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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">Bile Duct Cancer (Cholangiocarcinoma) 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 1, 2020.</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__315">This PDQ cancer information summary has current information about the treatment of 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__316">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 Bile Duct Cancer</h2><div id="CDR0000258011__1.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__2">Bile duct cancer is a rare disease in which malignant (cancer) cells
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form in the bile ducts. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__4">Having colitis or certain liver diseases can increase the risk of bile duct cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__11">Signs of bile duct cancer include jaundice and pain in the abdomen.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__15">Tests that examine the bile ducts and nearby organs are used to diagnose and stage bile duct cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__302">Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. </a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__19">Certain factors affect prognosis (chance of recovery) and
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treatment options.</a></div></li></ul></div><div id="CDR0000258011__2"><h3>Bile duct cancer is a rare disease in which malignant (cancer) cells
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form in the bile ducts. </h3><p id="CDR0000258011__267">A network of tubes, called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046441/" class="def">ducts</a>, connects 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000670006/" class="def">common hepatic duct</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000670008/" class="def">cystic duct</a> connects the gallbladder to the common hepatic duct. Bile from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is stored in the gallbladder.</p><p id="CDR0000258011__268"> When food is being digested, bile stored in the gallbladder is released and passes through the cystic duct to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046466/" class="def">common bile duct</a> and into the small intestine.</p><p id="CDR0000258011__317"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527370/" class="def">Bile duct cancer</a> is also called cholangiocarcinoma.</p><p id="CDR0000258011__269">There are two types of bile duct cancer:</p><ul id="CDR0000258011__276"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000770184/" class="def">Intrahepatic bile duct cancer</a></b>: This type of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> forms in the bile ducts inside the liver. Only a small number of bile duct cancers are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044871/" class="def">intrahepatic</a>. Intrahepatic bile duct cancers are also called intrahepatic cholangiocarcinomas.<div id="CDR0000258011__313" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20intrahepatic%20bile%20ducts&p=BOOKS&id=558865_CDR0000765897.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65851.13/bin/CDR0000765897.jpg" alt="Anatomy of the intrahepatic bile duct; drawing shows the liver, intrahepatic bile ducts, right and left hepatic ducts, gallbladder, pancreas, and small intestine. An inset shows a cross section of a liver lobule with a network of bile ductules leading into a bile duct." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Anatomy of the intrahepatic bile ducts. Intrahepatic bile ducts are a network of small tubes that carry bile inside the liver. The smallest ducts, called ductules, come together to form the right hepatic bile duct and the left hepatic bile duct, which drain bile from the liver. Bile is stored in the gallbladder and is released when food is being digested.</p></div></div></div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000523459/" class="def">Extrahepatic bile duct cancer</a></b>: This type of cancer forms in the bile ducts outside the liver. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430860/" class="def">extrahepatic bile duct</a> is made up of the hilum region and the distal region. Cancer can form in either region: <dl id="CDR0000258011__298" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin"><b>Perihilar bile duct cancer</b>: This type of cancer is found in the hilum region, the area where the right and left bile ducts exit the liver and join to form the common hepatic duct. Perihilar bile duct cancer is also called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000335074/" class="def">Klatskin tumor</a> or perihilar cholangiocarcinoma.</p></dd><dt>-</dt><dd><p class="no_top_margin"><b>Distal bile duct cancer</b>: This type of cancer is found in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256557/" class="def">distal</a> region. The distal region is made up of the common bile duct which passes through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046254/" class="def">pancreas</a> and ends in the small intestine. Distal bile duct cancer is also called extrahepatic cholangiocarcinoma.</p></dd></dl><div id="CDR0000258011__314" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Anatomy%20of%20the%20extrahepatic%20bile%20ducts&p=BOOKS&id=558865_CDR0000659742.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65851.13/bin/CDR0000659742.jpg" alt="Anatomy of the extrahepatic bile ducts; drawing shows the liver, right and left hepatic ducts, gallbladder, cystic duct, common hepatic duct (hilum region), common bile duct (distal region), extrahepatic bile duct, pancreas, and small intestine. An inset shows the liver, bile ducts, and gallbladder." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>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 through the common hepatic duct and the cystic duct to the gallbladder, where it is stored. Bile is released from the gallbladder when food is being digested.</p></div></div></div></li></ul></div><div id="CDR0000258011__4"><h3>Having colitis or certain liver diseases can increase the risk of bile duct cancer.</h3><p id="CDR0000258011__6">Anything that increases your risk of getting a disease is called
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a risk factor. Having a risk factor does not mean that you will
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get cancer; not having risk factors doesn't mean that you will
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not get cancer. People who think they may be at risk should
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discuss this with their doctor. </p><p id="CDR0000258011__299">Risk factors for bile duct cancer
