Therapy
The therapy of bile duct carcinoma is very difficult, as the carcinomas are often diagnosed in a stage that cannot be cured (non-curative). However, healing is only possible through an operation in which the entire tumour has been removed, including the affected lymph nodes. If the tumor is too advanced and surgery is no longer possible, palliative therapy is indicated.
This means that a curative approach is no longer possible, and that the therapy will provide relief from the tumor-related symptoms. Complete surgical removal of the tumor is the only curative therapy for this clinical picture. Unfortunately, surgery with a curative intent can only be attempted in 20% of patients.
As an example, patients with a Klatskin tumor of Bismuth Corlette type I and II undergo surgery. During the operation, in addition to the affected bile ducts, the gallbladder (cholecystectomy), the neighboring lymph nodes and often part of the liver (partial liver resection) are also removed, as the tumor has often already grown into the liver. It is important during the operation to restore a smooth bile flow.
In certain patients with non-operable bile duct cancer, a liver transplant can be considered. After removal, the biliary duct tumor is assessed by the pathologist in terms of fine tissue (histological). For this purpose, the tumor preparation is incised at specific sites and at the edges of the resection.
Wafer-thin incisions are made from these samples, stained and evaluated under the microscope. The type of tumor is determined, its spread in the gallbladder wall is assessed and the removed lymph nodes are examined for tumor infestation. It is also important that the edges of the tumor are sufficiently distant from the healthy tissue so that there should be no tumor cells at the edge of the incision that could later cause the tumor to grow back (recurrence).
Only after the pathological findings, the tumor can be clearly classified according to the TNM classification, which describes the primary tumor (T), the lymph nodes (N) and the distant metastases (M).Unfortunately, biliary tumors are often not very sensitive to cytostatic drugs (“cancer drugs”), so that chemotherapy has little chance of success in terms of a significant prolongation of life. Numerous studies are looking for a suitable combination of cytostatic drugs and other drugs that effectively inhibit the tumor’s growth. Radiotherapy is also not very successful in the case of biliary cancers.
In addition, the radiation sensitivity of the neighboring organs (such as the small intestine, liver and kidney) must be taken into account, and the radiation dose must be correspondingly lower. Another option is the so-called small area radiation therapy (brachytherapy). In this therapy, a small radiation source is introduced into the immediate vicinity of the tumor with a catheter in an ERCP examination (if necessary PCT examination; see diagnosis bile duct cancer).
This source can then exert the radiotherapeutic effect on site.
- Operative procedure
- Pathological diagnostics
- Chemotherapy
- Radiotherapy (radiotherapy)
Photodynamic Therapy (PDT) is a relatively novel therapy. Before the actual treatment, a drug is administered via the vein (intravenously).
This drug is a so-called photosensitizer, which accumulates quite selectively in the tumor tissue and makes it particularly sensitive to light. 2 days after the drug has been administered, photoactivation is performed using light with a low wavelength. In ERCP or PTC, a probe is placed in the bile duct to emit the light.
The activated photosensitizer in the tumor tissue can destroy the cells and cause the tumor to melt down. Currently, additional attempts are being made to improve the penetration depth of PTD. However, PTD also has some side effects.
For example, it can lead to inflammation of the bile ducts (cholangitis). In addition, the photosensitizer can sometimes also light-sensitize other tissues, so that skin burns can occur if the sun is not shining (phototoxic skin damage).
- Photodynamic therapy
