Treatments for resectable biliary tract cancers

The following are treatment options for resectable biliary tract cancers. Resectable means the tumour can be completely removed with surgery. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Surgery is the main treatment for resectable gallbladder or bile duct cancer. The type of surgery and amount of tissue that needs to be removed depends on several factors about the cancer including the stage and where the cancer started.

Find out more about surgery for cancer and side effects of surgery.

A cholecystectomy is a procedure that removes the gallbladder.

A simple cholecystectomy removes only the gallbladder. It may be used for small tumours in the gallbladder. Simple cholecystectomies are also used for non-cancerous conditions of the biliary tract.

An extended cholecystectomy removes the gallbladder as well as part of the liver, nearby tissues and lymph nodes.

A radical cholecystectomy( also called a radical resection) removes more of the surrounding tissue than an extended cholecystectomy. How much is removed depends on where the biliary cancer is and how much it has spread. In addition to the gallbladder and part of the liver, a radical cholecystectomy may remove:

• lymph nodes around nearby organs, such as the pancreas and nearby blood vessels
• bile ducts and the pancreatic duct
• the pancreas
• part of the ligament (band of tissue) that runs between the liver and the intestines
• the duodenum

An extended or radical cholecystectomy is typically used to treat early-stage gallbladder adenocarcinoma or perihilar cholangiocarcinoma that is found before surgery. But since early-stage biliary tract cancer causes very few symptoms, it is more often found when the gallbladder has been removed for a non-cancerous disease. If tests show that the cancer likely has spread to the area around the gallbladder, additional surgery will be done to remove more tissue.

Cholecystectomy procedures can be done through laparoscopic surgery or open surgery. With laparoscopic surgery, the surgeon makes several small cuts (incisions) on the right side of the abdomen. They will then pass a laparoscope (a long, flexible tube with a light and camera) through one incision to view the area. The gallbladder is removed through another incision. With open surgery, the gallbladder is removed through a wide cut in the upper-right part of the abdomen.

If the doctor thinks you have a biliary tract cancer, the surgeon will use open surgery to do a cholecystectomy to avoid cancer spreading to other parts of the abdomen or edges of the cuts that were made during surgery. If cancer is found during a laparoscopic cholecystectomy, the surgeon will transition to doing open surgery to remove as much of the tumour as possible. If cancer is found in the middle of either laparoscopic or open surgery and the tumour is not resectable, the surgeon will stop the surgery.

A hepatectomy is a procedure to remove all or part of the liver.

A partial hepatectomy removes part of the liver. A hepatic lobectomy removes an entire lobe( the right or left half of the liver). How much of the liver is removed depends on where the cancer is and how much it has spread. A hepatectomy can be done using a laparoscopic or open surgery.

A partial hepatectomy or hepatic lobectomy is typically used to treat intrahepatic cholangiocarcinoma.

A Whipple procedure ( pancreaticoduodenectomy) removes the gallbladder, bile ducts, pancreatic ducts, part of the pancreas, and the duodenum. It is typically used to treat distal cholangiocarcinoma.

Find out more about the Whipple procedure.

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may be used to:

• try to shrink a tumour to make it resectable so that it can be removed through surgery (called neoadjuvant therapy)

• destroy any cancer cells left behind after surgery (called adjuvant therapy) , typically for a maximum of 6 months

Chemotherapy drugs that may be offered for resectable biliary tract cancer include gemcitabine or capecitabine. The length of your treatment depends on specific information about your cancer and treatment plan.

Find out more about chemotherapy and side effects of chemotherapy.

Chemotherapy and radiation therapy may be given during the same time period to treat gallbladder or bile duct cancer. This is called chemoradiation. Some chemotherapy drugs can help make radiation work better by making cancer cells more sensitive to radiation. Combining chemotherapy and radiation therapy can work better than either treatment on its own.

Capecitabine and fluorouracil are the most common chemotherapy drugs used in chemoradiation for resectable biliary tract cancer. They are given with external radiation therapy.

Adjuvant chemoradiation is not used for intrahepatic cholangiocarcinoma.

Talk to your doctor about clinical trials open to people with resectable gallbladder or bile duct cancer in Canada. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.