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include the following <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>:</p><ul id="CDR0000258011__7"><li class="half_rhythm"><div>Primary sclerosing cholangitis (a progressive disease in which the bile ducts become blocked by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">inflammation</a> and scarring).</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><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046461/" class="def">Cysts</a> in the bile ducts (cysts block the flow of bile and can cause swollen bile ducts, inflammation, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">infection</a>).</div></li><li class="half_rhythm"><div>Infection 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__11"><h3>Signs of bile duct cancer include jaundice and pain in the abdomen.</h3><p id="CDR0000258011__285">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 bile duct cancer or by other conditions. Check with your doctor if you have any of the following:</p><ul id="CDR0000258011__14"><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>Dark <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046642/" class="def">urine</a>.</div></li><li class="half_rhythm"><div>Clay colored <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046605/" class="def">stool</a>.</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><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390302/" class="def">Nausea</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390324/" class="def">vomiting</a>.</div></li><li class="half_rhythm"><div>Weight loss for an unknown reason.</div></li></ul></div><div id="CDR0000258011__15"><h3>Tests that examine the bile ducts and nearby organs are used to diagnose and stage bile duct cancer.</h3><p id="CDR0000258011__300">Procedures that make pictures of the bile ducts and the nearby area help <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnose</a> bile duct cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the bile ducts or to distant parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. </p><p id="CDR0000258011__301">In order to plan treatment, it is important to know if the bile duct cancer can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>. Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time.</p><p id="CDR0000258011__17">The following tests and procedures may be used:</p><ul id="CDR0000258011__18"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270871/" class="def">Physical exam</a> and health history</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_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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044518/" class="def">bilirubin</a> and alkaline phosphatase released into the blood by the liver. A higher than normal amount of these substances can be a sign of liver disease that may be caused by bile duct cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046590/" class="def">Laboratory tests</a></b>: Medical procedures that test samples of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a>, blood, urine, or other substances in the body. These tests help to diagnose disease, plan and check treatment, or monitor the disease over time.</div></li><li class="half_rhythm"><div><b><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_CDR0000377727/" class="def">CA 19-9 tumor marker test</a></b>: A procedure in which a sample of blood, urine, or tissue is checked to measure the amounts of certain substances made by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a>, 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 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046636/" class="def">tumor markers</a>. Higher than normal levels of carcinoembryonic antigen (CEA) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000633729/" class="def">CA 19-9</a> may mean there is bile duct cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046157/" class="def">Ultrasound exam</a></b>: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, such as the abdomen, 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, such as the abdomen, 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.</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>MRCP (magnetic resonance cholangiopancreatography)</b>: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body such as the liver, bile ducts, gallbladder, pancreas, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044522/" class="def">pancreatic duct</a>.</div></li></ul></div><div id="CDR0000258011__302"><h3>Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. </h3><p id="CDR0000258011__304">Cells and tissues are removed during a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045164/" class="def">biopsy</a> so they can be viewed under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> by a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046244/" class="def">pathologist</a> to check for signs of cancer. Different procedures may be used to obtain the sample of cells and tissue. The type of procedure used depends on whether the patient is well enough to have surgery. </p><p id="CDR0000258011__305">Types of biopsy procedures include the following:</p><ul id="CDR0000258011__306"><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045556/" class="def">Laparoscopy</a></b>: A surgical procedure to look at the organs inside the abdomen, such as the bile ducts and liver, to check for signs of cancer. Small <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046353/" class="def">incisions</a> (cuts) are made in the wall of the abdomen and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044360/" class="def">laparoscope</a> (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as taking tissue samples to be checked for signs of cancer.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046238/" class="def">Percutaneous transhepatic cholangiography</a> (PTC)</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. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin, flexible tube called a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">stent</a> may be 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. This procedure may be used when a patient cannot have surgery.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046429/" class="def">Endoscopic retrograde cholangiopancreatography</a> (ERCP)</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 endoscope is passed through the mouth and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a> and into the small intestine. Dye is injected through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046428/" class="def">endoscope</a> (thin, tube-like instrument with a light and a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000572035/" class="def">lens</a> for viewing) into the bile ducts and an x-ray is taken. A sample of tissue is removed and checked for signs of cancer. If the bile duct is blocked, a thin tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. This procedure may be used when a patient cannot have surgery.</div></li><li class="half_rhythm"><div><b><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046602/" class="def">Endoscopic ultrasound</a> (EUS)</b>: A procedure in which an endoscope is inserted into the body, usually through the mouth or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046555/" class="def">rectum</a>. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. A sample of tissue is removed and checked for signs of cancer. This procedure is also called endosonography.</div></li></ul></div><div id="CDR0000258011__19"><h3>Certain factors affect prognosis (chance of recovery) and
