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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65851_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65851_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65851_"><span class="title" itemprop="name">Extrahepatic Bile Duct Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Patient Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: July 15, 2015.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000258011__168">This PDQ cancer information summary has current information about the treatment of extrahepatic bile duct cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p><p id="CDR0000258011__169">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.</p></div><div id="CDR0000258011__1"><h2 id="_CDR0000258011__1_">General Information About Extrahepatic Bile Duct Cancer</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__2">Extrahepatic bile duct cancer is a rare disease in which malignant
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(cancer) cells form in the ducts that are outside the liver.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__5">Having colitis or certain liver diseases can increase the risk of extrahepatic bile duct cancer. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__9">Signs and symptoms of extrahepatic bile duct cancer include
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jaundice and pain. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__13">Tests that examine the bile duct and liver are used to detect
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(find) and diagnose extrahepatic bile duct cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__97">Certain factors affect prognosis (chance of recovery) and treatment options.</a></div></li></ul></div><div id="CDR0000258011__2"><h3>Extrahepatic bile duct cancer is a rare disease in which malignant
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(cancer) cells form in the ducts that are outside the liver.</h3><p id="CDR0000258011__159">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430860/" class="def">extrahepatic bile duct</a> is made up of two parts:</p><ul id="CDR0000258011__160"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000670006/" class="def">Common hepatic duct</a>, which is also called the perihilar part of the extrahepatic duct. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046466/" class="def">Common bile duct</a>, which is also called the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a> part of the extrahepatic duct.</div></li></ul><p id="CDR0000258011__161">The extrahepatic bile duct is part of a network of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a> (tubes) that connect the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">gallbladder</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>. This network begins in the liver where many small ducts collect <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046508/" class="def">bile</a> (a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> made by the liver to break down fats during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463707/" class="def">digestion</a>). The small ducts come together to form the right and left <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045709/" class="def">hepatic</a> ducts, which lead out of the liver. The two ducts join outside the liver and form the common hepatic duct. Bile from the liver passes through the hepatic ducts, common hepatic duct and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000670008/" class="def">cystic duct</a> and is stored in the gallbladder.</p><p id="CDR0000258011__162">When food is being digested, bile stored in the gallbladder is released and passes through the cystic duct to the common bile duct and into the small intestine.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258011163" co-legend-rid="figlgndCDR0000258011163"><a href="/books/NBK65851.1/figure/CDR0000258011__163/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258011163" rid-ob="figobCDR0000258011163"><img class="small-thumb" src="/books/NBK65851.1/bin/CDR0000659742.gif" src-large="/books/NBK65851.1/bin/CDR0000659742.jpg" alt="Anatomy of the extrahepatic bile ducts" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258011163"><h4 id="CDR0000258011__163"><a href="/books/NBK65851.1/figure/CDR0000258011__163/?report=objectonly" target="object" rid-ob="figobCDR0000258011163">Figure</a></h4><p class="float-caption no_bottom_margin">Anatomy of the extrahepatic bile ducts. Extrahepatic bile ducts are small tubes that carry bile outside of the liver. They are made up of the common hepatic duct (hilum region) and the common bile duct (distal region). Bile is made in the liver and flows <a href="/books/NBK65851.1/figure/CDR0000258011__163/?report=objectonly" target="object" rid-ob="figobCDR0000258011163">(more...)</a></p></div></div></p></div><div id="CDR0000258011__5"><h3>Having colitis or certain liver diseases can increase the risk of extrahepatic bile duct cancer. </h3><p id="CDR0000258011__7">Anything that increases your risk of getting a disease is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045873/" class="def">risk factor</a>. Having a risk factor does not mean that you will get <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>; not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors include having any of the following
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407758/" class="def">disorders</a>:</p><ul id="CDR0000258011__8"><li class="half_rhythm"><div>Primary sclerosing cholangitis.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045641/" class="def">Chronic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045493/" class="def">ulcerative colitis</a>.</div></li><li class="half_rhythm"><div>Choledochal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046461/" class="def">cysts</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">Infection</a> with a Chinese liver fluke <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044310/" class="def">parasite</a>. </div></li></ul></div><div id="CDR0000258011__9"><h3>Signs and symptoms of extrahepatic bile duct cancer include
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jaundice and pain. </h3><p id="CDR0000258011__11">These and other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> may be caused by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">extrahepatic bile duct
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cancer</a> or by other <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>. Check with your doctor if you have any of the following:</p><ul id="CDR0000258011__12"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">Jaundice</a> (yellowing of the skin or whites of the eyes).</div></li><li class="half_rhythm"><div>Pain in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450108/" class="def">Fever</a>.</div></li><li class="half_rhythm"><div>Itchy skin.</div></li></ul></div><div id="CDR0000258011__13"><h3>Tests that examine the bile duct and liver are used to detect
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(find) and diagnose extrahepatic bile duct cancer.</h3><p id="CDR0000258011__15">The following tests and procedures may be used:</p><ul id="CDR0000258011__16"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689078/" class="def">history</a></b>: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound</a> exam</b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> and make echoes. The echoes form a picture of body tissues called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046587/" class="def">sonogram</a>. The picture can be printed to be looked at later.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046033/" class="def">CT scan</a> (CAT
