Cholangiocarcinoma (Bile Duct Cancer) Treatment in Malaysia

What is Cholangiocarcinoma (Bile Duct Cancer)?

Cholangiocarcinoma is a rare cancer that develops in the bile ducts. Bile ducts are narrow tubes that transport bile (a fluid used to break down fats) from the liver and gallbladder to the small intestine.

It is an aggressive cancer, meaning it spreads quickly. Cholangiocarcinoma is usually diagnosed after it has progressed outside of the bile ducts. Cholangiocarcinoma, often known as bile duct cancer, most commonly affects persons over the age of 50, but it can occur at any age.

What is the Importance of Timely Treatment?

• Early therapy is crucial for improving outcomes and raising survival rates in cholangiocarcinoma.
• It prevents cancer from spreading to other organs, increasing therapy effectiveness.
• Surgery may be an option if identified early, giving the best chance of long-term survival.
• Delays in treatment can cause cancer to spread, resulting in problems such as jaundice, liver damage, and infection.
• Targeted therapies, such as chemotherapy, can help with disease control and symptom management.
• Timely intervention improves prognosis, reduces complications, and enhances the quality of life for patients.

What are the Common Symptoms of Cholangiocarcinoma (Bile Duct Cancer)?

Signs and symptoms of cholangiocarcinoma include:

• Yellowing of your skin and the whites of your eyes (jaundice)
• Intensely itching skin
• White-coloured stools
• Fatigue
• Abdominal pain on the right side, just below the ribs
• Losing weight without trying
• Fever
• Night sweats
• Dark urine

Types of Bile Duct Cancer

Cholangiocarcinoma is categorised into three types:

• Intrahepatic Cholangiocarcinoma: It's bile duct carcinoma in your liver.
• Perihilar (Hilar) Cholangiocarcinoma: It is bile duct carcinoma in the hilum. The hilum is the area right outside your liver where the smaller bile ducts from within your liver join to form the common hepatic duct. It is the most frequent type of cholangiocarcinoma. Perihilar cholangiocarcinoma is also known as Klatskin tumour.
• Distal cholangiocarcinoma: It is Bile duct cancer that begins outside the liver, in the ducts closest to the small intestine.

Causes, Risk Factors and Complications of cholangiocarcinoma (Bile Duct Cancer)

Causes

Cholangiocarcinoma develops when cells in the bile ducts change their DNA. A cell's DNA includes instructions that teach it what to do. The modifications cause the cells to proliferate out of control, resulting in a mass of cells (tumor) that can infiltrate and kill healthy bodily tissue.

Risk Factors

The following factors may raise your risk of developing cholangiocarcinoma:

• Primary sclerosing cholangitis: This condition hardens and scars the bile ducts.
• Chronic liver illness: A history of chronic liver disease raises the likelihood of developing cholangiocarcinoma by scarring the liver.
• Bile duct issues are evident at birth: People born with a choledochal cyst, which produces dilated and uneven bile ducts, are at a higher risk for cholangiocarcinoma.
• A liver parasite. In Southeast Asia, cholangiocarcinoma is linked to liver fluke infection, which can result from eating raw or undercooked seafood.
• Older age: Cholangiocarcinoma most commonly affects adults over the age of 50.
• Smoking: Smoking is linked to an increased risk of cholangiocarcinoma.
• Diabetes: People with type 1 or 2 diabetes may be at a higher risk for cholangiocarcinoma.

Complications

If cholangiocarcinoma is not treated or discovered immediately, it can cause significant complications:

• Bile duct obstruction: This can cause jaundice, infection, or liver failure.
• An infection of the bile ducts (Cholangitis)
• Cancer-related liver failure.
• Metastasis: Treatment becomes more complicated when cancer spreads to surrounding organs or distant bodily parts.
• Blood clots: Cancer increases the risk of deep vein thrombosis and pulmonary embolism.

Latest Research and Technologies in the Treatment of Cholangiocarcinoma (Bile Duct Cancer) in Malaysia

• Treatment advances for cholangiocarcinoma in Malaysia include immunotherapy with immune checkpoint inhibitors, especially for tumours with microsatellite instability, and targeted therapies with BRAF and MEK inhibitors for specific genetic mutations, providing more individualised and efficient treatment options.

Cholangiocarcinoma (Bile Duct Cancer) Prevention Tips

While it is not always possible to prevent cholangiocarcinoma, specific lifestyle changes and preventive measures can reduce the risk:

• Avoid liver fluke infections by eating well-cooked fish and avoiding contaminated water in endemic areas.
• Protecting oneself against infections, including hepatitis B, C, and HIV.
• Hepatitis B vaccination can lower the chance of developing hepatitis-related liver cancer.
• Maintain a healthy weight to lower your risk of obesity-related liver disorders, which are associated with cholangiocarcinoma.
• Quit smoking to minimise your risk of developing liver cancer.
• Limit your alcohol usage to lower your risk of developing cirrhosis and other liver problems.