Bile Duct Tumors

Cancer is a far less common cause of bile duct obstruction than stones. Most cancers originate in the head of the pancreas, through which the common bile duct runs (see Section 9, Chapter 131). Less commonly, cancers originate in the biliary tract itself at the junction of the common bile duct and the pancreatic duct, in the gallbladder, or in the liver. Much less commonly, the bile ducts are obstructed by cancer that has spread (metastasized) from elsewhere in the body, or the bile ducts are compressed by lymph nodes affected with lymphoma (see Section 14, Chapter 177). Noncancerous (benign) tumors in bile ducts also cause obstruction.

Symptoms and Diagnosis

The symptoms of bile duct obstruction are progressive jaundice, abdominal discomfort, loss of appetite, weight loss, and itchiness, usually without fever and chills. Symptoms gradually worsen. When the obstruction is due to cancer, the person may experience fatigue, discomfort, and itchiness that may be particularly distressing.

A tumor in the bile ducts may be detected using ultrasound scanning or computed tomography (CT). A tissue sample can usually be obtained by inserting a thin needle through the skin under ultrasound or CT guidance. Endoscopic retrograde cholangiopancreatography (ERCP) may also be used to provide a tissue sample (see Section 10, Chapter 134).

Treatment

ERCP allows bypass tubes (stents) to be inserted to ensure that bile can flow around the obstruction, which also helps control pain and relieve itchiness. A cancerous tumor usually cannot be completely removed surgically. Most cancerous tumors do not respond well to radiation therapy. Chemotherapy for tumors that have spread from other parts of the body (metastatic tumors) may provide some relief from the symptoms but ultimately does not dramatically improve survival.