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Bile Duct Cancer

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
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.

Diagnosis

  • 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

  • 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.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

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).

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Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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