Intrahepatic Bile Duct Cancer Overview

Intrahepatic bile duct cancer is an uncommon type of cholangiocarcinoma that originates in the tiny tubes that collect and carry digestive fluid (bile) inside the liver, where the bile is produced. The smallest intrahepatic ducts (ductules) come together to form the right and left hepatic ducts. These larger branches join outside of the liver to form the common hepatic duct, which connects to the gallbladder. Bile is stored in the gallbladder until it is needed for digestion.

Cholangiocarcinoma is rare overall, and intrahepatic bile duct cancer accounts for only 5 to 10% of cases.

What causes intrahepatic bile duct cancer?

Intrahepatic bile duct cancer results from harmful DNA changes in the cells that line the bile ducts within the liver. These genetic mutations disrupt normal cellular function, causing the cells to multiply rapidly and form tumors inside the bile ducts. The precise triggers of the cellular changes that cause intrahepatic bile duct cancer are not fully understood.

What are the risk factors for intrahepatic bile duct cancer?

Known risk factors for intrahepatic bile duct cancer include:

• Advanced age (most cases are diagnosed after age 60)
• Diabetes
• Obesity and excess body weight
• Excessive consumption of alcoholic beverages
• Smoking and other forms of tobacco use
• Inflammatory bowel disease
• Certain chronic liver and bile duct conditions, including cirrhosis, hepatitis B and C, primary sclerosing cholangitis and bile duct stones
• Certain parasitic infections, such as liver flukes
• Prolonged exposure to certain chemicals, such as those used in the rubber and wood-finishing industries

What are the signs and symptoms of intrahepatic bile duct cancer?

Early-stage intrahepatic bile duct cancer does not always have noticeable symptoms. As the tumor progresses, it may cause:

• Yellowing of the skin and eyes (jaundice)
• Abdominal pain
• Loss of appetite
• Unexplained weight loss
• Dark urine
• Pale stools
• Itchy skin
• General fatigue

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How is intrahepatic bile duct cancer diagnosed?

Usually, intrahepatic bile duct cancer is diagnosed through a combination of tests, which may include:

• Imaging, such as ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) scans to help the physician visualize the tumor
• Blood work to check liver function and measure the levels of certain tumor markers, such as carbohydrate antigen 19-9 (CA 19-9)
• Biopsy to microscopically examine a small sample of suspicious tissue for evidence of cancer (required to confirm a diagnosis of bile duct cancer)
• Specialized tests, such as endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangiography (PTC), to help the physician evaluate the bile ducts more closely

How is intrahepatic bile duct cancer treated?

When possible, surgery is the primary treatment for intrahepatic bile duct cancer. Possible approaches include:

• Surgical removal of the affected bile duct – If the tumor is confined to the bile duct, the entire duct may be removed along with some nearby lymph nodes.
• Partial hepatectomy – In some cases, a portion of the liver will be surgically removed, and the remaining portion of the organ may regenerate itself over several weeks or months.
• Whipple procedure – If the tumor is near the pancreas, a pancreaticoduodenectomy may be performed to remove part or all of the pancreas and parts of the bile duct, small intestine and stomach. To reinstate the flow of bile, the surgeon may connect the remaining portion of the bile duct to the small intestine.
• Liver transplant – In rare cases, the liver will be completely removed followed by the transplantation of a donor liver.
• Stent placement and surgical bypass – If a tumor is blocking a bile duct and the tumor cannot be completely removed, the surgeon may place a plastic or metal tube (stent) inside the duct to keep it open and allow bile to bypass the blockage.

If a bile duct tumor cannot be completely removed, follow-up treatment such as chemotherapy may be considered. Chemo may also be administered before surgery to shrink the tumor and make it easier to remove, or as a standalone treatment if surgery is not feasible. Additionally, radiation therapy may be used to control the symptoms of advanced-stage bile duct cancer.

Benefit from world-class care at Moffitt Cancer Center

Moffitt offers the latest advances in intrahepatic bile duct cancer treatment in our comprehensive Gastrointestinal Oncology Program. Our team includes respected physicians from multiple specialties who focus exclusively on treating cholangiocarcinoma, helping each patient achieve the best possible outcome and quality of life. Moffitt also spearheads groundbreaking clinical trials that allow our patients to be among the first to benefit from promising new bile duct cancer treatment options, such as immunotherapies, anti-angiogenesis therapies and radiosensitizers.

If you would like to learn more about intrahepatic bile duct cancer, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488  or submitting a new patient registration form online. We do not require referrals.