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scan)</b>: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> machine. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">dye</a> may be <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044983/" class="def">spiral</a> or helical CT scan makes
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detailed pictures of areas inside the body using an x-ray machine that scans the body in a spiral path.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045788/" class="def">MRI</a> (magnetic
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resonance imaging)</b>: A procedure that uses a magnet, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651209/" class="def">radio waves</a>, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). </div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046140/" class="def">PET scan</a> (positron emission tomography scan)</b>: A procedure to find <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045772/" class="def">malignant</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the body. A small amount of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044033/" class="def">glucose</a> (sugar) is injected into a vein. The PET <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386220/" class="def">scanner</a> rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046424/" class="def">ERCP</a> (endoscopic
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retrograde cholangiopancreatography)</b>: A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes bile duct cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046428/" class="def">endoscope</a> is passed through the mouth, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046408/" class="def">esophagus</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> into the first part of the small intestine. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheter</a> (a smaller tube) is then inserted through the endoscope into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044522/" class="def">pancreatic ducts</a>. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">stent</a>) may be left in place to keep the duct open. Tissue samples may also be taken and checked under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> for signs of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046544/" class="def">PTC</a> (percutaneous
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transhepatic cholangiography)</b>: A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407759/" class="def">drain</a> bile into the small intestine or a collection bag outside the body.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">Biopsy</a></b>: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The sample may be taken using a thin needle inserted into the duct
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during an x-ray or ultrasound. This
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is called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045691/" class="def">fine-needle aspiration (FNA) biopsy</a>. The biopsy
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is usually done during PTC or ERCP. Tissue, including part of a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph node</a>, may also be removed during
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390293/" class="def">Liver function tests</a></b>: A procedure in which a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by extrahepatic bile duct cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000732562/" class="def">Tumor marker test</a></b>: A procedure in which a sample of blood, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a>, or tissue is checked to measure the amounts of certain substances made by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the body. These are called tumor markers. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000357558/" class="def">Carcinoembryonic antigen</a> (CEA) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000633729/" class="def">CA 19-9</a> are associated with extrahepatic bile duct cancer when found in increased levels in the body.</div></li></ul></div><div id="CDR0000258011__97"><h3>Certain factors affect prognosis (chance of recovery) and treatment options.</h3><p id="CDR0000258011__99">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> (chance of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454708/" class="def">recovery</a>) and treatment options depend on the following:</p><ul id="CDR0000258011__100"><li class="half_rhythm"><div>The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer (whether it affects only the bile duct or has spread to
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other places in the body).</div></li><li class="half_rhythm"><div>Whether the tumor can be completely removed by surgery.</div></li><li class="half_rhythm"><div>Whether the tumor is in the upper or lower part of the duct. </div></li><li class="half_rhythm"><div>Whether the cancer has just been <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosed</a> or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000258011__101">Treatment options may also depend on the symptoms caused by the tumor. Extrahepatic bile duct cancer is usually found after it has spread and can rarely be removed completely by surgery. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">Palliative therapy</a> may relieve symptoms and improve the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>. </p></div></div><div id="CDR0000258011__20"><h2 id="_CDR0000258011__20_">Stages of Extrahepatic Bile Duct Cancer</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__21">After extrahepatic bile duct cancer has been diagnosed, tests
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are done to find out if cancer cells have spread within the bile duct or to
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other parts of the body. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__119">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__165">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__80">There are two staging systems for extrahepatic bile duct cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__137">The following stages are used for <i>perihilar</i> extrahepatic bile duct cancer:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__157">The following stages are used for <i>distal</i> extrahepatic bile duct cancer:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__25">Extrahepatic bile duct
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cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:</a></div></li></ul></div><div id="CDR0000258011__21"><h3>After extrahepatic bile duct cancer has been diagnosed, tests
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are done to find out if cancer cells have spread within the bile duct or to
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other parts of the body. </h3><p id="CDR0000258011__23">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread within the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430860/" class="def">extrahepatic bile
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duct</a> or to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. The information gathered from the staging
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process determines the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the
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disease. It is important to know the stage in order to plan treatment.
