What is advanced bile duct cancer?

Advanced bile duct cancer means the cancer has spread either:

• outside the bile ducts into nearby lymph nodes or organs - this is called locally advanced bile duct cancer
• to another part of the body such as the lungs – this is called metastatic or secondary cancer

Unfortunately, most people with bile duct cancer already have advanced cancer when they are diagnosed. This is because bile duct cancer usually doesn’t cause symptoms early on. And when it does, they can be vague and difficult to spot.

The only potential cure for bile duct cancer is having surgery to remove it. If you can’t have surgery, or if the cancer comes back after the operation, the aim of treatment is to control the symptoms and improve your quality of life.

Locally advanced bile duct cancer

Bile duct cancers tend to spread locally along the bile ducts into lymph nodes or organs nearby. The cancer might have spread into the:

• liver
• small bowel
• pancreas
• nearby major blood vessels

The tests you had to stage the cancer show whether surgery might be possible or not. Unfortunately, if you are not well enough to have the operation you won’t be able to have the cancer removed. This is because surgery for bile duct cancer is a major operation

Secondary cancer

This means that the bile duct cancer cells have spread through the bloodstream or lymphatic system to organs further away.

The most common places for bile duct cancer to spread are the:

• lining of the abdomen (peritoneum)

• liver further away from the bile ducts

• lymph nodes away from the bile ducts

• lungs

• bones

• brain

• skin

Treatment options for advanced bile duct cancer

Deciding which treatment to have, or whether to have treatment at all, can be difficult.

Unfortunately, treatment for advanced bile duct cancer may affect your quality of life. It is important to understand what the aim of treatment is and what the side effects are. It is also important to think about other factors. This includes the amount of time you’ll spend in hospital or travelling to appointments.

Your doctor and specialist nurse will talk this through with you and answer any questions you have. You might also find it helpful to talk things over with a close relative or friend. Or there may be a counsellor at the hospital you can talk to.

Types of treatment

A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).

The best treatment for you depends on:

• if you can have surgery to remove locally advanced bile duct cancer
• where the cancer has spread to
• the size and number of any secondary cancers
• if there are gene changes (mutations) in the cancer cells
• your general health
• any treatment you have already had
• your symptoms
• your wishes

Chemotherapy

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.

You normally have a combination of chemotherapy drugs as your first treatment for advanced bile duct cancer. You might have them with an immunotherapy drug. Immunotherapy uses the immune system to attack cancer cells.

If the cancer starts to grow after you’ve had chemotherapy, you might have a different chemotherapy drug combination. This depends on whether the cancer has any gene changes or not.

Targeted and immunotherapy drugs

People with advanced bile duct cancer have the cancer checked for gene changes (mutations). These changes can make the cancer grow.

If the bile duct cancer has a gene change, targeted cancer drugs or immunotherapy can slow its growth. You may have them if the first chemotherapy treatment doesn’t work.

Which treatment you have depends on which gene has the change.

Radiotherapy

Radiotherapy uses high energy x-rays to treat cancer cells. Some people might have radiotherapy to help control the symptoms of bile duct cancer.

Other treatments to control the symptoms of advanced bile duct cancer

Bile duct cancer can block the bile ducts. This can cause yellowing of the skin and white of the eyes (jaundice). Your doctor usually puts in a small tube called a stent to relieve the blockage. 

You can also have medicines such as painkillers or anti sickness drugs to help relieve symptoms.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial for advanced bile duct cancer. Researchers do trials to make existing treatments better and develop new treatments.

Coping with advanced bile duct cancer

Finding out that you have advanced bile duct cancer, or that your cancer has come back, can be devastating. You may feel shocked and confused. And you may find it difficult to take in anything that is being said to you.

There is support available to help you cope with the effects of advanced cancer. You can read more about it on our coping with advanced bile duct cancer page.