A diagnosis of a biliary tumor can be difficult and complex to understand and navigate. Our mission is to stand by you and walk with you every step of the way. While every patient’s journey is different, and may start at different paths, a typical journey consists of:
Occurs when your regular doctors identify the need to consult with our Institute and refer you to us.
Includes all the labs, imaging studies, and procedures required to make a diagnosis.
A discussion about your care held by your treatment team at our Institute. After discussion, a recommendation is made about treatment options.
Can include a variety of treatments customized to you! Typical treatments include surgery, chemotherapy, radiation, or clinical trial.
Occurs after treatment is complete, and usually consists of imaging studies, labs, and examinations to make sure you are treated.
Your gallbladder and bile ducts are located in your right upper abdomen. The bile duct and hepatic ducts (biliary system), transport bile from your liver into the intestine. Bile helps with digesting fat. The gallbladder stores bile.
Cholecystitis is the inflammation and infection of the gallbladder, which occurs in some patients with gallstones . Cholangitis is an infection of the bile duct, which can occur, when the bile duct is blocked by a gallstone.
Cholecystitis and cholangitis can present with fevers, chills, low blood pressure and pain in the right upper abdomen. If the bile duct is blocked with a gallstone, the patient might also have jaundice (yellowing of the eyes and skin).
Some people are more prone to having gallstones , which can block the gallbladder duct (cystic duct) or bile duct, and cause inflammation and infection. In rare instances sick patients in the hospital have cholecystitis without gallstones. Rarely, patients can also form stones in the bile duct or hepatic duct, which can cause a blockage.
If you have symptoms of cholecystitis or cholangitis, your doctor may order blood tests or scans of your abdomen. Sometimes you may also need a procedure.
Patients with Cholecystitis and Cholangitis will be admitted to the hospital, and treated with intravenous fluids, antibiotics and pain medications.
Patients with Cholecystitis need to have their gallbladder removed surgically ( cholecystectomy ). Patients with cholangitis will have an endoscopic procedure called ERCP to remove the gallstone from the bile duct. Since the gallbladder is the most likely source of gallstones, patients will need a cholecystectomy after their acute cholangitis has resolved.
Gallbladder cancer is a cancer in that occurs in the wall of the gallbladder. Bile duct cancer (cholangiocarcinoma) arises from the wall of the liver ducts. It can occur in the liver or in the ducts connecting the liver to the intestine.
There are 3 different types of cholangiocarcinoma:
Gallbladder and bile duct cancer is often silent in early stages. Patients may present with:
More advanced stages can present with:
Gallbladder cancer is more common in older women.
If you have any symptoms of gallbladder or bile duct cancer, your doctor may order blood tests and pictures (imaging) of your belly. You may also need a biopsy to confirm the diagnosis.
The treatment of gallbladder and bile duct cancer depends on the stage of the tumor, and involves a multidisciplinary team of doctors, nurses and medical support staff:
Every patient seen here will be presented in our Multidisciplinary Tumor Board , where we will devise your individual treatment plan. This plan may include:
We strongly encourage and support all of our patients to participate in clinical trials. We are happy to talk to you about clinical trials during your clinic visit.
Bile duct cysts are abnormalities in the tubes connecting liver to the intestine. The bile ducts enlarge like balloons anywhere along their course towards the small bowel. There are different types of bile duct cysts, depending on where the ballooning occurs.
Choledochal cysts are usually diagnosed in children, but sometimes not recognized until adulthood. The may present as:
Bile duct cysts are congenital, which means that they have been present since birth, and might not get recognized until adulthood.
They can cause repeated infection and can turn into cancer.
If you have any symptoms of a bile duct cyst, your doctor may order blood tests and pictures (imaging) of your belly. You may also need a biopsy to confirm the diagnosis
Bile ducts cysts will always be removed with surgery. The type of surgery depends on the location of the cyst.
If the cyst is the part of the bile duct outside the liver and pancreas, the patient will need a bile duct excision and reconstruction .
If the bile duct cyst is not part of the main bile duct, it will be removed without removing and reconstructing the main bile duct.
If the cyst is in the part of the bile duct, which runs through the pancreas, the patient will need a Whipple Procedure .
Gallstones are stones that are Made in the gallbladder. They Can be very small and resemble Fine sand grains (also known as “Sludge” or as big as pebbles and rocks!
Patients, who have recovered from pancreatitis due to gallstones, may need to have their gallbladder removed surgically. The procedure is called a cholecystectomy, and can be done with a camera and small incisions (laparoscopic) or through a larger cut (open). During the operation the cystic duct and artery have to be clipped and cut. The gallbladder will be separated from the liver, and removed.
Patients can usually leave the hospital the day after the operation after laparoscopic surgery. They able to eat a regular diet, and will be given medication for pain at their incision (cut).
A Multidisciplinary Tumor Board is a team of doctors and nurses who discuss your individual case to recommend the best treatment options for you based on your specific information. The members of Tumor Board include:
Usually once a week
The Tumor Board needs to have the latest imaging available to make accurate recommendations. Patients are typically presented after all of the appropriate tests are completed.
Because multiple patients are presented at a single Tumor Board, having patients attend is discouraged for privacy concerns. However, you will learn the recommendations of the Tumor Board at your next clinical appointment.
Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with curative intent, or it may aim to prolong life or to reduce symptoms.
If your tumor can be removed with surgery, your surgeon will recommend one of the following operations. The type of operation is dependent on the location of your tumor.
For very early-stage cancers a cholecystectomy alone might be sufficient. Most patients with gallbladder cancer, that can be removed, will need a radical cholecystectomy. During surgery, the gallbladder, the adjacent liver, a portion of the bile duct (tube connecting the liver to intestines) and lymph nodes in the area will be removed. The goal of the surgery is to remove the entire tumor.
The bile duct needs to be reconnected to the intestine, so bile can reach the digestive tract. This is done with a hepaticojejunostomy, which means that the bile duct will be sewn to a piece of small intestine.
For bile duct cancer outside of the liver and pancreas (hilar cholangiocarcinoma), the bile duct, gallbladder and lymph nodes in the area will be removed. The bile duct needs to be reconnected to the intestine with a hepaticojejunostomy.
Patients with bile duct cancer in the liver (intrahepatic cholangiocarcinoma) will need a liver resection (hepatectomy) .
Patients with distal bile duct cancer (cholangiocarcinoma) will need a Whipple procedure .
Hepatectomy is the surgical resection (removal of all or part) of the liver. While the term is often employed for the removal of the liver from a liver transplant donor, this article will focus on partial resections of hepatic tissue and hepatoportoenterostomy.
The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.
Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is therapy using ionizing radiation, generally as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator.
The Whipple procedure, or pancreaticoduodenectomy, is the most common surgery to remove tumors in the pancreas. Surgery to remove a tumor offers the best chance for long-term control of all pancreatic cancer types. The Whipple removes and reconstructs a large part of the gastrointestinal tract and is a difficult and complex operation.