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</p><p id="CDR0000258011__104"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">Extrahepatic bile duct cancer</a> may be staged following a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045747/" class="def">laparotomy</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgical</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incision</a> is made in the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> to check the inside of the abdomen for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000750109/" class="def">signs</a> of disease and to remove <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044669/" class="def">fluid</a> for examination under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a>. The results of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045959/" class="def">diagnostic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689578/" class="def">imaging tests</a>, laparotomy, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> are viewed together to determine the stage of the cancer.
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Sometimes, a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045556/" class="def">laparoscopy</a> will be done before the laparotomy to see if the cancer has spread. If the cancer has spread and cannot be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044306/" class="def">surgeon</a> may decide not to do a laparotomy.</p></div><div id="CDR0000258011__119"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000258011__119_69">Cancer can spread through <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045764/" class="def">lymph system</a>, and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a>:</p><ul id="CDR0000258011__119_70"><li class="half_rhythm"><div>Tissue. The cancer spreads from where it began by growing into nearby areas.
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</div></li><li class="half_rhythm"><div>Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269462/" class="def">lymph vessels</a> to other parts of the body.
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</div></li><li class="half_rhythm"><div>Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> to other parts of the body.
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</div></li></ul></div><div id="CDR0000258011__165"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000258011__165_66">When cancer spreads to another part of the body, it is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">metastasis</a>. Cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> break away from where they began (the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>) and travel through the lymph system or blood.</p><ul id="CDR0000258011__165_67"><li class="half_rhythm"><div>Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor) in another part of the body.</div></li><li class="half_rhythm"><div>Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.</div></li></ul><p id="CDR0000258011__167">The metastatic tumor is the same type of cancer as the primary tumor. For example, if extrahepatic bile duct cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, the cancer cells in the liver are actually extrahepatic bile duct cancer cells. The disease is metastatic extrahepatic bile duct cancer, not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044242/" class="def">liver cancer</a>.</p></div><div id="CDR0000258011__80"><h3>There are two staging systems for extrahepatic bile duct cancer.</h3><p id="CDR0000258011__158"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044498/" class="def">Extrahepatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> cancer has two <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689095/" class="def">staging systems</a>. The staging system used depends on where in the extrahepatic bile duct the cancer first formed.</p><ul id="CDR0000258011__136"><li class="half_rhythm"><div><i>Perihilar</i> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256575/" class="def">proximal</a> extrahepatic bile duct <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a> (perihilar bile duct tumors) form in the area where the bile duct leaves the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>. This type of tumor is also called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335074/" class="def">Klatskin tumor</a>.<div class="iconblock whole_rhythm clearfix ten_col fig" id="figCDR0000258011164" co-legend-rid="figlgndCDR0000258011164"><a href="/books/NBK65851.1/figure/CDR0000258011__164/?report=objectonly" target="object" title="Figure" class="img_link icnblk_img figpopup" rid-figpopup="figCDR0000258011164" rid-ob="figobCDR0000258011164"><img class="small-thumb" src="/books/NBK65851.1/bin/CDR0000742477.gif" src-large="/books/NBK65851.1/bin/CDR0000742477.jpg" alt="Klatskin tumor" /></a><div class="icnblk_cntnt" id="figlgndCDR0000258011164"><h4 id="CDR0000258011__164"><a href="/books/NBK65851.1/figure/CDR0000258011__164/?report=objectonly" target="object" rid-ob="figobCDR0000258011164">Figure</a></h4><p class="float-caption no_bottom_margin">Klatskin tumor. A tumor that forms in the common hepatic duct, the area where the right and left hepatic duct meet. </p></div></div></div></li><li class="half_rhythm"><div><i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">Distal</a></i> extrahepatic bile duct tumors (distal bile duct tumors) form in the area where the bile duct empties into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>.</div></li></ul></div><div id="CDR0000258011__137"><h3>The following stages are used for <i>perihilar</i> extrahepatic bile duct cancer:</h3><div id="CDR0000258011__139"><h4>Stage 0 (Carcinoma in Situ)</h4><p id="CDR0000258011__141">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739353/" class="def">stage 0</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the innermost layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the perihilar <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a>. These abnormal cells may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. </p></div><div id="CDR0000258011__142"><h4>Stage I</h4><p id="CDR0000258011__144">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739355/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed in the innermost layer of the wall of the perihilar <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> and has spread into the muscle and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000344349/" class="def">fibrous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> of the wall.