February is Gallbladder and Bile Duct Cancer Awareness Month. Bile Duct Cancer is a complex and rare cancer that is also known as cholangiocarcinoma or bile duct tumors. Johanna Bendell, MD, Chief Development Officer at Sarah Cannon Research Institute is a leader in the field and discusses the intricacies of this cancer.

It’s not just one, but three types of cancer.

Bile duct cancer is the growth of cancer cells in the bile duct, a number of branching tubes that carry bile (a fluid that helps digest food and eliminate waste from the body) from the liver to the gallbladder and small intestine. There are actually three types of bile duct tumors, depending on the location in the bile duct.

• Cholangiocarcinoma, which is a bile duct tumor that arises from the bile duct branches inside the liver
• Gall bladder cancer, which arises from the gall bladder.
• Ampullary cancers, which occur where the common bile duct attaches to the duodenum (small intestine).

“While they all involve the bile duct they are three distinct diseases that likely have three different biologies,” said Dr. Bendell.

Although rare, there are treatment options.

“Bile duct cancer is a rare form of cancer, with only about 4,000 new cases in the U.S. each year, compared to 150,000 cases of colon cancer per year,” said Dr. Bendell. Even more challenging, there are no screening tests currently available, and generally no indications in the early stages. It’s not until the cancer has advanced that symptoms become apparent, such as jaundice, abdominal pain or changes in the urine and stool.

But once diagnosed, there are treatment options. These include:

• Surgery to remove the tumor and possibly part of the affected organ
• External or internal radiation therapy given possibly in conjunction with surgery
• Chemotherapy, mostly for advanced disease, but can be used prior to surgery to try to shrink a tumor, after surgery to try to prevent the tumor from coming back, or in combination with radiation therapy
• Liver-directed therapies – these can include radiation therapy such as Stereotactic Body Radiotherapy (SBRT) that delivers radiation to that distinct local area, chemoembolization that sends the anti-cancer drug into the blood vessel feeding the tumor along with a blood vessel blocking particle that keeps it there, and radiofrequency ablation (RFA) where a probe is inserted in the tumor and the probe is heated to kill the tumor, to name just a few.

“Another therapy we specialize in here at Sarah Cannon is radioembolization. Tiny plastic microbeads that have radiation on the outside are injected into the blood vessels in the liver, where they deliver a high dose of radiation directly to the tumor to kill it.”

Research is ongoing.

While bile duct tumors are rare, there is significant research conducted. “At Sarah Cannon Research Institute, we have several clinical trials underway,” said Dr. Bendell. “One involves using targeted therapy for bile duct tumors with IDH1 or IDH2 mutations, while others are studying immunotherapy and a class of drugs called MEK inhibitors. So there is most definitely active research going for these patients.”

Want to learn more about the bile duct cancer research being conducted at Sarah Cannon? Please contact our askSARAH help line at (844) 482-4812.