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treatment options.</h3><p id="CDR0000258011__21">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045849/" class="def">prognosis</a> and treatment options depend on the following:</p><ul id="CDR0000258011__22"><li class="half_rhythm"><div>Whether the cancer is in the upper or lower part of the bile duct system. </div></li><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 ducts or has spread to
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the liver, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or other places in the body).</div></li><li class="half_rhythm"><div>Whether the cancer has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373935/" class="def">nerves</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">veins</a>.</div></li><li class="half_rhythm"><div>Whether the cancer can be completely removed by surgery.</div></li><li class="half_rhythm"><div>Whether the patient has other conditions, such as primary sclerosing cholangitis.</div></li><li class="half_rhythm"><div>Whether the level of CA 19-9 is higher than normal.</div></li><li class="half_rhythm"><div>Whether the cancer has just been diagnosed or has <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurred</a> (come back).</div></li></ul><p id="CDR0000258011__23">Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed 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__25"><h2 id="_CDR0000258011__25_">Stages of Bile Duct Cancer</h2><div id="CDR0000258011__25.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__26">The results of diagnostic and staging tests are used to find out if cancer cells have spread.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__30">There are three ways that cancer spreads in the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__254">Cancer may spread from where it began to other parts of the body.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__32">Stages are used to describe
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the different types of bile duct cancer.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258011__121">Intrahepatic bile duct cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__118">Perihilar bile duct cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__34">Distal bile duct cancer </a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258011__257">The following groups are used to plan treatment:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258011__259">Resectable (localized) bile duct cancer</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__262">Unresectable (including metastatic and recurrent) bile duct cancer</a></div></li></ul></li></ul></div><div id="CDR0000258011__26"><h3>The results of diagnostic and staging tests are used to find out if cancer cells have spread.</h3><p id="CDR0000258011__324">The process used to find out if <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to other parts of the body is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046597/" class="def">staging</a>. For <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527370/" class="def">bile duct cancer</a>, the information gathered from <a href="#CDR0000258011__15">tests and procedures</a> is used to plan treatment, including whether the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> can be removed by <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a>.</p></div><div id="CDR0000258011__30"><h3>There are three ways that cancer spreads in the body.</h3><p id="CDR0000258011__30_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__30_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__254"><h3>Cancer may spread from where it began to other parts of the body.</h3><p id="CDR0000258011__254_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__254_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__256">The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> tumor is the same type of cancer as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045847/" class="def">primary tumor</a>. For example, if bile duct cancer spreads to the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>, the cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> in the liver are actually bile duct cancer cells. The disease is metastatic bile duct cancer, not liver cancer.</p><div id="CDR0000258011__333" class="box"><h3><span class="title">metastasis: how cancer spreads</span></h3><div class="caption"><p>Many cancer deaths are caused when cancer moves from the original tumor and spreads to other tissues and organs. This is called metastatic cancer. This animation shows how cancer cells travel from the place in the body where they first formed to other parts of the body.</p></div><p><a href="https://www.youtube.com/watch?v=fQwar_-QdiQ" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">YouTube</a></p></div></div><div id="CDR0000258011__32"><h3>Stages are used to describe
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the different types of bile duct cancer.</h3><div id="CDR0000258011__121"><h4>Intrahepatic bile duct cancer</h4><ul id="CDR0000258011__337"><li class="half_rhythm"><div><b>Stage 0:</b> In stage 0 intrahepatic bile duct cancer, <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_CDR0000044871/" class="def">intrahepatic 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.</div></li><li class="half_rhythm"><div><b>Stage I:</b> Stage I intrahepatic bile duct cancer is divided into stages IA and IB.<div id="CDR0000258011__350" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Tumor%20sizes%20are%20often%20measured%20in%20centimeters%20(cm)%20or%20inches&p=BOOKS&id=558865_CDR0000415526.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65851.13/bin/CDR0000415526.jpg" alt="Drawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).</p></div></div><dl id="CDR0000258011__338" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">In stage IA, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed in an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044871/" class="def">intrahepatic bile duct</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000354457/" class="def">centimeters</a> or smaller.</p></dd><dt>-</dt><dd><p class="no_top_margin">In stage IB, cancer has formed in an intrahepatic bile duct and the tumor is larger than 5 centimeters.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage II:</b> In stage II intrahepatic bile duct cancer, either of the following is found:<dl id="CDR0000258011__339" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread through the wall of an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044871/" class="def">intrahepatic bile duct</a> and into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessel</a>; or</p></dd><dt>-</dt><dd><p class="no_top_margin">more than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage III:</b> Stage III intrahepatic bile duct cancer is divided into stages IIIA and IIIB.