</p></div><div id="CDR0000258011__145"><h4>Stage II</h4><p id="CDR0000258011__147">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739357/" class="def">stage II</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread through the wall of the perihilar <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> to nearby fatty <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p></div><div id="CDR0000258011__148"><h4>Stage III</h4><p id="CDR0000258011__152"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739359/" class="def">Stage III</a> is divided into stages IIIA and IIIB.</p><ul id="CDR0000258011__153"><li class="half_rhythm"><div>Stage IIIA: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread to one branch of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> or of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045093/" class="def">portal vein</a>.</div></li><li class="half_rhythm"><div>Stage IIIB: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has also spread into the wall of the perihilar <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> and may have spread through the wall to nearby fatty <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, or to one branch of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a> or of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045093/" class="def">portal vein</a>.</div></li></ul></div><div id="CDR0000258011__150"><h4>Stage IV</h4><p id="CDR0000258011__154"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739361/" class="def">Stage IV</a> is divided into stages IVA and IVB.</p><ul id="CDR0000258011__155"><li class="half_rhythm"><div>Stage IVA: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a> and has spread to one or more of the following:<dl id="CDR0000258011__156" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">the main part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045093/" class="def">portal vein</a> or both branches of the portal vein;</p></dd><dt>-</dt><dd><p class="no_top_margin">the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044563/" class="def">hepatic artery</a>; </p></dd><dt>-</dt><dd><p class="no_top_margin">the right and left <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045709/" class="def">hepatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a>;</p></dd><dt>-</dt><dd><p class="no_top_margin">the right hepatic duct and the left branch of the hepatic artery or of the portal vein;</p></dd><dt>-</dt><dd><p class="no_top_margin">the left hepatic duct and the right branch of the hepatic artery or of the portal vein.</p></dd></dl></div></li><li class="half_rhythm"><div>Stage IVB: The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</div></li></ul></div></div><div id="CDR0000258011__157"><h3>The following stages are used for <i>distal</i> extrahepatic bile duct cancer:</h3><div id="CDR0000258011__82"><h4>Stage 0 (Carcinoma in Situ)</h4><p id="CDR0000258011__84">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413889/" class="def">stage 0</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044636/" class="def">abnormal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> are found in the innermost layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a>. These abnormal cells may become <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.</p></div><div id="CDR0000258011__85"><h4>Stage I</h4><p id="CDR0000258011__87">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413891/" class="def">stage I</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed. Stage I is divided into
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stages IA and
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IB.</p><ul id="CDR0000258011__108"><li class="half_rhythm"><div>Stage IA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> only.</div></li><li class="half_rhythm"><div>Stage IB: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread all the way through the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a>.</div></li></ul></div><div id="CDR0000258011__88"><h4>Stage II</h4><p id="CDR0000258011__90"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413892/" class="def">Stage II</a> is divided into
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stages IIA and
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IIB.</p><ul id="CDR0000258011__109"><li class="half_rhythm"><div>Stage IIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">gallbladder</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>, or other nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>. </div></li><li class="half_rhythm"><div>Stage IIB: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. Cancer may have spread through the wall of the distal bile duct or to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">gallbladder</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small intestine</a>, or other nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>.</div></li></ul></div><div id="CDR0000258011__91"><h4>Stage III</h4><p id="CDR0000258011__93">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413893/" class="def">stage III</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to the large <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">vessels</a> that carry <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270735/" class="def">blood</a> to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>. Cancer may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. </p></div><div id="CDR0000258011__94"><h4>Stage IV</h4><p id="CDR0000258011__96">In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413894/" class="def">stage IV</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to other parts of the body, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>.</p></div></div><div id="CDR0000258011__25"><h3>Extrahepatic bile duct
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cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:</h3><div id="CDR0000258011__27"><h4>Localized (and resectable)</h4><p id="CDR0000258011__29">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> is in an area where it can be removed completely by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</p></div><div id="CDR0000258011__30"><h4>Unresectable, recurrent, or metastatic</h4><p id="CDR0000258011__32"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045936/" class="def">Unresectable</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> cannot be removed completely by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. Most patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">extrahepatic bile duct cancer</a> have unresectable cancer.
