Chemotherapy ("chemo") is treatment with anti-cancer drugs that are given into a vein or by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful in some cancers that have spread to organs beyond the bile duct. Unfortunately, chemotherapy has not been found to be very effective against bile duct cancer, and for that reason its use has been somewhat limited.

For bile duct cancers that are resectable, chemotherapy may be used after surgery (often along with radiation therapy) to try to lower the risk that the cancer will return. Some doctors may use it before surgery for borderline resectable cancers to try to improve the odds that surgery will be successful. Chemotherapy may also be used (with or without radiation therapy) for more advanced cancers. But it is not clear if chemotherapy used in this situation helps people live longer.

Doctors give chemotherapy in cycles, with each period of treatment followed by a rest period to allow the body time to recover. Chemotherapy cycles generally last about 3 to 4 weeks. Chemotherapy is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.

Hepatic artery infusion: Because of the poor response to systemic chemotherapy, doctors are now studying whether hepatic artery infusion (HAI) might be more effective. This technique delivers the chemotherapy directly into the hepatic artery, which supplies most bile duct tumors. The healthy liver then removes most of the remaining drug before it can reach the rest of the body. HAI may allow some people whose cancer was not removable by surgery to live longer, but more research is needed. This technique may not be useful in all cases because it often requires surgery to insert a catheter into the hepatic artery, an operation that many bile duct cancer patients may not tolerate well.

Drugs used to treat bile duct cancer

Several drugs can be used to treat bile duct cancer. In some cases, 2 or more of these drugs may be combined to try to make them more effective. The drugs that have been used most often to treat bile duct cancer include:

• 5-fluorouracil (5-FU)
• gemcitabine
• mitomycin C
• doxorubicin (Adriamycin)
• cisplatin
• capecitabine
• oxaliplatin

Possible side effects

Chemotherapy drugs work by attacking cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow, the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells are also likely to be affected by chemotherapy, which can lead to side effects.

The side effects of chemotherapy depend on the type and dose of drugs given and the length of time they are taken. These side effects can include:

• hair loss
• mouth sores
• loss of appetite
• nausea and vomiting
• increased chance of infections (due to low white blood cell counts)
• easy bruising or bleeding (due to low blood platelet counts)
• fatigue (due to low red blood cell counts)

These side effects are usually short-term and go away after treatment is finished. There are often ways to lessen these side effects. For example, there are drugs that can be given to help prevent or reduce nausea and vomiting. Be sure to ask your doctor or nurse about medicines to help reduce side effects, and let him or her know when you do have side effects so they can be managed effectively.

For more general information about chemotherapy, please see our document, Understanding Chemotherapy: A Guide for Patients and Families.