Fast Facts for Patients and Supporters: Cholangiocarcinoma

K. Spencer, C. Denlinger

Description

Cholangiocarcinoma (bile duct cancer) is a cancer of the bile duct and liver. A person can seem healthy and/or can have a variety of symptoms, such as weight loss, bloating, abdominal pain, jaundice (yellowing of the skin and/or eyes), itchy skin, dark urine and/or pale stools. The location of the tumor within the liver/bile duct and its size and spread to other areas of the body will determine the cancer treatment plan. Treatment options may include surgery, chemotherapy, radiotherapy, liver transplant, targeted therapies and clinical trials. This book aims to help patients understand their options, enabling informed decisions, in conjunction with their doctor and other members of the medical team, about their cancer treatment. Table of Contents: • Understanding cholangiocarcinoma • How does cholangiocarcinoma develop? • Symptoms • Seeing your doctor • Diagnostic tests and procedures • Staging • Biomarker testing • Multidisciplinary teams and tumor boards • Surgery • Radiation therapy • Systemic therapy • Treatments and schedules • Infusion therapy • Clinical trials • What new treatments are being studied? • Targeted treatments • Taking part in research • Palliative procedures • Stents • Reducing side effects • Follow-up care • Outlook • If treatment is unsuccessful • Coping • Being supported • What can I do to help myself?

Sujets

• Gastroenterology

Informations

• Publié par: S. Karger AG
• Date de parution: 08 avril 2021
• Nombre de lectures: 0
• EAN13: 9783318068146
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

First, the facts ...

Cholangiocarcinoma (bile duct cancer) is a cancer of your bile duct and liver.
A person can seem healthy and/or can have a variety of symptoms, such as weight loss, bloating, abdominal pain, jaundice (yellowing of the skin and/or eyes), itchy skin, dark urine and/or pale stools.
The location of your tumor within the liver/bile duct and its size and spread to other areas of the body will determine your cancer treatment plan.
Treatment options may include surgery, chemotherapy, radiotherapy, liver transplant, targeted therapies and clinical trials, but will depend on your individual cancer and health.
Taking care of yourself is important, and there are things you can do to help with your cancer treatment.

This book aims to help you understand your options so you can talk to your doctors, nurses and medical team about your cancer and its treatment. Use the spaces on the pages to organize your notes and questions.

My main concerns
Make a note of anything you want to discuss with your doctor here.
Understanding cholangiocarcinoma
Symptoms
Diagnostic tests and procedures
Staging
Biomarker testing
Surgery
Radiation therapy
Systemic therapy
Infusion therapy
Targeted treatments
Palliative procedures
Stents
Drains
Reducing side effects
Follow-up care
What can I do to help myself?
Understanding cholangiocarcinoma
Cholangiocarcinoma is a cancer of the body s hepatobiliary system, which includes the liver, gallbladder and tubes called bile ducts.
The hepatobiliary system makes, stores and transports bile. Bile helps the body break down fat in the diet and get rid of waste from the body.

The liver makes bile, which is collected in small tubes (ductules) and funneled into increasingly larger ducts as it is carried through the liver. As the bile leaves the liver, the duct system merges into left and right hepatic ducts. These two ducts leave the liver and join at the hilum to form the common hepatic duct.
The gallbladder stores bile. It connects to the hepatobiliary system about one-third of the way down the common hepatic duct, via the cystic duct. This duct is now called the common bile duct, and it continues through the pancreas before reaching the small intestine (the destination for the bile).

Knowledge point
Cholangiocarcinoma is also called bile duct cancer.
There are two main types of cholangiocarcinoma : intrahepatic and extrahepatic.
Intrahepatic cholangiocarcinoma occurs in the bile ducts inside the liver.
Extrahepatic cholangiocarcinoma occurs in the bile ducts outside the liver. These drain bile into the small intestine.
A perihilar tumor is an extrahepatic cholangiocarcinoma that develops at or near the junction of the left and right bile ducts (the hilum). These tumors were previously called Klatskin tumors.
A distal tumor develops in the common bile duct.
Cholangiocarcinomas are rare tumors, accounting for only about 3 in every 100 cancers in the gastrointestinal system. Perihilar tumors are the most common type of cholangiocarcinoma (approximately half), followed by distal tumors (approximately 4 in every 10), and intrahepatic tumors (approximately 1 in every 10).

