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What to Know About Surgery for Bile Duct Cancer

Photo of surgery in progress

Surgery is commonly used to treat bile duct cancer. It is currently the only treatment that can sometimes cure bile duct cancer in people whose cancer has not spread. However, if the cancer is too far advanced to be able to completely remove the cancer, a palliative procedure may be done. Palliative procedures may be used to improve a person's situation by providing relief from pain and other symptoms, as well as to treat or prevent complications. 

The type of surgery your doctor chooses depends on the exact location of the cancer and how far it has spread. Here are some surgical options for bile duct cancer:

  • Removal of the bile duct. If you have a small tumor that is confined to the bile duct outside but near the liver, called perihilar bile duct cancer, the surgeon may remove the entire bile duct. The surgeon will make a new connection to your small intestine, allowing the bile to flow again. If the cancer has spread to nearby tissues, usually the liver, the surgeon may need to remove part of that tissue as well. Your surgeon may also remove nearby lymph nodes and examine them for signs of cancer.

  • Partial hepatectomy (also called liver resection). For this operation, the surgeon removes the part of your liver where the intrahepatic bile duct cancer is found. This may also be done if cancer is in the hepatic duct very close to the liver. A large or small part of your liver may be removed. The surgeon may also remove some surrounding normal tissue to be sure that all the cancer is taken out.

  • Whipple procedure (also called pancreaticoduodenectomy). If the bile duct cancer is very close to your pancreas, you may need this surgery. For this procedure, the surgeon takes out your bile duct and your gallbladder, along with part of your pancreas, part of your stomach, and the first part of your small intestine. 

  • Surgical biliary bypass. If the surgeon cannot completely remove the bile duct cancer, he or she may do a bypass to lessen symptoms caused by the cancer. For example, if the cancer is blocking the bile ducts and bile builds up behind the blockage, surgery can help relieve the obstruction. During this operation, the doctor will connect your bile duct to a piece of your small intestine. This will create a new pathway around the blockage to allow the bile to flow to your intestine for normal digestion of fats. This surgery does not cure the cancer, but it can relieve jaundice and other symptoms. It may precede other types of treatment. 

Questions to ask your doctor about surgery for bile duct cancer

You may be overwhelmed with the information that you receive from your doctor. It is important to take the time to gather as much information as possible. To help understand the medical information and remember all of your questions, it is helpful to bring a family member or close friend with you to doctor's appointments. Here are some questions you may want to ask your doctor about surgery for bile duct cancer:

  • What kind of surgery can I consider? What option do you recommend for me?

  • Are there any other treatment options besides surgery? 

  • What will happen if I don't have the surgery? 

  • Will it cure me of the cancer?

  • How will I feel after surgery?

  • Will I need radiation and chemotherapy before or after surgery?

  • Where will the scars be? What will they look like?

  • When can I get back to my normal activities?

  • How will surgery affect my diet?

  • What kind of follow-up care will I need after surgery?

  • Will I need other treatment after surgery?

What to expect after surgery

Surgery for bile duct cancer is typically a complex operation that can have major side effects, so it is important that it is done by a surgeon with a lot of experience. After surgery, you may be in an intensive care unit. There you can be watched closely by nursing staff. When you have recovered from the surgery, you'll be moved to a regular nursing unit to continue to recover. Care after surgery is called postoperative care. It focuses on monitoring how much you eat and drink and checking for the return of normal bowel function. These are some potential side effects or complications after surgery:

  • Infection at the incision site

  • Poor wound healing

  • Pain

  • Blood clots

  • Leakage at the bile drainage site

  • Nausea or vomiting

  • Problems with digestion

If you or a family member have been diagnosed with bile duct cancer, you may want to consider getting a second opinion. In fact, some insurance companies require a second opinion for such diagnoses. It is very rare that the time it will take to get a second opinion will have a negative impact on your treatment. The peace of mind it may bring may be well worth the effort. 

FYH

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