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Localized Extrahepatic Bile Duct Cancer
Current Clinical Trials
In a minority of cases, proximal bile duct cancer can be completely resected.
Cures are not often achieved in these patients, in contrast to patients with
tumors arising in the distal bile duct, for whom a 5-year survival may be
achieved in as many as 25% of patients.
Standard treatment options:
- Surgery. The optimum surgical procedure for carcinoma of the extrahepatic
bile duct will vary according to its location along the biliary tree, the
extent of hepatic parenchymal involvement, and the proximity of the tumor to
major blood vessels in this region. It is important to assess the state of the
regional lymph nodes at the time of surgery because proven nodal involvement
may preclude potentially curative resection. It should be fully recognized
that operations for bile duct cancer are usually extensive and have a high
operative mortality (5%–10%) and low curability. Cases with cancer of the
lower end of the duct and regional lymph node involvement may warrant an
extensive resection (Whipple procedure), but bypass operations or endoluminal
stents are alternatives if lymph nodes are clinically involved by the
cancer.[1]
In jaundiced patients, percutaneous transhepatic catheter drainage or endoscopic placement of a stent
for relief of biliary obstruction should be considered before surgery, particularly if jaundice is severe or an
element of azotemia is present. An understanding of both the normal and varied
vascular and ductal anatomy of the porta hepatis has increased the number of
hepatic duct bifurcation tumors (Klatskin tumors) that can be resected.[1-3]
- External-beam radiation (EBRT). EBRT has been used in
conjunction with surgical resection.[4]
Current Clinical Trials
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with localized extrahepatic bile duct cancer. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
References
-
Shutze WP, Sack J, Aldrete JS: Long-term follow-up of 24 patients undergoing radical resection for ampullary carcinoma, 1953 to 1988. Cancer 66 (8): 1717-20, 1990.
[PUBMED Abstract]
-
Bismuth H, Nakache R, Diamond T: Management strategies in resection for hilar cholangiocarcinoma. Ann Surg 215 (1): 31-8, 1992.
[PUBMED Abstract]
-
Pinson CW, Rossi RL: Extended right hepatic lobectomy, left hepatic lobectomy, and skeletonization resection for proximal bile duct cancer. World J Surg 12 (1): 52-9, 1988.
[PUBMED Abstract]
-
Cameron JL, Pitt HA, Zinner MJ, et al.: Management of proximal cholangiocarcinomas by surgical resection and radiotherapy. Am J Surg 159 (1): 91-7; discussion 97-8, 1990.
[PUBMED Abstract]
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