Treatment of Cholangiocarcinoma: Prognosis, Survival Rate

Cholangiocarcinoma, the scientific term for bile duct cancer, is a rare type of life-threatening cancer. Affecting only 2000-3000 people a year in USA, this cancer is more common in the Southeastern Asia due to a parasitic infection of the liver fluke Clonorchis sinensis and Opisthorchis viverrini and the blood fluke Schistosoma haematobium. Although cholangiocarcinoma affects mostly the elderly people who are above 60, it can also affect children and also those who have had liver disease, jaundice (though not always), and people with liver cirrhosis. The stage of cholangiocarcinoma is finalized based on the TNM staging system where T stands for Tumor, N stands for Node and M for Metastases. The diagnosis of the type and stages of cholangiocarcinoma determines the treatment to be done. Let us now have a look at the treatment, alternative treatment, prevention, prognosis and epidemiology of Cholangiocarcinoma in detail.

The treatment of cholangiocarcinoma depends on the some of the factors like:

• Type and stage of Cholangiocarcinoma
• Whether the tumor is removable or non-removable
• Overall health of the patient suffering from Cholangiocarcinoma is also a factor in its treatment
• Possible side-effects of the treatment for Cholangiocarcinoma
• Curability of the Cholangiocarcinoma, life expectancy and the extent of relief of symptoms that can be achieved

The types of treatment available for cholangiocarcinoma are:

• Surgery
• Chemotherapy
• Radiation Therapy
• Palliative Therapy – This involves placing of stent and catheter to drain the bile in to the intestine from accumulating in the ducts.

Removal of tumor surgically is still the only option to save a Cholangiocarcinoma patient from furthering with this deadly disease. However, there remains no option except exploratory surgery for Cholangiocarcinoma as operability in most of the cases can only be assessed during the surgery. As far as the operability of cholangiocarcinoma is concerned, there are two types of surgical conditions that can be found in the bile duct, viz. resectable bile duct cancer and unresectable bile duct cancer.

• Treatment of Resectable Bile Duct Cancer: In this type, an instant surgery to remove the cancer is performed followed by radiation or chemotherapy. In case of perihilar and extrahepatic bile duct cancer, stent placement or percutaneous transhepatic biliary drainage therapy is performed to prevent relapse of jaundice or other symptoms.
• Treatment of Unresectable Bile Duct Cancer: In case of unresectable bile duct cancer or recurrent intrahepatic cholangiocarcinoma, the tumor remains in metastatic stage and thus is surgically inoperable. In such situation the following treatments are applied depending upon the clinical condition of the patient:
  • Stent placement for the betterment of health condition.
  • Chemotherapy
  • Internal and external radiation therapy
  • External radiation therapy accompanied by radio sanitizer drugs, hyperthermia therapy or chemotherapy.

Higher death rate and comparatively fewer life expectancy of cholangiocarcinoma have made the patients and their family members to look for complementary and alternative treatments for Cholangiocarcinoma. There are a few claims of alternative treatment methods particularly in ayurveda and homeopathy to cure Cholangiocarcinoma if detected at an early stage. In some rare instances, though not clinically proved, patients have shown remarkable improvements when undergone IPT (Insulin Potentiation Therapy). In this apparently unpopular form of treatment for Cholangiocarcinoma, chemo is applied in very low dose along with insulin. Insulin puts the cancer cells in starvation for a long time thereby allowing the chemo to be more effective on them.

Complementary therapies are therapies provided alongside the treatments available for cholangiocarcinoma to provide some relief from the side effects and stress associated with cancer. Some of the complementary therapies are:

• Counseling – Counseling for Cholangiocarcinoma patients and family members either individually or in group to help cope with the disease and situation.
• Psychotherapies – Includes art, music, dance and various others therapies to help relieve the stress and anxiety associated with Cholangiocarcinoma and also bring out the emotional turmoil the patient goes through.
• Meditation – Helps in calming the mind and body and increases the immunity.
• Acupressure and Acupuncture – Usually used for relieving the pain associated with treatment of Cholangiocarcinoma.
• Peppermint Tea – Used to reduce nausea caused as a side-effect of the treatment of Cholangiocarcinoma.
• Body Cleansing – Involves detoxification of the body with the help of various diet plans. However, be sure to consult with your primary doctor before going for it.

Counseling and psychotherapies are offered in most of the cancer department these days and are incorporated into the multi-disciplinary treatment plan for cancer due to its effectiveness in reducing stress. However, a complementary and alternative therapy for Cholangiocarcinoma must always be an adjunct to the main treatment plan rather than being a substitute for it. Do consult your primary healthcare specialist before starting with any of it.

The epidemiology of cholangiocarcinoma is quite interesting:

• Males have higher tendency of getting Cholangiocarcinoma than the females.
• The older populations of the world, those who have crossed 60 years are at higher risk of having cholangiocarcinoma.
• The highest rate of Cholangiocarcinoma is detected in the northern part of Thailand, where almost 96 persons per 100000 people are affected by Cholangiocarcinoma. In Japan and Israel, the disease is much wide spread than in the West or other parts of Asia.
• The epidemiological studies conducted by WHO have shown that the mortality rate for IHBT (Intrahepatic Cholangiocarcinoma or Intrahepatic bile duct tumors) is increasing, while the same for EHBT (Extrahepatic Cholangiocarcinoma or Extrahepatic biliary tumors) is decreasing.

The survival statistics of cholangiocarcinoma has been showing very pathetic figure over the decades. Application of different medical treatment and aggressive surgeries try to prolong the life expectancy of the Cholangiocarcinoma patients, but live saving treatments seem to be a distant dream yet. As far as the treatment of cancer patients is concerned, doctors standardize the life expectancy for at least 5 years. This standardized survival statistics determines a patient’s prognosis in similar situation. Based on this, the Prognosis and Survival Rate of Cholangiocarcinoma are broadly depicted as:

• Delayed diagnosis of Cholangiocarcinoma leads to progressive deterioration of physical condition with average survival rate of 1-2 years. The survival rate is too meager due to presence of metastatic conditions in maximum number of situations.
• Patients, who have undergone surgeries, show 5 years survival rate of just 20-60%. This is much lower in comparison to other types of cancers. The survival rates in surgical cases of bile duct cancer vary markedly due to different locations and stages of tumor.

Intrahepatic Cholangiocarcinoma or Intrahepatic bile duct tumor cases possess very poor prognosis, while Extrahepatic Cholangiocarcinoma or Extrahepatic biliary tumor patients possess better prognosis.

The specific reasons of bile duct cancer are not known to the Medical Practitioners yet and hence prevention becomes difficult as most of the risk factors for cholangiocarcinoma are uncontrollable. In many instances cholangiocarcinoma have found to be developed in people with no visible risk factors. Regular exercising, healthy diet, less smoking, less alcohol, taking preventive actions against hepatitis B and C, and avoiding hazardous chemicals as much as possible can keep everyone in good physical condition and also cancers at bay. People already have bile duct diseases should be extra cautious and need to go for routine health check up often. People residing in the southeastern Asia must be more cautious about the digestive problems or liver related infections which increase the chances of the Cholangiocarcinoma.

Researchers are on constant efforts to get more information on the disease and newer ways for its early detection. The growing incidence of cholangiocarcinoma is also a concern for the medical practitioners. Healthy lifestyle, periodical health check up and knowledge on the disease can help a lot in regulating the ever increasing cases of cholangiocarcinoma.

Also Read:

• What Causes Cholangiocarcinoma & What are its Symptoms & Pathophysiology?
• Cholangiocarcinoma: Types, Staging, Diagnosis