Cholangiocarcinoma: Symptoms, Causes, Risk Factors, Prevention, Diagnosis, Treatment

Cholangiocarcinoma, a specific type of cancer, grows in the bile ducts that transport the bile which is a digestive fluid. Bile ducts link your small intestine, gallbladder, and liver together.

Cholangiocarcinoma is divided into many different categories by doctors depending on where it first appears in the bile duct:

Intrahepatic cholangiocarcinoma, often known as liver cancer, is a disorder that appears in the bile ducts that are situated inside the liver.

Hepatic cholangiocarcinoma occurs in the bile ducts adjacent to the liver. Another name for this type is perihilar cholangiocarcinoma.

Symptoms of Cholangiocarcinoma

Cholangiocarcinoma symptoms include:

• Jaundice 
• Itching skin
• pale stools
• Fatigue
• Right side abdominal discomfort just below the ribs
• Weight loss without exerting any effort
• Fever
• Nighttime perspiration
• Dark urination

Causes of Cholangiocarcinoma

When bile duct cells experience changes to their DNA, cholangiocarcinoma develops. The modifications instruct the cells to proliferate and aggregate into a mass of cells (tumor) that is capable of invading and destroying healthy body tissue. The alterations that result in cholangiocarcinoma are not entirely understood as to their origin.

Risk Factors of Cholangiocarcinoma

Cholangiocarcinoma risk factors include the following:

• Primary Sclerosing cholangitis- The bile ducts become hardened and scarred as a result of this condition.
• A chronic liver condition- Cholangiocarcinoma risk is increased by scarring of the liver brought on by a history of chronic liver illness.
• Choledochal cysts- which result in dilated and disorganized bile ducts, increase the risk of cholangiocarcinoma in people.
• Parasite of the liver- Cholangiocarcinoma is linked to liver fluke infection in parts of Southeast Asia, which can be brought on by consuming raw or undercooked seafood.
• Aged more- Adults over the age of 50 are more likely to develop cholangiocarcinoma.
• Smoking- Cholangiocarcinoma risk is correlated with cigarette smoking.
• Diabetes- Diabetes of either type 1 or type 2 may enhance a person's chance of developing cholangiocarcinoma.
• A few inherited ailments- Conditions that raise the risk of cholangiocarcinoma are brought on by DNA mutations that parents pass on to their offspring. These illnesses include Lynch syndrome and cystic fibrosis, for instance.

Prevention of Cholangiocarcinoma

You can do the following to lower your risk of cholangiocarcinoma:

• Give up smoking. Cholangiocarcinoma risk is correlated with smoking. Stop smoking if you do. If you've previously tried to stop smoking but were unsuccessful, discuss quitting methods with your doctor.
• Cholangiocarcinoma risk is higher in people with chronic liver illness. However, there are several causes of liver disease that can be avoided. Take all precautions you can to protect your liver. For instance, if you choose to drink, do it in moderation to lower your risk of liver inflammation (cirrhosis).

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Diagnosis of Cholangiocarcinoma

• Liver function tests: These liver tests look for excessive amounts of substances in your blood, such as elevated liver enzymes, that may indicate your liver isn't functioning properly or there is a bile duct blockage.
• Tests that look for proteins and other compounds that could indicate cancer in your blood or urine are known as tumor marker tests.
• Abdominal ultrasound: With the help of sound waves, your liver, pancreas, and gallbladder can be visualized during an abdominal ultrasound. If your doctor suspects bile duct cancer, this can be the first imaging test they perform on you.
• MRI-based magnetic resonance cholangiopancreatography (MRCP) is a specialized imaging test. It produces precise images of the pancreas, pancreatic duct, gallbladder, liver, and bile ducts.
• ERCP- A catheter (thin, flexible tube) and an endoscope are used in endoscopic retrograde cholangiopancreatography (ERCP) to check your bile ducts. As you are sedated (in light sleep), the endoscope is inserted into your mouth and advanced to your small intestine. 

Your bile ducts outline will be visible on X-rays thanks to the contrast dye the catheter supplies. An ERCP procedure can be used to open a clogged bile duct if you have one by inserting a stent device inside the blocked bile duct.

• The procedure known as percutaneous transhepatic cholangiography (PTC) produces X-rays of your bile ducts similar to an ERCP. However, your healthcare professional administers contrast dye by penetrating your bile ducts and liver with a needle rather than using an endoscope and catheter. Usually, only individuals can use a PTC.

Treatment of Cholangiocarcinoma

The following are possible cholangiocarcinoma (bile duct cancer) treatments:

• Surgery- Surgeons strive to remove as much of the cancer as they are able to. In order to treat extremely small bile duct cancers, this includes severing the bile duct in half and joining the severed ends. If the bile duct cancer is more advanced, it can also be necessary to remove nearby lymph nodes or the liver, pancreas, or pancreatic tissue.
• An Organ Transplant- For those with hepatic cholangiocarcinoma, surgery to remove your liver and replace it with one from a donor (a liver transplant) may be an option. Although hepatic cholangiocarcinoma is often curable with a liver transplant, there is a chance that the cancer will return.
• Chemotherapy- chemotherapy  uses drugs to kill cancer cells. Chemotherapy may be used prior to a liver transplant. It might also help people with advanced cholangiocarcinoma manage their symptoms and slow the disease's course. To disseminate throughout the body, chemotherapy drugs might be pumped into a vein. Or the drugs could be administered in a way that delivers them straight to the cancer cells.
• Radiation therapy- Radiation therapy kills cancer cells by directing powerful energy beams from sources like protons and X-rays. Radiation therapy called external beam radiation uses a machine to beam radiation onto your body. Contrarily, brachytherapy involves injecting radioactive material into your body near the site of the tumor. 
• Targeted pharmacological therapy- Targeted medication therapies concentrate on particular defects that are prevalent in cancer cells. Targeted medication therapies can kill cancer cells by preventing these aberrations. Your doctor may do a test on your cancer cells to see if or not targeted therapy can treat your cholangiocarcinoma.
• Immunotherapy- Immunotherapy, a method of cancer treatment, employs your immune system. Your body's immune system may fail to combat your cancer because cancer cells have the ability to produce proteins that help them hide from immune system cells. For immunotherapy to be effective, that process must be altered. When all other options for treating cholangiocarcinoma have failed, immunotherapy may be an effective option.
• Warming up Cancerous Cells-  Electric current is used in radiofrequency ablation to heat and kill cancer cells. The doctor makes a few tiny incisions in your belly and inserts one or more thin needles using an imaging test, such as an ultrasound, as a guide. When the needles get close to the tumor, an electric current heats them up, killing the cancer cells.
• Photodynamic treatment- In photodynamic therapy, a substance that is light-sensitive is injected into a vein and it builds up in the quickly proliferating cancer cells. The cancer cells are killed by a chemical reaction brought on by laser light that is directed at the tumor. Usually, you'll require several treatments. Your signs and symptoms may be lessened by photodynamic therapy, and it may also slow the spread of cancer. After treatments, you must prevent exposure to the sun.
• Drainage of the bile- To drain the bile, it can need inserting a tiny tube into the bile duct. Stents are used to keep a bile duct that has been collapsed by cancer open as well as bypass surgery to reroute the bile around the malignancy. Cholangiocarcinoma symptoms and indications are lessened by biliary drainage.

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