How does cholangiocarcinoma develop?
The starting point for cholangiocarcinoma is a harmful change (mutation) to the DNA in cells in the bile duct. One of the effects is that cells start to grow and divide without the usual controls. Eventually, a mass of cells forms a tumor.
Doctors do not know exactly what causes the changes in the DNA, though some medical conditions and lifestyle factors increase the risk.

Medical conditions and lifestyle factors that increase the risk
Bile duct: primary sclerosing cholangitis, primary biliary cirrhosis, bile duct stones or cysts
Digestive system: inflammatory bowel disease (Crohn s disease or ulcerative colitis), chronic pancreatitis
Diabetes
Chronic liver disease: cirrhosis, hemochromatosis, fatty liver disease (non-alcoholic fatty liver disease or NASH), hepatitis B or C
Obesity
Smoking
High alcohol intake
Infection with liver fluke (a problem in some South-East Asian countries)
Symptoms
The symptoms of cholangiocarcinoma can vary from person to person. Intrahepatic and extrahepatic cholangiocarcinomas may cause different symptoms. If the tumor blocks the flow of bile, infections can cause fever, chills and yellowing of the skin and eyes (jaundice).
Intrahepatic cholangiocarcinoma
Symptoms may be caused by the tumor mass in the liver. Abdominal pain, bloating, weight loss, fatigue, jaundice, itching, or sweats at night are common symptoms.
If symptoms are mild or absent, the cancer may be discovered by chance during blood tests, imaging or surgery for other reasons.
Extrahepatic cholangiocarcinoma
The skin or eyes may become yellow (jaundice) and the skin may become itchy. Urine color may be darker than usual. Stools may become pale. A person may feel fatigued (extremely tired) and lose weight.


Seeing your doctor
If you see your doctor about your symptoms, you will probably also be asked about your family history, any medical problems affecting you now or in the past, medications you take and whether you smoke or drink alcohol. You will usually have a physical examination, too.
You may be asked for a sample of blood and/or urine. Tests on these samples may include:
a complete blood count (CBC) to look at the number and types of different cells in the blood (white blood cells, red blood cells and platelets)
a comprehensive metabolic panel (CMP) , which is a package of tests that measure how well your kidneys and liver are working
tests for proteins (tumor markers) in the blood, as levels can be higher than normal in certain types of cancer.

Your doctor may also recommend imaging. This involves taking pictures (or images) of the site where the cancer started. Other areas may also be checked to see if the cancer has spread.

Who s who?
Medical oncologist: a doctor who specializes in the treatment of cancer, typically with chemotherapy, targeted therapy or immunotherapy (see page 21 ). A medical oncologist typically oversees the care of people with cholangiocarcinoma and coordinates between other specialists.
Radiation oncologist: a doctor who treats cancer using radiation therapy.
Gastroenterologist: a doctor who diagnoses and treats disorders of the gastrointestinal tract. An interventional gastroenterologist can place stents in the bile ducts to help the flow of bile (see page 32 ).
Interventional radiologist: a doctor who specializes in carrying out procedures using imaging for guidance. An interventional radiologist may put a drain in place (see page 34 ).
Surgeon: a doctor who performs surgery to remove a cancerous part of the liver or bile duct. The surgeon can be a surgical oncologist (specializing in cancer surgery), hepatobiliary surgeon (specializing in surgery on the liver and/or pancreas), liver transplant surgeon (specializing in transplanting livers) and/or a general surgeon (who performs different types of surgery).
Nurse: a person trained to assess individuals and provide education on treatment and symptom management. Nurses work closely with doctors to coordinate care.
Nutritionist or dietician: a health professional who is trained and certified to provide guidance on how and what to eat to help improve the diet.
Social worker: a person who may provide emotional or practical support by providing counseling or information on community resources, as well as guidance regarding financial and insurance issues.
Advanced practice clinician: a person trained as either a nurse practitioner or physician assistant. Advanced practice clinicians provide care under the supervision of the doctor, but they can see patients and prescribe medications independently.
Patient navigator: a person, who may also be a nurse, who helps with scheduling, obtaining materials for appointments and coordinating care.
Clinical trial/research co