Chemotherapy for Bile Duct Cancer
Chemotherapy (chemo) is treatment with anti-cancer drugs that are usually given into a vein or taken by mouth. These drugs enter the bloodstream and reach all areas of the body, making this treatment useful for some cancers that have spread to organs beyond the bile duct. Because the drugs reach all the areas of the body, this is known as a systemic treatment. Chemo can help some people with bile duct cancer, but so far its effects against this type of cancer have been found to be limited.
For resectable bile duct cancers (cancers that can be removed completely), chemo may be used after surgery (often along with radiation therapy) to try to lower the risk that the cancer will return. This is known as adjuvant chemo. Some doctors may use it before surgery for borderline resectable cancers to try to improve the odds that surgery will be successful. This is called neoadjuvant treatment.
Chemo can also be used (sometimes with radiation therapy) for more advanced cancers. Chemo does not cure these cancers, but it might shrink or slow the growth of tumors for a time. This can help relieve symptoms from the cancer, and may help people live longer.
Doctors give chemo in cycles, with each period of treatment followed by a rest period to give the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Chemo is often not recommended for patients in poor health, but advanced age by itself is not a barrier to getting chemotherapy.
Hepatic artery infusion (HAI): Because giving chemo into a vein is not always helpful for bile duct cancer, doctors have tried giving the drugs directly into the main artery going into the liver, called the hepatic artery. Since the hepatic artery also supplies most bile duct tumors, more chemo goes to the tumor. The healthy liver then removes most of the remaining drug before it can reach the rest of the body. HAI may help some people whose cancer was not removable by surgery live longer, but more research is needed. This technique may not be useful for some people because it often requires surgery to insert a catheter into the hepatic artery, an operation that many bile duct cancer patients might 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 used most often to treat bile duct cancer include:
- 5-fluorouracil (5-FU)
- Gemcitabine (Gemzar®)
- Capecitabine (Xeloda®)
- Oxaliplatin (Eloxatin®)
Possible side effects of chemotherapy
Chemo drugs attack 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 (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, also divide quickly. These cells can also be affected by chemo, which can lead to side effects.
The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken. Side effects can include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Nerve damage ( neuropathy), which can lead to trouble swallowing or numbness, tingling, and even pain in the hands and feet
- Increased chance of infections (from having too few white blood cells)
- Easy bruising or bleeding (from having too few blood platelets)
- Fatigue (from having too few red blood cells)
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, drugs 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 them know when you do have side effects so they can be managed effectively.
Last Medical Review: November 1, 2014 Last Revised: January 20, 2016