<dl id="CDR0000258011__340" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">In stage IIIA, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> has spread through the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsule</a> (outer lining) of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">In stage IIIB, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissues</a> near the liver, such as the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046443/" class="def">duodenum</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046462/" class="def">colon</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomach</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046466/" class="def">common bile duct</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046684/" class="def">abdominal</a> wall, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046451/" class="def">diaphragm</a>, or the part of the vena cava behind the liver, or the cancer has spread to nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>. </p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b> In stage IV intrahepatic bile duct cancer, <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 bone, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, distant <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and most <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen.</div></li></ul></div><div id="CDR0000258011__118"><h4>Perihilar bile duct cancer</h4><ul id="CDR0000258011__341"><li class="half_rhythm"><div><b>Stage 0:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739353/" class="def">stage 0 perihilar bile duct cancer</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 bile duct. 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 or high-grade dysplasia.</div></li><li class="half_rhythm"><div><b>Stage I:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739355/" class="def">stage I perihilar bile duct cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed in the innermost layer of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the perihilar bile duct and has spread into the muscle layer or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000344349/" class="def">fibrous</a> tissue layer of the perihilar bile duct wall.</div></li><li class="half_rhythm"><div><b>Stage II:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739357/" class="def">stage II perihilar bile duct cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread through the wall of the perihilar bile duct to nearby fatty <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> or to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a> tissue.</div></li><li class="half_rhythm"><div><b>Stage III:</b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739359/" class="def">Stage III perihilar bile duct cancer</a> is divided into stages IIIA, IIIB, and IIIC.<dl id="CDR0000258011__342" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Stage IIIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has spread to branches on one side 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>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIIB: cancer has spread to one or more of the following: <ul id="CDR0000258011__349"><li class="half_rhythm"><div>the main part of the portal vein or its branches on both sides;</div></li><li class="half_rhythm"><div>the common hepatic artery;</div></li><li class="half_rhythm"><div>the right hepatic duct and the left branch of the hepatic artery or of the portal vein;</div></li><li class="half_rhythm"><div>the left hepatic duct and the right branch of the hepatic artery or of the portal vein.</div></li></ul></p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIIC: cancer has spread to 1 to 3 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000739361/" class="def">Stage IV perihilar bile duct cancer</a> is divided into stages IVA and IVB.<dl id="CDR0000258011__344" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Stage IVA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread to 4 or more nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IVB: Cancer 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>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a>, bone, brain, skin, distant lymph nodes, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and most <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen.</p></dd></dl></div></li></ul></div><div id="CDR0000258011__34"><h4>Distal bile duct cancer </h4><ul id="CDR0000258011__345"><li class="half_rhythm"><div><b>Stage 0:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413889/" class="def">stage 0 distal bile duct cancer</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 distal bile duct. 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 or high-grade dysplasia.<div id="CDR0000258011__351" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Millimeters%20(mm)&p=BOOKS&id=558865_CDR0000578121.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK65851.13/bin/CDR0000578121.jpg" alt="Millimeters; drawing shows millimeters (mm) using everyday objects. A sharp pencil point shows 1 mm, a new crayon point shows 2 mm, and a new pencil-top eraser shows 5 mm." class="tileshop" title="Click on image to zoom" /></a></div><div class="caption"><p>Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.</p></div></div></div></li><li class="half_rhythm"><div><b>Stage I:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413891/" class="def">stage I distal bile duct cancer</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> has formed and spread fewer than 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> into the wall of the distal bile duct.</div></li><li class="half_rhythm"><div><b>Stage II:</b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413892/" class="def">Stage II distal bile duct cancer</a> is divided into stages IIA and IIB.<ul id="CDR0000258011__346"><li class="half_rhythm"><div>Stage IIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread:<dl id="CDR0000258011__347" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">fewer than 5 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044215/" class="def">millimeters</a> into the wall of the distal bile duct and has spread to 1 to 3 nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>; or</p></dd><dt>-</dt><dd><p class="no_top_margin"> 5 to 12 millimeters into the wall of the distal bile duct.</p></dd></dl></div></li><li class="half_rhythm"><div>Stage IIB: Cancer has spread 5 millimeters or more into the wall of the distal bile duct. Cancer may have spread to 1 to 3 nearby lymph nodes.</div></li></ul></div></li><li class="half_rhythm"><div><b>Stage III:</b>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413893/" class="def">Stage III distal bile duct cancer</a> is divided into stages IIIA and IIIB.<dl id="CDR0000258011__348" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Stage IIIA: <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">Cancer</a> has spread into the wall of the distal bile duct and to 4 or more nearby <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">lymph nodes</a>.