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Bile duct cancer develops in the cells that line the bile duct, both inside and outside the liver. It mostly affects people over the age of 40 and is more common in men than in women. Bile duct cancer is a major public health problem in regions like the northeast of Thailand where infection with liver flukes is linked to the consumption of raw freshwater fish. 

Types of Bile Duct Cancer
There are 2 types of bile duct cancer, depending on its location:
  • Intrahepatic bile duct cancer starts in the cells that line the bile duct in the liver. The cancer then spreads through the liver by growing along the bile duct in a similar manner to liver cancer. Because of this, intrahepatic bile duct cancer is sometimes confused with liver cancer.
  • Extrahepatic bile duct cancer starts in the bile duct outside the liver. The cancer in the bile duct blocks the flow of bile, causing a yellowing of the skin and eyes.
The main risk factor for developing bile duct cancer in the northeast of Thailand is eating raw freshwater fish, leading to an infection of liver flukes in the bile duct.
 
Other risk factors for developing bile duct cancer include:
  • Chronic inflammation of the bile duct
  • Bile duct disorders
  • Bile duct stones
  • Sclerosing Cholangitis
  • Congenital genetic disorders, such as choledochal cysts (bile-filled sacs that are connected to the bile duct)
In the early stage, bile duct cancer usually does not have any observable symptoms. In the advanced stage, however, symptoms include:
  • Yellowing of the skin and eyes due to a blockage of bile duct flow
  • Abdominal discomfort, swelling, feeling of fullness
  • Pain in the upper right abdomen, possible pain in the back and shoulders
  • Unexplained fever
  • Itchy body
  • Light colored stool and dark urine
  • Tiredness, fatigue
  • Loss of appetite, unexplained weight loss
  • Nausea, vomiting
  • Swollen liver 
The doctor will check the patient’s history and conduct a physical examination supported by the following tests:
  • Blood test to assess liver function and identify possible tumor markers
  • Liver and upper abdominal ultrasound
  • Computerized tomography (CT scan)
  • Magnetic resonance imaging (MRI)
The most appropriate treatment option will depend on several factors, including the severity of the condition, the size and appearance of the cancerous cells, the stage and spread of the cancer, and the patients’ overall health. Treatment options include the following:
  • Surgery is the main treatment for bile duct cancer.
    • Surgery to remove the tumor is an effective standard treatment that increases the patient’s survival rate.
    • If during the surgery to remove the tumor, the surgeons discover that the cancer has spread to such an extent that it cannot be removed, the surgeons will provide palliative therapy by draining bile to relieve the patient’s itchy skin and jaundice (yellowing of the skin and eyes).     
  • ERCP (endoscopic retrograde cholangiopancreatography) is a non-invasive means of diagnosing and treating the cancer which can be used if for any reason the patient cannot undergo surgery to remove the tumor.
  • Chemotherapy/radiotherapy is used if the cancer cannot be completely removed or after the surgery has been performed so as to increase the chance of a complete cure.
Follow-up appointments are important. During these sessions, the doctor will ask questions about any symptoms and perform an ultrasound or x-ray examination every 3-6 months for at least 2 years after treatment to observe for any recurrence of the cancer. 

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