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</p><p id="CDR0000258011__129"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> cancer is cancer that has recurred (come back) after it has been treated. Extrahepatic bile duct cancer may come back in the bile duct or in other parts of the body.</p><p id="CDR0000258011__130"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046710/" class="def">Metastasis</a> is the spread of cancer from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary</a> site (place where it started) to other places in the body. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">Metastatic</a> extrahepatic bile duct cancer may have spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046466/" class="def">common bile duct</a>, nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, other parts of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a>, or to distant parts of the body. </p></div></div></div><div id="CDR0000258011__35"><h2 id="_CDR0000258011__35_">Treatment Option Overview</h2><div class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__36">There are different types of treatment for patients with
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extrahepatic bile duct cancer. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__40">Three types of standard treatment are used:</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__49">New types of treatment are being tested in clinical trials.
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__121">Patients may want to think about taking part in a clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__123">Patients can enter clinical trials before, during, or after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__125">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258011__36"><h3>There are different types of treatment for patients with
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extrahepatic bile duct cancer. </h3><p id="CDR0000258011__38">Different types of treatment are available for patients with
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">extrahepatic bile duct cancer</a>. Some treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used
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treatment), and some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical
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trials</a>. A treatment clinical trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research
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study</a> meant to help improve current treatments or obtain information on new
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treatments for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new
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treatment is better than the standard
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treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p></div><div id="CDR0000258011__40"><h3>Three types of standard treatment are used:</h3><div id="CDR0000258011__42"><h4>Surgery </h4><p id="CDR0000258011__44">The following types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> are used to treat extrahepatic bile duct
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cancer:</p><ul id="CDR0000258011__45"><li class="half_rhythm"><div>Removal of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile
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duct</a>: If the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is small and only in the bile duct, the
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entire bile duct may be removed. A new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">duct</a> is made by connecting the duct
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openings in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a> are removed and viewed
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under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to see if they contain cancer. </div></li><li class="half_rhythm"><div> Partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044562/" class="def">hepatectomy</a>: Removal of the part of the liver
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where cancer is found. The part removed may be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322895/" class="def">wedge</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, an entire
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046188/" class="def">lobe</a>, or a larger part of the liver, along with some normal tissue around it.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046653/" class="def">Whipple
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procedure</a>: A surgical procedure in which the head of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a>, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046395/" class="def">gallbladder</a>, part of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046582/" class="def">small
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intestine</a>, and the bile duct are removed. Enough of the pancreas is left to
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make digestive <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046239/" class="def">juices</a> and
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046187/" class="def">insulin</a>.</div></li><li class="half_rhythm"><div>Surgical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044970/" class="def">biliary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046498/" class="def">bypass</a>: If the tumor cannot be removed but is
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blocking the small intestine and causing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046508/" class="def">bile</a> to build up in the gallbladder, a biliary
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bypass may be done. During this operation, the gallbladder
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or bile duct will be cut and sewn to the small intestine to create a new pathway around
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the blocked area. This procedure helps to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">jaundice</a> caused by the
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build-up of bile. </div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">Stent</a> placement: If the tumor is blocking the bile duct, a
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stent (a thin tube) may be placed in the duct to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407759/" class="def">drain</a> bile that has built up
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in the area. The stent may drain to the outside of the body or it may go around
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the blocked area and drain the bile into the small intestine. The doctor may
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place the stent during surgery or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046544/" class="def">PTC</a>, or with an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046428/" class="def">endoscope</a>. </div></li></ul></div><div id="CDR0000258011__46"><h4>Radiation therapy
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</h4><p id="CDR0000258011__105"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that uses high-energy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-rays</a> or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> or keep them from growing. There are two types of radiation therapy. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">External radiation therapy</a> uses a machine outside the body to send radiation toward the cancer. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">Internal radiation therapy</a> uses a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046550/" class="def">radioactive</a> substance sealed in needles, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257219/" class="def">seeds</a>, wires, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheters</a> that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer being treated.</p></div><div id="CDR0000258011__131"><h4>Chemotherapy</h4><p id="CDR0000258011__133"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a> is a cancer treatment that uses <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy is placed directly into the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046483/" class="def">cerebrospinal fluid</a>, an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>, or a body <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463703/" class="def">cavity</a> such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a>, the drugs mainly affect cancer cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>). The way the chemotherapy is given depends on the type and stage of the cancer being treated.</p></div></div><div id="CDR0000258011__49"><h3>New types of treatment are being tested in clinical trials.
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</h3><p id="CDR0000258011__118">This summary section describes treatments that are being studied in
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clinical trials. It may not mention every new treatment being studied.
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Information about clinical trials is available from the
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<a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258011__51"><h4>Radiation sensitizers </h4><p id="CDR0000258011__53">Clinical trials are studying ways to improve the effect of
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radiation therapy on tumor cells, including the following:</p><ul id="CDR0000258011__54"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046263/" class="def">Hyperthermia therapy</a>: A treatment in which body tissue is exposed
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to high temperatures to damage and kill cancer cells or to make cancer cells
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more sensitive to the effects of radiation therapy and certain anticancer
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drugs.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046553/" class="def">Radiosensitizers</a>: Drugs that make tumor cells more
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sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more
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tumor cells.</div></li></ul></div></div><div id="CDR0000258011__121"><h3>Patients may want to think about taking part in a clinical trial.</h3><p id="CDR0000258011__121_23">For some patients, taking part in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard treatment</a>.</p><p id="CDR0000258011__121_24">Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.</p><p id="CDR0000258011__121_25">Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.</p></div><div id="CDR0000258011__123"><h3>Patients can enter clinical trials before, during, or after starting their cancer treatment.</h3><p id="CDR0000258011__123_29">Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurring</a> (coming back) or reduce the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> of cancer treatment.</p><p id="CDR0000258011__123_30">Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044267/" class="def">NCI's</a> listing of clinical trials. </p></div><div id="CDR0000258011__125"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258011__125_33">Some of the tests that were done to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> the cancer or to find out the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045885/" class="def">stage</a> of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.</p><p id="CDR0000258011__125_34">Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">condition</a> has changed or if the cancer has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046556/" class="def">recurred</a> (come back). These tests are sometimes called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044671/" class="def">follow-up</a> tests or check-ups.</p></div></div><div id="CDR0000258011__76"><h2 id="_CDR0000258011__76_">Treatment Options for Extrahepatic Bile Duct Cancer</h2><div id="CDR0000258011__64"><h3>Localized Extrahepatic Bile Duct Cancer</h3><p id="CDR0000258011__65">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045754/" class="def">localized</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">extrahepatic bile duct cancer</a> may include
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the following: </p><ul id="CDR0000258011__66"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">Stent</a> placement or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044970/" class="def">biliary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046498/" class="def">bypass</a> to relieve blockage of the
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046738/" class="def">bile duct</a> may be done before <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">jaundice</a>.</div></li><li class="half_rhythm"><div>Surgery, with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046751/" class="def">external-beam radiation
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therapy</a>.</div></li></ul><p id="CDR0000258011__TrialSearch_64_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38753&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">localized extrahepatic bile duct cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div><div id="CDR0000258011__67"><h3>Unresectable, Recurrent, or Metastatic Extrahepatic Bile Duct Cancer</h3><p id="CDR0000258011__68">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045936/" class="def">unresectable</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">extrahepatic bile duct cancer</a> is usually within a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a>. Treatment may include the following: </p><ul id="CDR0000258011__69"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">Stent</a> placement or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044970/" class="def">biliary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046498/" class="def">bypass</a> with or without <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">internal</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046686/" class="def">external radiation therapy</a>, as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative treatment</a> to
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relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> and improve the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">Chemotherapy</a>.</div></li><li class="half_rhythm"><div>A clinical trial of new ways to give palliative <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>, such as combining it with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046263/" class="def">hyperthermia therapy</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046553/" class="def">radiosensitizers</a>, or chemotherapy. </div></li><li class="half_rhythm"><div>A clinical trial of new <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> and drug combinations.</div></li></ul><p id="CDR0000258011__TrialSearch_67_10">Check the list of NCI-supported cancer clinical trials that are now accepting patients with <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38754&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">unresectable extrahepatic bile duct cancer</a>, <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=38755&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">recurrent extrahepatic bile duct cancer</a> and <a href="http://www.cancer.gov/search/ClinicalTrialsLink.aspx?Diagnosis=709296&tt=1&format=1&cn=1" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">metastatic extrahepatic bile duct cancer</a>. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. Talk with your doctor about clinical trials that may be right for you. General information about clinical trials is available from the <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p></div></div><div id="CDR0000258011__114"><h2 id="_CDR0000258011__114_">To Learn More About Extrahepatic Bile Duct Cancer</h2><p id="CDR0000258011__115">For more information from the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044266/" class="def">National Cancer Institute</a> about extrahepatic bile duct cancer, see the <a href="http://www.cancer.gov/types/liver/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Liver and Bile Duct Cancer Home Page</a>.</p><p id="CDR0000258011__114_40">For general <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information and other resources from the National Cancer Institute, see the following:</p><ul id="CDR0000258011__114_41"><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/diagnosis-staging/staging/staging-fact-sheet" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Staging</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/chemo-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Chemotherapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/publications/patient-education/radiation-therapy-and-you" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Radiation Therapy and You: Support for People With Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Coping with Cancer</a></div></li><li class="half_rhythm"><div><a href="http://www.cancer.gov/about-cancer/coping/questions" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Questions to Ask Your Doctor about Cancer</a></div></li><li class="half_rhythm"><div><a href="http://cancercontrol.cancer.gov/ocs/resources/survivors.html" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">For Survivors and Caregivers</a>
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</div></li></ul></div><div id="CDR0000258011__77"><h2 id="_CDR0000258011__77_">Changes to This Summary (07/15/2015)</h2><p id="CDR0000258011__78">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044271/" class="def">PDQ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.</p><p id="CDR0000258011__127">Editorial changes were made to this summary.</p></div><div id="CDR0000258011__AboutThis_1"><h2 id="_CDR0000258011__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000258011__AboutThis_2"><h3>About PDQ</h3><p id="CDR0000258011__AboutThis_3">Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in <a href="http://www.cancer.gov/espanol/publicaciones/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Spanish</a>.</p><p id="CDR0000258011__AboutThis_4">PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.</p></div><div id="CDR0000258011__AboutThis_5"><h3>Purpose of This Summary</h3><p id="CDR0000258011__AboutThis_6">This PDQ cancer information summary has current information about the treatment of extrahepatic bile duct cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.</p></div><div id="CDR0000258011__AboutThis_7"><h3>Reviewers and Updates</h3><p id="CDR0000258011__AboutThis_8">Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change.
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</p><p id="CDR0000258011__AboutThis_9">The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>.
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</p></div><div id="CDR0000258011__AboutThis_10"><h3>Clinical Trial Information</h3><p id="CDR0000258011__AboutThis_11">A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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</p><p id="CDR0000258011__AboutThis_12">Clinical trials are listed in PDQ and can be found online at <a href="http://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
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</p></div><div id="CDR0000258011__AboutThis_13"><h3>Permission to Use This Summary</h3><p id="CDR0000258011__AboutThis_14">PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
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</p><p id="CDR0000258011__AboutThis_15">The best way to cite this PDQ summary is:</p><p id="CDR0000258011__AboutThis_21">National Cancer Institute: PDQ® Extrahepatic Bile Duct Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq</a>. Accessed <MM/DD/YYYY>.</p><p id="CDR0000258011__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 2,000 scientific images.
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</p></div><div id="CDR0000258011__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000258011__AboutThis_18">The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000258011__AboutThis_19"><h3>Contact Us</h3><p id="CDR0000258011__AboutThis_20">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div><div id="CDR0000258011__GetMore_3"><h2 id="_CDR0000258011__GetMore_3_">Get More Information From NCI</h2><p id="CDR0000258011__GetMore_15"><i><b>Call 1-800-4-CANCER</b></i></p><p id="CDR0000258011__GetMore_16">For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.</p><p id="CDR0000258011__GetMore_25"><i><b>Chat online
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</b></i></p><p id="CDR0000258011__GetMore_26">The <a href="https://livehelp.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's LiveHelp®</a> online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI websites and answer questions about cancer.
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65851.1/?report=reader">PubReader</a></li><li><a href="/books/NBK65851.1/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65851" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65851" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. 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