Bile Duct (Biliary) Cancer
Bile duct cancer or cholangiocarcinoma is a rare and very serious disease that is best treated by a team of specialists. You can find those teams at NewYork-Presbyterian. We have exceptional experience caring for people with biliary cancer, offering advanced surgical, oncologic and interventional endoscopic approaches—including those not widely available elsewhere—to relieve obstructed bile ducts and improve your quality of life.
A Team of Biliary Cancer Experts
Your team includes hepatologists (liver doctors), gastroenterologists, interventional endoscopists, surgeons, radiologists, oncologists, nurses, physician assistants, social workers, registered dietitians, and others with the skills and compassion to provide you with coordinated, advanced, and individualized care. If you have primary sclerosing cholangitis, ulcerative colitis, or gallstones—diseases which raise the risk of bile duct cancer—we can provide treatment for those disorders, too. You can receive all of the care you need at one medical center.
Diagnosing Bile Duct Cancer
The tests we use to diagnose bile duct cancer include sophisticated examinations offered primarily at academic medical centers such as NewYork-Presbyterian. Our doctors employ:
- Imaging tests. CT scanning and magnetic resonance imaging (MRI).
- Magnetic resonance cholangiopancreatography (MRCP). MRI is used to produce detailed cross-sectional images of your digestive organs and tissues.
- Endoscopic retrograde cholangiopancreatography (ERCP) with the Spyglass® direct visualization system. This advanced procedure combines x-rays and the use of an endoscope to obtain a tissue sample to analyze it for cancer cells. NewYork-Presbyterian’s interventional endoscopists routinely perform this procedure and are highly regarded experts in its use.
- Endoscopic ultrasound (EUS) with fine-needle aspiration to biopsy tissue. EUS involves the use of a special endoscope with high-energy sound waves ("echoendoscope") to visualize your digestive tract and nearby organs.
- Probe-based confocal endomicroscopy. NewYork-Presbyterian is one of few hospitals offering this highly specialized approach, which involves the use of a small microscope to analyze cells to determine if they are normal or precancerous. Cancerous tissue may be immediately removed through the endoscope for further examination.
Bile Duct Cancer Surgery
If your cancer was found early enough, you might be able to have surgery to remove it. We perform most surgeries for bile duct cancer laparoscopically. Our doctors may insert a small tube called a stent to promote drainage through the duct before surgery.
- Small bile duct cancers. If the cancer is small and contained within the ducts, your surgeon removes the bile ducts containing cancer and joins those that are remaining to the small bowel so that bile can flow.
- Bile duct cancers that spread to the liver. If the cancer has spread to the liver, the surgeon removes the affected section of the liver, as well as the affected bile ducts.
- More extensive bile duct cancer. If the cancer has spread to surrounding areas, your surgeon will generally perform a Whipple procedure, removing the bile ducts, a part of the stomach, part of the duodenum (the top of the small bowel), the pancreas, gallbladder, and the surrounding lymph nodes. This is an extensive operation best performed by experienced surgeons at major medical centers. NewYork-Presbyterian surgeons are very skilled in this procedure.
- Inoperable bile duct cancer. If there are blockages in your bile ducts and your tumor cannot be removed, your surgeon may perform bypass surgery to join the gallbladder or bile duct to a part of the small intestine to enable bile to flow from the liver to the intestine. If the cancer blocks the duodenum, your surgeon can connect part of the small bowel to the stomach to bypass the duodenum.
Liver Transplantation for Bile Duct Cancer
If you have a large biliary cancer that cannot be treated using other approaches, we may need to perform a liver transplant. NewYork-Presbyterian is one of only a few centers in the country that offers liver transplantation for selected individuals with inoperable biliary cancer. We have a distinguished track record for liver transplantation and a team of world-renowned leaders in the field. Our Center for Liver Disease and Transplantation offers a seamless integration of services, using both deceased and living donor liver tissue and minimally invasive laparoscopic techniques whenever possible to achieve excellent outcomes.
Advanced Interventional Endoscopy
You may be able to benefit from nonsurgical treatment with interventional endoscopy. Our endoscopy specialists employ novel technologies to treat bile duct cancer, including:
- ERCP with stent placement. Our interventional endoscopists are highly proficient in using this approach to open a narrowed bile duct and improve the quality of life in people with advanced biliary cancer.
- ERCP guided by EUS. The endoscopist employs this treatment to relieve obstructions in the bile ducts caused by cholangiocarcinoma and to relieve jaundice when the tumor cannot be removed.
- Photodynamic therapy. With this advanced interventional endoscopic treatment, you first receive an injection of a special light-activated chemotherapy drug. During treatment, the endoscopist applies laser light to the areas of cancer, activating the drug to kill cancer cells. NewYork-Presbyterian is one of the few centers in the United States to offer this therapy for bile duct cancer.
- Radiofrequency ablation. This technique uses high-energy radiofrequency waves to treat inoperable bile duct cancers and reduce pain and other symptoms.
Chemotherapy Drugs for Bile Duct Cancer
Gemcitabine and cisplatin are the anticancer drugs most commonly used to treat cancer of the bile ducts. If these medications are part of your treatment plan, you can receive them in our modern and comfortable infusion centers. They are staffed by experienced oncology nurses who monitor your comfort and attend to your needs during your infusion.
Brachytherapy for Bile Duct Cancer
Our radiation oncologists offer a sophisticated brachytherapy program, in which tiny catheters are threaded to the site of the bile duct tumor to deliver a high dose of concentrated radiation. With this method, the radiation is targeted precisely to the tumor, avoiding nearby healthy tissue.
Treating All of You
To support your quality of life, we offer palliative care, which includes services such as pain management. Our nutritionists, social workers, palliative care experts, and others will help you and your loved ones address the effects of cancer and its treatment — physical, emotional, and spiritual. We understand the burden cancer can place on your life and the lives of your loved ones, and we do whatever we can to lessen that burden.
Clinical Trials for Bile Duct Cancer
Bile duct cancer is challenging to treat successfully, and researchers are continually seeking more effective therapies. At NewYork-Presbyterian, you may have access to clinical trials of new targeted treatments designed to interfere with the pathways involved in biliary cancer growth. We are also assessing new surgical and endoscopic procedures. One promising investigational treatment is Spyglass, which involves combining bile duct stent placement with photodynamic therapy. Our goal is to develop better therapies that relieve symptoms and help people with biliary cancer to live longer.