Bile duct cancer care

At Allina Health, we will work with you during every step of your care, from diagnosis to treatment and recovery. You will have a team of highly experienced cancer care specialists who work together seamlessly, which includes your primary care provider, medical and radiation oncologists, advanced practice providers, surgeons, radiologists, pathologists and nurses who specialize in cancer care. This care will be coordinated by a nurse navigator, who will be your primary point of contact. This can help reduce your stress and makes it easier for you to get the care you need. 

We also want you to be actively involved in your care. One way you can do that is through the Allina Health account, an online tool that lets you track your appointments, review your test results, communicate with your team and more.  

In the diagnosis of bile duct cancer, your provider will order tests and diagnostics to gather the information needed to make a diagnosis. These tests may include:

• Blood tests: Blood tests can assess your liver function and provide a complete blood count (CBC) to better understand your overall health and detect any potential medical conditions. Another blood test, known as the tumor marker test, checks the level of cancer antigen (CA) 19-9, which bile duct cancer cells overproduce. If CA 19-9 levels are high, it can indicate bile duct cancer.   
   
• Imaging tests: Imaging tests produce pictures of specific areas in the body. Imaging tests that may be performed include: ultrasound, computerized tomography (CT) scans and magnetic resonance imaging (MRI), which can be combined with magnetic resonance cholangiopancreatography (MRCP) to provide detailed pictures of biliary and pancreatic ducts.
   
• Biopsy of bile duct tissue:  Biopsy of these tumors is most often by endoscopic ultrasound (EUS) and/or through the ERCP procedure. A biopsy of the tumor through the abdomen also can be done but typically is not the first choice for biopsy.
   
• Endoscopic retrograde cholangiopancreatography (ERCP): This diagnostic involves the insertion of a thin, lighted scope (duodenoscope) down the esophagus and into the digestive system to view the bile duct, liver, pancreas and gallbladder. The specialist or advanced gastroenterologist may take samples for biopsy and may introduce a contrast dye through a small tube (cannula), passed through the duodenoscope, to help the bile ducts show up better on imaging tests. 

Your health care team will work closely with you to determine the best type of cancer treatment. The main treatment for bile duct cancer is surgery to remove the tumor.

Other treatments that may be used with surgery, or if surgery is not an option, include:   

Liver-directed therapies: These therapies may include: 

• Microwave ablation: heating the cancer cells to destroy them. 
   
• Radioembolization: placing tiny beads filled with radiation into the liver to destroy cancer cells. 

Systemic therapy: This treatment affects your entire body. Medicine is used to help slow the growth of cancer cells or destroy them. Types of systemic therapy include: 

• Chemotherapy: powerful drugs used to kill cancer cells, control their growth or relieve symptoms. 
   
• Immunotherapy: this treatment uses the body’s own immune system to fight cancer cells.  
   
• Targeted therapy: this treatment uses medications to target specific genes and proteins in cancer cells.  

Surgery may also be used to manage your cancer. If unable to remove all of the cancer, biliary drainage surgery may be performed to bypass the bile duct around the cancer to restore the flow of bile. 

• A stent may be placed to relieve the obstruction caused by the cancer to help maintain normal flow of bile.
   
• If unable to place a stent, a special drainage catheter may need be placed from the outside of the abdomen into the liver, and specifically the bile duct, by a radiology specialist. This drain is called a percutaneous transhepatic catheter (PTC).

If your primary care provider suspects bile duct cancer, you will be referred to a medical oncologist and a team of experts that may include a hepatologist, oncologist, nurse navigator, interventional radiology, surgery and gastrointestinal specialist.

It is recommended that you check with your health insurance provider to be sure of what is covered under your health insurance plan. Ideally, you should do this before you undergo testing and treatment so you know what is covered and what you will need to pay for on your own. 

Contact your health insurance provider any time you have questions about your coverage. You can do this by calling the number on your membership card.