Treatment options for bile duct cancer

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

The treatment you have depends on:

• where in the bile ducts the cancer is
• how big it is and whether it has spread (the stage)
• is it near important blood vessels?
• can doctors removed the cancer completely by surgery?
• your general health and level of fitness

Your doctor will discuss your treatment, its benefits and the possible side effects with you. 

Deciding which treatment you need

To decide about what treatment you need, your team looks at your tests and scan results to see if they can remove (resect) the cancer or not. Your cancer can be:

Resectable, which means they can remove it with surgery.

Unresectable, which means that surgery to remove the cancer is not possible. The cancer may have grown into nearby organs (locally advanced) or spread elsewhere in the body (advanced).

Treatment for resectable bile duct cancer

This usually means that the cancer is only in the bile ducts or has grown just outside it. Generally, early stage bile duct cancers are resectable.

Your surgeon removes the cancer and an area of tissue around it that doesn’t contain any cancer cells.

The type of surgery you have depends on where the bile duct cancer is. Surgery for bile duct cancer is a major operation. Your surgeon will only suggest surgery if you are fit enough to cope with a major operation.

You might have the chemotherapy drug capecitabine after surgery. This helps to lower the chance of the cancer coming back. You usually have capecitabine for 6 months.

Treatment for unresectable bile duct cancer

This usually means that cancer has grown into the nearby organs, or spread elsewhere in the body.

You usually have chemotherapy if you can't have surgery. This can help to control the growth of the cancer and relieve symptoms. Common chemotherapy treatments include:

• gemcitabine and cisplatin
• a combination of chemotherapy drugs called FOLFOX

You may also have a targeted cancer drug called pemigatinib. You can only have this if you have a change in a gene called the FGFR2 gene . Pemigatinib works by blocking proteins that tell cancer cells to grow and divide. It is a type of targeted cancer drug called cancer growth blocker.

Or you might have gemcitabine and cisplatin chemotherapy with a type of immunotherapy drug called durvalumab (Imfinzi). Immunotherapy uses the immune system to attack cancer cells. 

You might also have other treatments to help control your symptoms. Treatments include painkillers and having a tube (stent) put in to clear a blockage in your bile ducts.

Treatment to control symptoms of bile duct cancer

Bile duct cancer can cause symptoms such as:

• weight loss
• pain in the stomach area
• yellowing of the skin

You usually see the symptom control team (palliative care team). They help to manage your symptoms. You might have different treatments depending on the type of symptoms you have. This might include painkillers and anti sickness medicines.

You might also have radiotherapy to help control cancer spread (metastases) and relieve symptoms.

Treatment to clear a blockage in the bile ducts

Bile duct cancer can block the bile ducts and cause symptoms such as yellowing of the skin and whites of the eyes (jaundice). Your doctor usually puts in a tube called a stent to relieve the blockage and allow bile to flow into the bowel again.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Your choices

Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:

• whether you need extra appointments
• if you need more tests
• the distance you need to travel to and from hospital

You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.

If you decide not to have treatment

You may decide not to have cancer treatments such as chemotherapy. But you can still have medicines to help control symptoms such as sickness or pain.

Your doctor or nurse will explain what treatment you can have. They can also refer you to a local symptom control team to give you support at home.

Getting a second opinion

You might feel that you would like to get an opinion from a second doctor before deciding about your treatment. If so, ask your specialist or your GP to refer you to a doctor specialising in liver and bile duct cancers.

It can be better to arrange a second opinion through your specialist because they can send all your notes and test results with you.

Do remember that a second opinion does not necessarily mean that the second doctor will take over your care. Your treatment will usually still be managed by your original specialist.