</p></dd><dt>-</dt><dd><p class="no_top_margin">Stage IIIB: Cancer 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 1 or more nearby lymph nodes.</p></dd></dl></div></li><li class="half_rhythm"><div><b>Stage IV:</b> In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000413894/" class="def">stage IV distal bile duct cancer</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>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lungs</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> lining the wall of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045070/" class="def">abdomen</a> and most <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organs</a> in the abdomen.</div></li></ul></div></div><div id="CDR0000258011__257"><h3>The following groups are used to plan treatment:</h3><div id="CDR0000258011__259"><h4>Resectable (localized) bile duct cancer</h4><p id="CDR0000258011__261">The cancer is in an area, such as the lower part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046466/" class="def">common bile duct</a> or perihilar area, where it can be removed completely by surgery.</p></div><div id="CDR0000258011__262"><h4>Unresectable (including metastatic and recurrent) bile duct cancer</h4><p id="CDR0000258011__264"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045936/" class="def">Unresectable</a> cancer cannot be removed completely by surgery. Most patients with bile duct cancer cannot have their cancer completely removed by surgery.</p><p id="CDR0000258011__266"><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> bile duct cancer may have spread to the liver, 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><p id="CDR0000258011__265"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">Recurrent</a> bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body.</p></div></div></div><div id="CDR0000258011__51"><h2 id="_CDR0000258011__51_">Treatment Option Overview</h2><div id="CDR0000258011__51.kp" class="box"><h4><span class="title">Key Points for This Section</span></h4><ul><li class="half_rhythm"><div><a href="#CDR0000258011__52">There are different types of treatment for patients
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with bile duct cancer.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__66">Three types of standard treatment are used:</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258011__68">Surgery</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__71">Radiation therapy</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__74">Chemotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258011__79">New types of treatment are being tested in clinical
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trials.</a></div><ul><li class="half_rhythm"><div><a href="#CDR0000258011__295">Liver transplant</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__379">Targeted therapy
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</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__381">Immunotherapy</a></div></li></ul></li><li class="half_rhythm"><div><a href="#CDR0000258011__334">Treatment for bile duct cancer may cause side effects.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__86">Patients may want to think about taking part in a
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clinical trial.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__88">Patients can enter clinical trials before, during, or
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after starting their cancer treatment.</a></div></li><li class="half_rhythm"><div><a href="#CDR0000258011__90">Follow-up tests may be needed.</a></div></li></ul></div><div id="CDR0000258011__52"><h3>There are different types of treatment for patients
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with bile duct cancer.</h3><p id="CDR0000258011__54">
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Different types of
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treatments are available for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000527370/" class="def">bile duct cancer</a>. Some
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treatments are <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> (the currently used treatment), and
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some are being tested in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>. A treatment clinical
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trial is a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651211/" class="def">research study</a> meant to help improve current
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treatments or obtain information on new treatments for patients
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with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>. When clinical trials show that a new treatment is
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better than the standard treatment, the new treatment may
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become the standard treatment. Patients may want to think about
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taking part in a clinical trial. Some clinical trials are open
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only to patients who have not started treatment.</p></div><div id="CDR0000258011__66"><h3>Three types of standard treatment are used:</h3><div id="CDR0000258011__68"><h4>Surgery</h4><p id="CDR0000258011__70">The following types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">surgery</a> are used to treat bile duct
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cancer:</p><ul id="CDR0000258011__151"><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>: A surgical procedure to remove part of the bile duct if the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a> is small and in the bile duct only. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045762/" class="def">Lymph nodes</a> are removed and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046683/" class="def">tissue</a> from the lymph nodes is viewed
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under a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000638184/" class="def">microscope</a> to see if there is cancer. </div></li><li class="half_rhythm"><div> Partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044562/" class="def">hepatectomy</a>: A surgical procedure in which the part of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046312/" class="def">liver</a>
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where cancer is found is removed. The part removed may be a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000322895/" class="def">wedge</a> of tissue, 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></ul><p id="CDR0000258011__310">After the doctor removes all the cancer that can be seen at the
