We're Ready To Help Call us to schedule an appointment or contact us online 
|
|
|
Several treatment options are available for patients with gallbladder or bile duct cancer depending upon which organ is involved, how extensive the tumor is, and the patient's general health and age.
Surgery
Surgery in this region of the body can be difficult for several reasons, particularly if a tumor has spread beyond its initial location or if it involves more than one organ. Most surgeries to remove gallbladder or bile duct cancer do involve multiple organs, simply because of the close proximity and overlap of the hepatobiliary region of the body. Also, many of the major blood vessels pumping blood to and from the heart pass behind or through the liver, further increasing the complexity of surgery.
For most biliary cancers, surgery is often the most effective therapy, and therefore proper surgical evaluation is an important part of a treatment plan. Our surgeons have developed a full range of techniques to ensure that surgery is effective and safe, which often allow us to perform surgery on tumors considered inoperable elsewhere. If additional treatment is necessary following surgery, experienced gastroenterologists, interventional radiologists, radiation oncologists, and medical oncologists are available.
Surgery for gallbladder and bile duct cancer depends upon the location of the tumor. It usually requires surgical removal of portions of the liver, pancreas, and -- almost always -- local lymph nodes. For example, when surgery is performed to remove a tumor in the gallbladder, it usually involves removing portions of the liver, which is a very complicated surgery. Since hepatocellular cancer is relatively rare in the United States, many surgeons may not have experience performing liver resections. (Our surgeons perform the highest number of liver surgeries of any cancer center in the country -- 300 to 400 per year.)
Intrahepatic bile duct cancer, which is bile duct cancer within the liver, almost always involves some degree of liver surgery. Extrahepatic bile duct cancer, which is bile duct cancer outside the liver, involves surgery on the bile duct and almost always includes the liver. Distal bile duct cancer -- found in the common bile duct near the intestine and pancreas -- sometimes involves surgical resection of the pancreas.
Our surgeons are also pioneering laparoscopic surgical methods. In this type of surgery, a small incision is made and a thin, lighted tube (called a laparoscope) is inserted through the abdominal wall to inspect the inside of the abdomen and remove a tissue sample. This technique is sometimes used to stage (determine the extent of) a cancer, which may eliminate the need for exploratory surgery. Laparoscopic surgical methods have also been used to biopsy cancers by removing a small piece of the cancer to examine further once it is removed. Since the procedure is less invasive than traditional surgery, recovery is faster.
Since the gallbladder is so close to the liver, treating gallbladder cancer usually involves the surgical removal of a portion of the liver. At many institutions, surgeons may not be experienced with these types of cancers, and that may have an effect on the outcome of surgery. Our physicians can often safely remove these tumors and offer a good chance of long-term survival for the patient.
Approaches to Image-Guided Therapies
Although surgery remains the best treatment option for most patients with gallbladder and bile duct cancer, many individuals are not candidates for surgery by the time their cancer is detected. For some, minimally invasive, image-guided treatments provide palliation for symptoms related to the obstruction of the bile duct. These image-guided procedures are performed percutaneously -- through the skin without the need for an incision. They can be very effective but are usually intended to control symptoms.
Biliary Drainage
In some patients, hepatobiliary cancers may cause the bile duct to become obstructed. A blocked bile duct can cause jaundice, itching of the skin, nausea, vomiting, and fever. If this obstruction cannot be relieved through surgery, radiation therapy, or chemotherapy, biliary drainage procedures can be used to relieve jaundice. These procedures are used to relieve symptoms and improve quality of life; they are not curative. Biliary drainage is typically used when a patient cannot be treated in any other way, or if an obstruction is not resolved by other cancer therapies.
Biliary drainage is used in response to any of the following three conditions:
- When infection occurs
- If jaundice is making the patient uncomfortable
- If doctors are treating the condition with a certain kind of chemotherapy
Biliary drainage involves inserting a small tube through the liver into the obstructed bile duct. Sometimes it is necessary for the tube to be connected to a drainage bag outside of the patient. In many cases, a stent can be inserted into the obstructed bile duct, so that there is no tube outside of the body.
Adjuvant Therapy
Adjuvant therapy is treatment given following primary treatment in order to increase the chances of a cure in specific cases of gallbladder cancer. This may include chemotherapy, radiation therapy, or any other form of treatment that is given after a tumor is surgically removed.
Chemotherapy
While there is no chemotherapy regimen that is established as a "standard of care" for the treatment of gallbladder cancer or bile duct cancer, different chemotherapy regimens have shown good results in the treatment of these diseases. In few instances, chemotherapy may be administered to shrink a tumor in order to increase the chances of surgical resection. Gemcitabine, fluorouracil (5FU), and a combination of other drugs are the most common chemotherapy regimen for gallbladder or bile duct cancer. Intrahepatic infusion chemotherapy can be administered directly to this region of the body through a pump in the abdomen.
With the lack of a standard of care, our medical oncologists' team at Memorial Sloan-Kettering is usually involved in developing clinical trials that helps identify potentially new active therapies, especially novel targeted therapies, for gallbladder cancer or bile duct cancer.
Radiation
Physicians at Memorial Sloan-Kettering also helped develop brachytherapy to treat hilar cholangiocarcinomas, which are bile duct tumors just outside the liver. In this outpatient procedure, radioactive seeds are sent through catheters in the gallbladder and bile duct to deliver high-dose radiation directly to the tumor. Physicians use ultrasound images of the gallbladder and bile duct to determine the most effective placement of the seeds; the seeds are then permanently implanted into the gallbladder and bile duct. The seeds are tiny (about the size of sesame seeds) and cause little or no discomfort, and their radioactivity diminishes over time.
A combination treatment of chemotherapy and radiation therapy is sometimes used for gallbladder and bile duct cancer.
