Ask Dr. Renee: What Is Bile Duct Cancer?

April 1, 2015  |  

Many of you now know that Daisy Lewellyn of Bravo’s Blood, Sweat and Heels has bile duct cancer. If you saw Sunday’s season premiere, you heard her mention what happened to cause her to visit the doctor. Lewellyn had a classic symptom of liver disease: jaundice. Her makeup artist told her the whites of her eyes appeared green in pictures. Bile duct cancer is extremely rare, but I am so grateful that Lewellyn decided to use her platform to get the word out about her illness.

First, let’s understand what the bile duct does in our body. The bile duct carries bile to the intestine. Bile is the fluid that is required for digestion of food. It is secreted by the liver into passages that carry bile to the bile ducts, which open into the intestine. This all takes place in the liver, which is the organ that detoxifies the body.

Signs and Symptoms

The signs and symptoms experienced with bile duct cancer are usually caused by a tumor blocking the bile duct. Some people with bile duct cancer will not experience the common symptoms while others may experience them because of another medical condition, unrelated to cancer.

One common symptom is jaundice, which is a yellowing of the skin and the whites (the sclera) of the eyes. When the bile duct is blocked, the liver can’t excrete bile, causing the bile to back up into the bloodstream. (The blockage may not always be cancer; it can also be caused by a gallstone or scar tissue.) Bile contains bilirubin, which is dark yellow in color and can cause the skin and whites of the eyes to turn yellow if there are high levels of it in the bloodstream. A person’s urine may also become a dark color while bowel movements may become pale.

It is important to note that jaundice is a common symptom of many conditions, so your doctor may need to do several diagnostic tests to find the exact cause. Many diseases associated with jaundice are not serious or life threatening, but bile duct cancer is one of the less common causes.

In addition to jaundice, other symptoms of bile duct cancer include the following:

  • Itching, caused by a buildup of bile salts and bilirubin in the body that is then deposited in the skin
  • Weight loss
  • Loss of appetite
  • Fever
  • Abdominal pain (Early bile duct cancer usually does not cause pain, but a person may experience pain if the cancer has spread.)

If you are concerned about one or more of the symptoms or signs on this list, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This information will help them determine which tests need to be performed to come to the right diagnosis.

Diagnosis

In addition to your medical history and physical examination, some of these tests may be performed to diagnose bile duct cancer or determine if it is another medical condition.

  • Blood tests
  • Tumor marker tests
  • Biopsy
  • Ultrasound
  • CT scan
  • Magnetic resonance imaging (MRI)
  • PTC
  • ERCP
  • Laparoscopy

Once the tests have been performed the doctor will review the results and let you know your diagnosis. If it is cancer they will then let you know the staging. Staging describes the severity of a person’s cancer. Lewellyn was diagnosed with Stage III bile duct cancer. There are four stages of cancer, therefore her diagnosis is very serious. Stage I cancers are the least advanced and often have a better prognosis. Higher stage cancers are more advanced but in many cases can still be treated successfully. There is a lot of information that determines the stage (location, the size of the tumor,  etc.), but it also helps the doctors to determine the plan of treatment.

Treatment

The most obvious treatment, of course, is to remove the cancerous tumor surgically. Lewellyn underwent surgery to remove her bile duct tumor. Surgery could entail removing the bile duct or other structures involved in the cancer. After surgery, the doctor determines if chemotherapy is necessary. There may be cancer cells in the body even after the tumor has been removed, so, in that case, chemotherapy is necessary to kill those cancer cells. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed. A chemotherapy regimen usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time. Radiation therapy can be used for treatment or to control the symptoms and pain of an advanced disease. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished.

Risk Factors 

There are some diseases that put you at higher risk to be diagnosed with bile duct cancer. If you have chronic inflammation of the bile ducts you will have an increased risk of developing bile duct cancer. Several conditions of the liver or bile ducts can cause this:

  • Primary sclerosing cholangitis
  • Bile duct stones
  • Choledochal cysts
  • Liver fluke infections
  • Cirrhosis
  • Infection with hepatitis B virus or hepatitis C virus

Some other risk factors are common to most types of cancer.

  • Diabetes
  • Obesity
  • Smoking
  • Alcohol
  • Family History

I hope that this information will help you understand what Lewellyn is going through. But more importantly, if you recognize any of these signs or symptoms in yourself or a loved one, please go to the doctor immediately. I know this season of Blood, Sweat and Heels will be a good one as we follow Lewellyn along her journey with what she calls “The Big C.” If you have any questions please Ask Dr. Renee.

 

Dr. Renee Matthews has appeared on television shows such as “The Oprah Winfrey Show” and WGN’s “People to People”  where she discussed different health topics. She started her media career with her own radio show on ReachMD, a programming source for health professionals. In addition, Dr. Renee has been a featured medical correspondent on Sirius XM’s “Sway in the Morning.” 

Twitter: @AskDrRenee

Facebook.com/AskDrRenee

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