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time of the surgery, some patients may be given <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a> after surgery to kill any cancer
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cells</a> that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant
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therapy</a>. It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back.</p><p id="CDR0000258011__308">The following types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative</a> surgery may be
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done to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a> caused by a blocked bile duct and improve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045417/" class="def">quality of life</a>:</p><ul id="CDR0000258011__309"><li class="half_rhythm"><div>Biliary bypass: If cancer is blocking the bile duct and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046508/" class="def">bile</a> is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the part of the bile duct that is past the blockage or to the small intestine to create a new pathway around the blocked area.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046428/" class="def">Endoscopic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">stent</a> placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407759/" class="def">drain</a> bile that has built up in the area. The doctor may place the stent through a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045637/" class="def">catheter</a> that drains the bile into a bag on the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
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</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000377729/" class="def">Percutaneous transhepatic biliary drainage</a>: A procedure used to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045944/" class="def">x-ray</a> the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000409764/" class="def">Dye</a> is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044678/" class="def">injected</a> into the liver or bile ducts and an x-ray is taken. If the bile duct is blocked, a thin, flexible tube called a stent may be 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></ul></div><div id="CDR0000258011__71"><h4>Radiation therapy</h4><p id="CDR0000258011__73">
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a> is a cancer treatment that
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uses high-energy x-rays or other types of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045072/" class="def">radiation</a> to kill
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cancer cells or keep them from growing. There are two types
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of radiation therapy:
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</p><ul id="CDR0000258011__325"><li class="half_rhythm"><div>
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<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.</div></li><li class="half_rhythm"><div><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 catheters that are placed directly into or near the cancer.</div></li></ul><p id="CDR0000258011__326">External and internal radiation therapy are used to treat bile duct cancer.</p><p id="CDR0000258011__311">It is not yet known whether external radiation therapy helps in the treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044568/" class="def">resectable</a> bile duct cancer. In <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045936/" class="def">unresectable</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>, or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> bile duct cancer, new ways to improve the effect of
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external radiation therapy on cancer cells are being studied:</p><ul id="CDR0000258011__284"><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 make cancer cells
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more sensitive to the effects of radiation therapy and certain anticancer
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046553/" class="def">Radiosensitizers</a>: Drugs that make cancer cells more
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sensitive to radiation therapy. Combining radiation therapy with radiosensitizers may kill more
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cancer cells.</div></li></ul></div><div id="CDR0000258011__74"><h4>Chemotherapy</h4><p id="CDR0000258011__76">
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Chemotherapy is a cancer treatment that uses drugs
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to stop the growth of cancer cells, either by killing the
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cells or by stopping them from dividing. When chemotherapy
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is taken by mouth or injected into a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476471/" class="def">vein</a> or muscle, the
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drugs enter the bloodstream and can reach cancer cells
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throughout the body (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000301626/" class="def">systemic chemotherapy</a>). When chemotherapy
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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
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<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
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cells in those areas (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046559/" class="def">regional chemotherapy</a>).
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</p><p id="CDR0000258011__312">Systemic chemotherapy is used to treat unresectable, metastatic, or recurrent bile duct cancer. It is not yet known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer. </p><p id="CDR0000258011__294">In unresectable, metastatic, or recurrent bile duct cancer, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043968/" class="def">intra-arterial embolization</a> is being studied. It is a procedure in which the blood supply to a tumor is blocked after anticancer drugs are given in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045020/" class="def">blood vessels</a> near the tumor. Sometimes, the anticancer drugs are attached to small beads that are injected into an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000440100/" class="def">artery</a> that feeds the tumor. The beads block blood flow to the tumor as they release the drug. This allows a higher amount of drug to reach the tumor for a longer period of time, which may kill more cancer cells.</p></div></div><div id="CDR0000258011__79"><h3>New types of treatment are being tested in clinical
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trials.</h3><p id="CDR0000258011__81">This summary section describes treatments that are being
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studied in
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>.
