Symptoms
The cardinal symptom is a painless jaundice (icterus), which is caused by the narrowing of the bile ducts and causes the accumulation of bile in the liver. The accompanying symptoms of icterus are a yellowing of the skin and white eye color (sclera) and a straining itchy skin due to deposited bile salts in the skin. In addition, there is a loamy discoloration of the stool due to the absence of the bile pigment in the stool and a darkening of the urine, since the kidney is responsible for excretion of the bile pigment.
Due to the absence of bile acids in the small intestine, fats can be digested more poorly, which can lead to intolerance to fatty meals and to fatty stools (steatorrhea). If the tumor closes the ductus cysticus, the bile is retained in the gallbladder. Thus, in addition to the painless icterus, a bulging gall bladder can be palpated under the right costal arch.
This symptom complex is also known as the Courvoisier ́sches sign.Other complaints may include non-specific diffuse upper abdominal pain, nausea, vomiting, loss of appetite and digestive problems. As late symptoms, pain in the right upper abdomen can be added and other unspecific symptoms that can occur in many cancers, such as weight loss (tumor cachexia), anemia, fatigue and lack of drive. Due to the congestion in the bile ducts, a dangerous infection of the bile ducts (cholangitis) can easily develop, as the “standing” bile is a suitable breeding ground for bacteria. In the course of the disease, the congestion of bile can lead to liver failure (hepatic insufficiency) and, in the final stage, to complete loss of liver function with coma and severe blood clotting disorders.
Tumor spread (metastasis)
Here we will describe different forms of metastasis: The lymph vessels drain the lymphatic fluid from all parts of our body. When the tumor grows and connects to a lymph vessel, it is easy for some cells to detach from the tumor cell cluster and be carried along with the lymphatic flow. There are numerous lymph nodes in the course of a lymph vessel.
They are the seat of the immune system, which has the task of intercepting and fighting germs (bacteria). The tumor cells settle in the nearest lymph nodes and multiply there again. This leads to a lymph node metastasis.
This type of cancer affects lymph nodes in the immediate vicinity, i.e. in the vascular lobe of the liver (hepatic hilus) and later also in those in the course of the aorta. This type of cancer often shows lymph node metastases when diagnosed, so that it is always recommended to remove the surrounding lymph nodes during surgery. If the bile duct cancer grows and connects to a blood vessel, cells can also break away in this situation and be scattered throughout the body via the bloodstream.
The first station is the blood flow through the liver, where the carcinoma cells can settle and form daughter tumors (distant metastases). In the further course of the disease, cells can also detach from the liver metastases and spread further into the lungs. Later, metastases can also spread into the peritoneum, which is also called peritoneal carcinomatosis.
The bile duct cancer can grow into other neighbouring organs on its way to spread (tumorous infiltration). Depending on the proximity of the carcinoma to the liver, the tumor has grown into the liver at the time of diagnosis. In addition, the tumor can also grow into the duodenum, stomach, pancreas, neighboring vessels such as the portal vein and other adjacent structures.
- Lymphogenic metastasis:
- Hematogenic metastasis:
- Per continuitatem:
