Bile Duct Cancer

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Dr Thng Yongxian

MBBS

MMed

MRCS (IRE)

FRCSED

FAMS

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What Is Bile Duct Cancer?

Bile duct cancer, also known as cholangiocarcinoma, is a rare form of cancer that arises in the bile ducts. These ducts are slender tubes that connect the liver, gallbladder, and small intestine, playing a crucial role in digestion by transporting bile, a fluid produced by the liver that helps digest fats.

This type of cancer is categorised based on its location within the bile duct system. Intrahepatic cholangiocarcinoma occurs within the liver’s bile ducts, while extrahepatic cholangiocarcinoma is found in the bile ducts outside the liver.

Risk Factors

Chronic liver diseases

Such as hepatitis and cirrhosis.

Bile duct inflammation and conditions

Including primary sclerosing cholangitis.

Infections

Certain liver fluke infections can occur from consuming raw or undercooked freshwater fish.

Age

A higher prevalence in individuals over 50.

Symptoms

Bile duct cancer often does not present symptoms in its early stages, making it difficult to detect promptly. However, as the disease progresses, symptoms may begin to appear.

  • Jaundice
    It is a condition characterised by yellowing of the skin and eyes, resulting from the buildup of bilirubin, a byproduct of old red blood cells that the liver normally removes.
  • Itching
    Severe itching is a common symptom, often due to the accumulation of bile salts in the skin.
  • Abdominal Pain
    Pain in the upper right area of the abdomen may indicate the cancer’s growth or spread.
  • Weight Loss and Loss of Appetite
    Unintentional weight loss and a reduced desire to eat are not associated with dieting.
  • Changes in Stool and Urine
    Pale or clay-coloured stools and dark urine result from bile secretion changes.

Diagnosis

The diagnosis of bile duct cancer involves a combination of clinical evaluation, imaging tests, and other diagnostic procedures.

Imaging Tests

Imaging tests play a crucial role in diagnosing bile duct cancer, helping to visualise the bile ducts, liver, and surrounding tissues:

  • Ultrasound: Often, the first test performed is an ultrasound, which can detect abnormalities in the liver and bile ducts.
  • Computed Tomography (CT) Scan: Provides detailed cross-sectional images of the body, identifying tumours and assessing their spread.
  • Magnetic Resonance Imaging (MRI): It is useful for detailed images of the bile ducts and liver.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): A specialised technique that combines endoscopy and X-rays to visualise the bile and pancreatic ducts. It can also be used to collect tissue samples.
Biopsy

A biopsy, removing a small tissue sample for examination under a microscope, is the definitive way to diagnose bile duct cancer.

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Treatment Options

Treatment for bile duct cancer depends on the cancer’s location, stage, and the patient’s overall health.

Surgery

Surgery is the only potentially curative treatment for bile duct cancer and is typically considered when the cancer is localised and operable:

  • Resection: If the cancer has spread, the cancerous part of the bile duct and sometimes nearby organs or tissues are removed.
  • Liver Transplantation: In selected cases, especially for certain intrahepatic cholangiocarcinomas, a liver transplant might be an option.
Radiation Therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It may be used:

  • As a primary treatment when surgery is not an option.
  • After surgery to eliminate any remaining cancer cells.
  • To relieve symptoms of advanced cancer.
Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells, usually administered through the bloodstream to reach cancer cells throughout the body. It may be used:

  • Before surgery, to shrink tumours, making them easier to remove.
  • After surgery, to kill any cancer cells that might remain.
  • As the main treatment when surgery is not suitable.
Palliative Care

For advanced bile duct cancer, the focus may shift to palliative care, aimed at relieving symptoms and improving quality of life.

  • Biliary drainage to relieve jaundice caused by blocked bile ducts.
  • Pain management through medications.
  • Nutritional support to address weight loss and appetite issues.
Targeted Therapy and Immunotherapy

Recent advances in treatment include targeted therapy and immunotherapy, which may be options for some patients based on the cancer’s specific genetic markers.

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Dr Thng Yongxian

MBBS (SG)

MMed (Surg)

MRCS (Ire)

FRCSEd (Gen)

FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery,
    National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.

Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.

Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

Patient Reviews

I cannot possibly express how grateful I am for the compassionate care received by Dr Thng during my hospitalization. I was 20 hours away from flying back to the USA after a long work trip, and homesick already when diagnosed with acute appendicitis and a UTI. To say that I was nervous to undergo surgery so far away from home, friends and family is an understatement. He was expedient, attentive and thorough. He even took the time to text and call my husband back home multiple times to update him on my status. His infectious laugh, sense of humor and kindness helped to sooth my own frazzled nerves. I am so appreciative to have had Dr Thng as my surgeon.

Ms Tina Hunter

I was diagnosed for ampullory cancer in 2021. I am very thankful to Dr. Thng Yongxian who kept me calm when revealing the report to me. I really felt like God sent his angel to speak to me.He helped me overcome the operation. Dr. Thng said 3 things that I needed to do before the operation....Stay positive, exercise n eat well, have faith in God. He even gave me his handphone number incase I need to consult him when home. Indeed the 8 hrs operation was a success n I am able to write this testimonial, living a normal life. Finally, its still God who works all things good for those who love Him... Romans 8:28.

Mdm Tang K H

I recently underwent gallbladder stone removal surgery performed by Dr. Thng, and I am impressed with the quality of care I received during this process. Dr. Thng demonstrated exceptional professionalism and expertise throughout my entire experience. From the initial consultation to the post-operative care, Dr. Thng explained the procedure in great details, answered all my questions, and alleviated my concerns and ensuring that I fully understood each step of the process. His compassionate and caring demeanor put me at ease, making me feel confident in his abilities. The outcome of the procedure was beyond my expectations. Dr. Thng successfully removed all my 3 gallstones, and I experienced a smooth recovery process. I am grateful for his expertise and the care I received under his supervision. Overall, my experience with Dr. Thng was exceptional. I highly recommend him for his professionalism, compassion, and outstanding surgical skills. Thank you, Dr. Thng for your excellent care.

Mr Low LT

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    Frequently Asked Questions (FAQ)

    What are the survival rates for bile duct cancer?

    Survival rates depend on several factors, including the cancer’s stage and location, the patient’s overall health, and the treatments received. Early-stage bile duct cancer has a better prognosis than advanced-stage cancer.

    How does bile duct cancer affect liver function?

    Bile duct cancer can block the bile ducts, causing bile to build up in the liver, leading to jaundice and other liver function problems. Over time, this can significantly impair liver function.

    What is the role of liver transplantation in treating bile duct cancer?

    Liver transplantation may be considered for certain patients, particularly those with early-stage intrahepatic cholangiocarcinoma and those who cannot undergo traditional surgery due to the location or extent of the cancer.

    How does targeted therapy differ from chemotherapy in treating bile duct cancer?

    Targeted therapy focuses on specific genetic markers or proteins in cancer cells, blocking their growth and spread, whereas chemotherapy attacks rapidly dividing cells indiscriminately, affecting both cancerous and healthy cells.

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