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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="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><div id="CDR0000258011__295"><h4>Liver transplant</h4><p id="CDR0000258011__297">In a liver <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046631/" class="def">transplant</a>, the entire liver is removed and replaced with a healthy <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643010/" class="def">donated</a> liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed.</p></div><div id="CDR0000258011__379"><h4>Targeted therapy
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</h4><p id="CDR0000258011__395"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">Targeted therapy</a> is a type of treatment that uses drugs or other substances to identify and attack certain cancer cells. Targeted therapies may cause less harm to normal cells than chemotherapy or radiation therapy do. The following targeted therapies are being studied in patients with bile duct cancer that is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045955/" class="def">locally advanced</a> and cannot be removed by surgery or has spread to other parts of the body:</p><ul id="CDR0000258011__378"><li class="half_rhythm"><div>Ivosidenib is a type of targeted therapy that blocks a specific <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutation</a> in a gene called <i>IDH1</i>. It works by slowing or stopping the growth of cancer cells.</div></li><li class="half_rhythm"><div>Pemigatinib is a type of targeted therapy that blocks specific changes in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">gene</a> called <i>FGFR2</i>. This may help keep cancer cells from growing and may kill them.</div></li></ul></div><div id="CDR0000258011__381"><h4>Immunotherapy</h4><p id="CDR0000258011__387"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">Immunotherapy</a> is a treatment that uses the patient's <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a> to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or biologic therapy.</p><p id="CDR0000258011__412"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000772606/" class="def">Immune checkpoint inhibitor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> is a type of immunotherapy that may be used to treat bile duct cancer.</p><ul id="CDR0000258011__413"><li class="half_rhythm"><div>PD-1 inhibitor: PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. When PD-1 attaches to another protein called PDL-1 on a cancer cell, it stops the T cell from killing the cancer cell. PD-1 inhibitors attach to PDL-1 and allow the T cells to kill cancer cells. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000764538/" class="def">Pembrolizumab</a> is a type of PD-1 inhibitor that may be used in patients whose cancer is locally advanced and cannot be removed by surgery or has spread to other parts of the body.</div></li></ul></div></div><div id="CDR0000258011__334"><h3>Treatment for bile duct cancer may cause side effects.</h3><p id="CDR0000258011__334_73">For information about <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046580/" class="def">side effects</a> caused by treatment for cancer, see our <a href="https://www.cancer.gov/about-cancer/treatment/side-effects" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Side Effects</a> page.</p></div><div id="CDR0000258011__86"><h3>Patients may want to think about taking part in a
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clinical trial.</h3><p id="CDR0000258011__86_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__86_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__86_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__88"><h3>Patients can enter clinical trials before, during, or
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after starting their cancer treatment.</h3><p id="CDR0000258011__88_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__88_30">Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trials search</a> webpage. Clinical trials supported by other organizations can be found on the <a href="https://clinicaltrials.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">ClinicalTrials.gov</a> website.</p></div><div id="CDR0000258011__90"><h3>Follow-up tests may be needed.</h3><p id="CDR0000258011__90_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__90_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__398"><h2 id="_CDR0000258011__398_">Treatment of Resectable (Localized) Bile Duct Cancer</h2><p id="CDR0000258011__399">For information about the treatments listed below, see the <a href="#CDR0000258011__66">Treatment Option Overview</a> section.</p><p id="CDR0000258011__400">Treatment of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044568/" class="def">resectable</a>
|
|
<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000770184/" class="def">intrahepatic bile duct cancer</a> may include:</p><ul id="CDR0000258011__401"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, which may include partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044562/" class="def">hepatectomy</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046436/" class="def">Embolization</a> may be done before surgery.</div></li></ul><p id="CDR0000258011__402">Treatment of resectable perihilar bile duct cancer many include:</p><ul id="CDR0000258011__403"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, which may include partial <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044562/" class="def">hepatectomy</a>.</div></li><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_CDR0000377729/" class="def">percutaneous transhepatic biliary drainage</a> as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a>, to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">jaundice</a> and other <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></ul><p id="CDR0000258011__404">Treatment of resectable distal bile duct cancer may include:</p><ul id="CDR0000258011__405"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045570/" class="def">Surgery</a> to remove the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>, which may include a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046653/" class="def">Whipple procedure</a>.</div></li><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_CDR0000377729/" class="def">percutaneous transhepatic biliary drainage</a> as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative therapy</a>, to relieve <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046328/" class="def">jaundice</a> and other <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></ul><p id="CDR0000258011__406"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">Adjuvant therapy</a> for resectable bile duct cancer may include:</p><ul id="CDR0000258011__407"><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 href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046751/" class="def">External-beam radiation therapy</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045587/" class="def">adjuvant therapy</a>.</div></li></ul><p id="CDR0000258011__TrialSearch_398_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258011__408"><h2 id="_CDR0000258011__408_">Treatment of Unresectable Bile Duct Cancer (Including Metastatic or Recurrent Disease)</h2><p id="CDR0000258011__409">For information about the treatments listed below, see the <a href="#CDR0000258011__66">Treatment Option Overview</a> section.</p><p id="CDR0000258011__410">Treatment of <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_CDR0000527370/" class="def">bile duct cancer</a> (including <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045862/" class="def">recurrent</a> disease) may include:</p><ul id="CDR0000258011__411"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044903/" class="def">Stent</a> placement or biliary bypass as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045815/" class="def">palliative</a> treatment 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_CDR0000046686/" class="def">External</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046345/" class="def">internal radiation therapy</a> as palliative treatment to
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relieve symptoms and improve the quality of life.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045650/" class="def">Combination chemotherapy</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of various combinations of chemotherapy.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045729/" class="def">immunotherapy</a> in patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a> (changes) in certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>.</div></li><li class="half_rhythm"><div>A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270742/" class="def">targeted therapy</a> for patients with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046063/" class="def">mutations</a> (changes) in certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045693/" class="def">genes</a>.</div></li></ul><p id="CDR0000258011__TrialSearch_408_19">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">clinical trial search</a> to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000258011__111"><h2 id="_CDR0000258011__111_">To Learn More About Bile Duct Cancer</h2><p id="CDR0000258011__112">For more information from the National Cancer Institute
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about bile duct cancer, see the following:</p><ul id="CDR0000258011__113"><li class="half_rhythm"><div><a href="https://www.cancer.gov/types/liver" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Liver and Bile Duct Cancer Home Page</a></div></li></ul><p id="CDR0000258011__111_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__111_41"><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">About Cancer</a></div></li><li class="half_rhythm"><div><a href="https://www.cancer.gov/about-cancer/diagnosis-staging/staging" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Staging</a></div></li><li class="half_rhythm"><div><a href="https://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="https://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="https://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="https://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="https://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__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="https://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 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 ("Updated") 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="https://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 can be found online at <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI's website</a>. For more information, call the <a href="https://www.cancer.gov/contact/contact-center" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Cancer Information Service</a> (CIS), NCI's contact center, at 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">PDQ® Adult Treatment Editorial Board. PDQ Bile Duct Cancer (Cholangiocarcinoma) Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/liver/patient/bile-duct-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389290]</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="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>. Visuals Online is a collection of more than 3,000 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="https://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="https://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="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">E-mail Us</a>.</p></div></div></div></div>
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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/NBK65851.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65851.13/?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. Bile Duct Cancer (Cholangiocarcinoma) Treatment (PDQ®): Patient Version. 2020 Jul 1. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65851.22/">NBK65851.22</a></span> May 24, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65851.21/">NBK65851.21</a></span> May 15, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65851.20/">NBK65851.20</a></span> 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class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" 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="#CDR0000258011__1" ref="log$=inpage&link_id=inpage">General Information About Bile Duct Cancer</a></li><li><a href="#CDR0000258011__25" ref="log$=inpage&link_id=inpage">Stages of Bile Duct Cancer</a></li><li><a href="#CDR0000258011__51" ref="log$=inpage&link_id=inpage">Treatment Option Overview</a></li><li><a href="#CDR0000258011__398" ref="log$=inpage&link_id=inpage">Treatment of Resectable (Localized) Bile Duct Cancer</a></li><li><a href="#CDR0000258011__408" ref="log$=inpage&link_id=inpage">Treatment of Unresectable Bile Duct Cancer (Including Metastatic or Recurrent Disease)</a></li><li><a href="#CDR0000258011__111" ref="log$=inpage&link_id=inpage">To Learn More About Bile Duct Cancer</a></li><li><a href="#CDR0000258011__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65869/">Health Professional Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389165" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Delirium (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389398" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pruritus (PDQ®): Patient Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pruritus (PDQ®): Patient Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" 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