Palliative therapy for bile duct cancer
Palliative therapy is treatment given to help control or reduce symptoms caused by advanced cancer. It is not meant to cure the cancer. If the cancer has spread too far to be removed by surgery, doctors may focus on palliative operations, radiation, or other treatments to help make you feel better or to help prevent possible complications from the cancer. Because these cancers tend to advance quickly, doctors try to use palliative therapies that are less likely to have unpleasant short-term side effects, when possible.
Biliary stent or biliary catheter
If cancer is blocking a bile duct, it can lead to jaundice and other problems. The doctor may insert a small tube (either a stent or catheter) into the duct to help keep it open. This may be done as part of a cholangiography procedure such as ERCP or PTC (see the section “How is bile duct cancer diagnosed?”) or, in some cases, during surgery.
- A stent is a small metal or plastic tube that keeps the duct open to allow the bile to drain into the small intestine.
- A catheter is a thin, flexible tube. One end of the tube is placed into a bile duct to allow bile to drain into a bag outside the body through a small hole in the skin of the abdomen. The bag can be emptied when needed. If you have a catheter, your doctor or nurse will teach you how to care for it.
These procedures are often done to help prevent or relieve symptoms from more advanced cancers, but they can also be done to help relieve jaundice before potentially curative surgery is done. This helps lower the risk of complications from the surgery.
The stent or catheter may need to be replaced every few months if it becomes clogged and to reduce the risk of infection and gallbladder inflammation.
Another option to allow bile to reach the small intestine is to use a surgery called biliary bypass. There are several different biliary bypass operations, and the decision on which one to use is based on the location of the blockage. In these procedures, the surgeon creates a bypass around the tumor blocking the bile duct by connecting part of the bile duct before the blockage with a part of the duct that lies past the blockage, or with the intestine itself.
As mentioned in the section “Surgery for bile duct cancer”, this option is more likely to be used if a patient is already having surgery to try to cure the cancer, but it turns out to be unresectable. While a bypass is clearly more invasive than placing a stent or catheter, it has some advantages in that the effects may last longer and infection is less likely to be a problem.
Palliative radiation therapy
Radiation therapy may be used to help relieve pain and other symptoms by killing some cancer cells that are causing blockage of the bile duct or are pressing on nerves.
Tumor ablation (radiofrequency ablation or cryosurgery)
Tumors in the liver that can’t be resected can sometimes be destroyed (ablated) by placing a long metal probe through the skin and into the tumor. The tip of the probe is then heated (in radiofrequency ablation) or frozen (in cryotherapy) to kill the cancer cells.
Photodynamic therapy (PDT)
For this technique, a light-activated drug is injected into a vein. The drug is more likely to collect in cancer cells than in normal cells. A few days later, an endoscope (a long, flexible tube that can be used to look inside the body) is passed down the throat, through the stomach and intestine, and into the bile ducts. A special red light on the end of the endoscope is aimed at the tumor, causing the cells to die. The combination of PDT and stenting can be helpful for patients with bile duct cancer whose tumors aren’t resectable.
This drug can also collect in normal cells in the body, making a person very sensitive to sunlight or strong indoor lights. You will likely need to stay out of any strong light for several weeks after the injection.
To relieve pain, doctors may deaden the nerves that convey sensations of pain from the bile duct and intestinal area to the brain by injecting these nerves with alcohol. This can be done during surgery or by guiding a long, hollow needle into place with the help of a CT scan.
Doctors can prescribe strong pain-relieving drugs if needed. Some people with cancer may be worried about taking opioid drugs (such as morphine) for fear of being sleepy all the time or becoming addicted to them. But many people get very effective pain relief from these medicines without serious side effects. It’s very important to let your cancer care team know if you are having pain so that it can be treated effectively.
Pain medicines work best when they are taken on a regular schedule. They do not work as well if they are only used when the pain becomes severe. Several long-acting forms of morphine and other opioids are in pill form and only need be taken once or twice a day. There is even a long-acting patch that only needs to be applied every few days.
Common side effects of these drugs are nausea and feeling sleepy, which often get better over time. Constipation is a common side effect that does not get better on its own, so it needs to be treated. Most people on these drugs need to take laxatives daily.
Last Medical Review: 11/01/2014
Last Revised: 01/20/2016