The Difference Between Liver and Bile Duct Cancers
- Liver and bile duct cancers occur in the liver region but differ in origin; liver cancer starts in liver cells, while bile duct cancer affects the bile-carrying ducts.
- Cholangiocarcinoma or biliary cancer is a rare form of malignancy (approximately 8,000 people in the U.S. are diagnosed every year).
- While it can occur in younger people, bile duct cancer is typically found in older adults above the age of 70.
- This type of cancer may be treated with surgery, chemotherapy and radiation.
- Unfortunately, most bile duct cancers are already diagnosed in advanced stages. In such advanced cases, chemotherapy is generally the preferred treatment.
“The treatments for liver or bile duct cancer are really quite different and the behaviors of the cancers are quite different. I would not lump them in the same bucket,” Dr. Mariam F. Eskander, a surgical oncologist and assistant professor of surgery at the Rutgers Cancer Institute of New Jersey, tells SurvivorNet.
Read MoreWhat is Liver Cancer?
Liver cancer, specifically Hepatocellular Carcinoma (HCC), is the most common form of true liver cancer that arises from damage to the liver cells or hepatocytes. The major risk factor for this type of cancer is hepatitis, which is a viral infection that causes inflammation to the liver. Usually, chronic hepatitis B or C infection are associated with a liver cancer diagnosis.Other risk factors include:
- Excessive alcohol use
- Non-alcoholic fatty liver disease, a build up of fat in the liver usually not associated with drinking alcohol
- Cirrhosis, where liver tissue is replaced with scar tissue over time
- Obesity, type 2 diabetes, and other “metabolic” diseases
“The risk factors associated with it deal with injury to the liver, especially anything that causes irreversible injury to the liver or a kind of fibrosis known as cirrhosis,” Dr. Eskander says. “The primary factors that cause cirrhosis are alcohol, viral hepatitis, including hepatitis B and C, and what’s now called metabolic dysfunction-associated steatotic liver disease or MASLD, and more specifically, metabolic dysfunction-associated steatohepatitis, or MASH.”
The symptoms of HCC may not be apparent in the early stages, making it a challenging disease to diagnose promptly.
When symptoms do appear, they can include weight loss, loss of appetite, upper abdominal pain, jaundice (yellowing of the skin and eyes), and swelling in the abdomen due to fluid accumulation.
Prevention and early detection are crucial in managing HCC. People with risk facts should discuss getting screened regularly.
Treatment options for HCC vary depending on the cancer’s stage. This may include include:
- Surgery
- Liver transplantation
- Ablation therapies that destroy tumors without removing them.
- Embolization therapies that block blood flow to cancer cells in the liver.
- Targeted therapy drugs that specifically attack cancer cells without harming normal cells.
- Immunotherapy treatments that boost the body’s natural defenses to fight cancer.
The choice of treatment depends on the size, number, and location of the tumors in the liver, as well as the liver’s overall function and patient’s general health.
What is bile duct cancer?
The biliary system plays a role in digestion by creating a liquid called bile. Bile is produced in the liver and stored in the gallbladder.
Think of the bile ducts as tree-like structures that exist in and around the liver and gallbladder. These ducts act operate like a transportation system, moving bile from the liver to the upper section of the small intestine, known as the duodenum.
Biliary cancer is also known as cholangiocarcinoma or bile duct cancer.
In the US, this type of cancer is quote rare, only accounting for about 3% of all gastrointestinal cancers year. Approximately 8,000 people in the U.S. are diagnosed with this type of cancer every year, according to the American Cancer Society.
Eskander says that bile duct cancer, or cholangiocarcinoma, though rare, has specific risk factors associated with its development. Understanding these can help in identifying individuals at higher risk and implementing preventive strategies:
Risk for bile duct cancer include:
- Primary Sclerosing Cholangitis: A chronic liver disease that comes with inflammation and scarring of the bile ducts
- Chronic Liver Diseases: Conditions such as hepatitis and cirrhosis, which damage the liver over time, can also elevate the risk of developing bile duct cancer.
- Inherited Genetic Conditions: Certain genetic diseases, like Lynch syndrome and bile duct cysts, predispose individuals to bile duct cancer
- Exposure to Chemicals: Workers exposed to certain chemicals in the manufacturing and rubber industries may have a higher risk of bile duct cancer.
For individuals with known liver conditions or genetic predispositions, regular monitoring and medical check-ups are crucial for early detection.
Additionally, minimizing exposure to harmful chemicals and adopting a healthy lifestyle that supports liver health can play a preventive role.
While not all risk factors are avoidable, awareness and proactive health management can help reduce the risk of bile duct cancer. If you are at risk for this disease, your doctor may recommend annual or biannual screening such as imaging tests blood tests to check liver function and detect tumor markers.
Bile duct cancer symptoms may include:
- Jaundice (yellowing of your skin and the whites of your eyes)
- Intensely itchy skin
- White or clay-like stool (acholia)
- Dark urine (choluria)
- Fatigue
- Abdominal pain on the right side, just below the ribs
- Losing weight without trying
- Fever
- Night sweats
Are there different types of bile duct cancer?
- Bile cancer can be further diagnosed into one of three types:
- Intrahepatic bile duct cancer (or intrahepatic cholangiocarcinoma): makes up around 10% of all bile duct cancer cases. This type of tumor happens inside the bile ducts of the liver (inside the liver). Even though it’s not common, the number of cases of intrahepatic bile duct cancer is on the rise.
- Extrahepatic bile duct cancers are found in the bile ducts outside the liver. There are two main types of extrahepatic bile duct cancer:
- Perihilar bile duct cancer: The most common form of extrahepatic bile duct cancer, making up 40 to 60% of all cases, it occurs where the bile ducts exit the liver and is sometimes referred to as perihilar cholangiocarcinoma or a Klatskin tumor.
- Distal bile duct cancer originates in the part of the bile ducts that runs through the pancreas and connects with the small intestine. It accounts for 20 to 40% of all bile duct cancer cases.
- Gallbladder cancer: A cancer that arises in the wall of the gallbladder, the small organ that stores bile. Gallbladder cancer is often found when looking for or doing surgery to remove gallstones.
“Unfortunately bile duct cancers often don’t have symptoms. Patients usually seek medical assistance once symptoms appears. That usually means that the cancer has grown bigger and more advanced,” Dr. Eskander says.
The most important thing when it comes to treating liver and bile duct cancers is a multidisciplinary approach, meaning that it’s not just one type of doctor that helps you decide on what treatment and care you need.
Surgeons, medical oncologists and sometimes radiation oncologists are all part of a team that are necessary to create a comprehensive and yet personalized plan for each individual patient.
Most bile duct cancers are already diagnosed in advanced stages indicating that the cancer has extended beyond the bile ducts. In such advanced cases, chemotherapy is generally the preferred treatment.
Treatment will be determined by factors such as the location and size of the cancer, its extent of spread, and your overall health.
Primary treatment options for bile duct cancer typically include:
- Surgical procedures
- Chemotherapy
Questions for your doctor
- What specific risk factors do I have for developing liver or bile duct cancer?
- How often should I undergo screening tests for these cancers given my risk level?
- Can I make any lifestyle changes that can improve my risk or diagnosis?
- What are the best treatment options for my diagnosis?
- What will my insurance cost and how much can I expect to pay out of pocket?
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