Can it be treated?
Treatment options vary across different regions of the world depending on what is available and approved in each country. Currently, the only potentially curative treatment is surgery; however, this is only an option in approximately 25% of patients.1 Surgery can be performed to remove the cancer or to relieve the symptoms the patient is experiencing. The location of the tumor can affect the surgical treatment, so it is critical that the patient is properly evaluated by a specialist to determine if surgery is an option.1,3,4,9
Surgical treatment options include the following11–13:
- Removal of the affected bile ducts. This is usually only performed in early stages of the disease when only the bile ducts are affected. The remaining healthy ducts are reconnected to the small intestine.
- Partial liver resection (removal) can be carried out at earlier stages if the cancer has only spread to certain parts of the liver and is removed with the affected bile ducts.
- The Whipple procedure involves removal of the bile ducts, part of the stomach, part of the small intestine, the pancreas, gall bladder, and the surrounding lymph nodes, if affected.
- Bypass of the blocked bile ducts to allow the flow of bile to the small intestine and relieve the symptoms of jaundice. This is usually carried out where removal of the tumor is not possible.
- Stent insertion, where a tube is placed into the bile ducts to hold them open and prevent blockages.
For patients where surgery is not an option, chemotherapy with the anticancer drugs gemcitabine and cisplatin is the first treatment option. Second-line treatment for those in which the first-line treatments have not worked or the cancer has come back and is advanced or metastatic, include a combination of folinic acid, fluorouracil, and oxaliplatin (often referred to as FOLFOX).1,13
These chemotherapeutic drugs are given intravenously and work together to destroy fast growing cells, such as cancer cells, by interfering with the process of cell replication. However, because other cells in the body also divide quickly, they can cause several side effects, including easy bruising/bleeding, anemia, fatigue, susceptibility to infections, sickness, diarrhea, mouth ulcers, suppressed appetite, changes in taste, hair loss, and changes to the skin and nails. Damage to the kidneys and liver may occur as the body tries to excrete these toxic agents.11–13
Radiation therapy may be given to lower the risk of the cancer coming back after surgery or to relieve symptoms. It utilizes high-energy X-rays, gamma rays, or protons to kill cancer cells. The two main types of radiation therapy are:
- Stereotactic body radiation therapy (SBRT) that directs radiation beams from many different positions around the body, which results in the cancer receiving high doses of radiation, but the surrounding tissues receiving only a low dose, thus lowering the risk of side effects.11
- Selective internal radiation therapy (SIRT), which uses small pellets of radioactive material that are inserted next to or into the tumor to minimize the risk of radiation to other organs and tissues. (Note: this is type of therapy is not approved in the UK).15
The side effects of radiation therapy are similar to chemotherapy and may also result in skin changes such as redness, blistering, and peeling, but usually only occur in the area being treated.15
More personalized/targeted therapies for patients with specific gene mutations are currently under investigation in clinical trials. One targeted therapy that has already been approved in the US, UK, and Europe is pemigatinib, which can be used for patients who have an FGFR2 fusion.16–18
Please find patient information sheets available here.