical Trials for Bile Duct Cancer

Today, more and more people are surviving cancer. Clinical trials benefit patients with access to breakthrough therapies and treatments. These new advances in cancer treatment are occurring every day at Penn Medicine, giving patients hope that even greater discoveries lie ahead. Through clinical trials:

  • Diagnosing cancer has become more precise.
  • Radiation and surgical techniques have advanced.
  • Medications are more successful.
  • Combinations of medical, surgical and radiation therapy are improving treatment effectiveness and enhancing outcomes.
  • Strategies to address the late effects of cancer and its treatment are improving quality of life.

Other Treatments for Bile Duct Cancer

In addition to standard treatments and clinical trials, patients at Penn Medicine may wish to add additional therapies and treatments such as massage therapy, acupuncture and art therapy. These therapies do not have curative intent, and are designed to complement, not replace, standard treatments.

Integrative Medicine and Wellness Programs

At Penn Medicine, integrative medicine and wellness services can supplement traditional cancer treatments such as chemotherapy, surgery and radiation therapy. While conventional medicine plays a critical role in eradicating cancer, integrative medicine and wellness programs offer patients and their families ways to enhance the quality of their lives, minimize or reduce the side effects of cancer and cancer treatment, and promote healing and recovery.

Cancer specialists at Penn Medicine are knowledgeable and supportive of complementary cancer treatments. The cancer team works with patients and families to integrate these supportive programs into the overall care plan, while ensuring the safety and health of patients.

The Abramson Cancer Center’s range of integrative supportive services is designed to help patients cope with the cancer experience and improve their overall sense of well-being. Services include:

The Abramson Cancer Center at Pennsylvania Hospital at Pennsylvania Hospital offers a variety of supportive care programs for patients and families, from diagnosis through survivorship. These programs are available at no cost to the patients treated at Pennsylvania Hospital, and some are open to patients treated elsewhere. These services include social work counseling, nutrition counseling, psychological counseling and spiritual counseling.

The Cancer Appetite and Rehabilitation Clinic focuses on patients with loss of appetite and weight.

The Supportive Care Clinic helps to manage cancer related symptoms. Integrative support programs include:

Support groups and educational programs are available at Pennsylvania Hospital throughout the year.

Palliative Care

Palliative care provides medical and non-medical interventions to ease the symptoms of cancer and its treatment. Palliative care includes physical, emotional and spiritual care that can enhance the quality of life for cancer patients.

Palliative care can be used to complement traditional cancer therapies, or can be used to improve quality of life when curative therapies are no longer an option.

Palliative care is an approach to patient care that can be integrated with curative therapies at any point from diagnosis to survivorship or end-of-life care.

Palliative care services include palliative chemotherapy, radiation therapy and surgery as well as psychological counseling, art therapy and support groups for patients and families. The goals of palliative care are to enhance the quality of life for cancer patients and their families and provide emotional and spiritual support to enhance personal growth.

Palliative care services are offered at Pennsylvania Hospital, and at the Hospital of the University of Pennsylvania.  

Penn Home Care and Hospice Services

Penn Home Care and Hospice Services offer a full range of home health care needs by partnering three top-level home health care services under one roof:

Penn Home Care and Hospice Services offer an array of specialized therapies and medications for patients with cancer and cancer-related conditions.

Oncology Navigation Specialists

Every step of cancer treatment – from cancer diagnosis, to surgery and treatment to forming a survivorship plan – comes with different needs and issues that should be addressed.

Oncology Navigation Specialists at the Abramson Cancer Center are available to make a patient’s experience as seamless as possible. As experts in navigating complex health care situations, patient support specialists serve as a consistent point of contact and a reliable source for advice, support and direction for patients and families. They can help in a variety of ways including; provide emotional support, identify resources, and ensure access to information, support services, educational programs and community resources.

Learn more about Patient Navigation specialists at the Abramson Cancer Center.

Bile Duct Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of bile duct cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

Cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Bile Duct Cancer Survivorship


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Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more

Clinical Trials

Clinical Trials

Clinical trials are studies to find new ways to prevent, detect and treat cancer. The purpose of each clinical trial is to answer a specific question. Our physicians carefully design these studies to find new ways to improve care and quality of life ... more about clinical trials