Rare Cancer in Adulthood - Bile Duct Cancer (Cholangiocarcinoma)

Bile duct, the tube-like structure carries bile to the intestine for foods digestion secreted by the liver through the common bile duct.

Bile duct cancer is defined as the malignant cells originated from the cells in the duct. It more likely to affects people between age of 50 - 70 with an annual incident rate of less 2 cases per 100,000 in the Western world.

Symptoms
1 Abdominal pain
Due to the enlarged tumor that has blocked the flow of bile.
2. Jaundice
Any blockage of the flow of bile will reduce liver function in waste procession, in this case, it is death of blood cells.
3. Weight loss
Weight loss is a general cause of cancer
4. Itching
Due to abnormal function in toxins procession.
5. Fever
As a result of infection or inflammation
6. Stool or urine color change
Due to bile flows back to the liver.
7. Enlarged liver
May be caused by back flow of bile
8. Nausea and vomiting
They are the general symptoms of cancer
9. Loss of appetite
Another general symptom of cancer

10. Etc.

Causes and risk factors
The exact cause of bile duct is unknown
1. Liver diseases

Increased risk of bile duct cancer for people with liver diseases such as primary sclerosing cholangitis, ulcerative colitis, choledochal cysts, cirrhosis, etc.

2. Parasites
Due to eating uncooked fish, meat and plant growth in the infected water contains tiny fluke parasite worm.

3. Age
The cancer is more likely to develop in the age between 50- 70.

4. Obesity
Hormonal change due to obesity increase the risk of bile duct cancer.

5. Gene
In a study of K-ras Mutation, p53 Overexpression, and Microsatellite Instability in Biliary Tract Cancers by Asif Rashid1, Takashi Ueki, Yu-Tang Gao, Patrick Scott Houlihan, Charita Wallace, Bing-Sheng Wang, Ming-Chang Shen, Jie Deng, and Ann W. Hsing reserchers found that ...K-ras mutation was present in 14.3% of the biliary tract cancers in our study......p53 overexpression was present in 27.6% of biliary tract cancers.... MSI-high was present in 3.2% of biliary tract cancers.... genetic alterations in biliary tract cancer vary by subsite and histological type of tumor and by age of onset of the tumor. The frequency of the K-ras mutation is dependent on the subsite of the biliary tract cancer and associated with prognosis of bile duct cancers; p53 overexpression and MSI are associated with the histological type of tumor; and MSI is associated with early age of onset without HNPCC.

6. Chemical exposure
People have exposed to certain chemical substances such as thorium dioxide, nitrosamines, dioxins and polychlorinated biphenyls are st risk of bile duct cancer.

7. Infection of hepatitis B and C
Inflammation and infection caused by hep B, C can cause the increased risk of the disease.

9. Family history
Risk of bile duct cancer increase for people with family history of bile duct cancer.

10. Alcohol drinking
Excessive drinking can cause cirrhosis, leading to increased risk of bile duct cancer.

11. Etc.

Grades
The grade of bile duct cancer are depending to the tendency of spreading. Low grade cancers usually grow more slowly and are less likely to spread while high grade cancer indicates otherwise.

Stages
Bile duct cancer is classified as 5 stages
1. Stage 0
If the cancerous cell have not penetrated into deeper tissue but on the surface of the inside lining of the bile duct .

2. Stage I
In stage I, the cancerous cells are no longer in the surface but have invaded into deep the inside bile duct lining but still completely inside the bile duct.
a. Stage IA
The cancer is not ≤ 3 mm (1/8 inch) deep and ≤ 7 mm (1/4 inch) wide.
a.1. Stage IA1:
The spreading is not less than 3mm(1/8 inch) deep and & less than 7mm (1/4 inch) wide.
a.2. Stage IA2:The invasion area is ≥ 3 mm but ≤ 5 mm (about 1/5 inch) deep and & less than 7 mm (about 1/4 inch) wide.
b.Stage IB:
The cancer in this stage have invaded the connective tissue, & less than 5mm (1/5 inch).
b.1. Stage IB1:Cancer is 4 cm large (1 3/4 inches).
b.2. Stage IB2:Cancer is ≥ 4 cm (1 3/4 inches) but & less than 5cm (1/5 inch)

3. Stage II
In stage II, the cancerous cells have spread to distant tissues, but is still within the bile duct.

4. Stage III
In this stage, cancerous cells has spread to the tissues immediately surrounding the bile duct.

5. Stage IV
In this stage, cancerous cells has spread to the tissue immediately outside of the bile duct to distant parts of the body.

Diagnosis and tests
After recording the family history and physical exam to check for any sign of cancer such as swelling, lump, etc. Your doctor may suggested the diagnosis and tests below.
1. Blood test
With the blood withdrawn from your vein, it is test to measure the levels of bilirubin and alkaline phosphatase. Higher levels of above are indication of improper function of the bile duct.

2. Blood test for tumor markers (CEA and CA19-9)
Any indication of high levels of carcinoembryonic antigen (CEA) and CA19-9 in the blood may be result of bile duct cancer.

3. Biopsy
In bile duct cancer biopsy, a very small tissue sample is extracted and examined under a microscope for the presence of cancer cells by using a thin, tube like medical instrument to look for the grade of abnormal cells growth by a pathologist, depending to the location of the cancer.

4. Ultrasound
Ultrasound allows your doctor to visualize and assess the size and to check for any abnormality and surrounding area with image taken from the test.

5. CT scan
A CT scan generates a large series of two-dimensional X-ray images taken around a single axis of rotation, to create a three-dimensional picture of the inside of the body in details. The pictures are viewed by your doctor to see the extent of the tumors abnormalities, such as spreading of cancer to the nearby structure and lymph nodes. Unfortunately, CT scan can only review the existence of cancer, but can not tell it is a primary or secondary cancer.

6. MRI (magnetic resonance imaging)
MRI (magnetic resonance imaging) is one of many advanced technology used to visualize internal structures cross sectional imaging of your body used effectively in providing the better details of the metastasis of cancer in the vulva and surrounding areas.

7. Fine needle aspiration (FNA)
In fine needle aspiration (FNA) bile duct diagnosis, a needle is guided by ultrasound or CT scan from the skin through the abdomen and into the bile duct to exam the tumor if there is one. Sample is also taken for examination by a pathologist under microscope.

8. Etc.

Preventions
A. How to avoid
1. Avoid eating raw fish and meat
It is proven that raw fish and meat may contain parasites which cause bile duct cancer.
2. Clean your raw vegetables
vegetables grown in contaminated water can contain parasites that cause the disease.
3. Avoid infected by hepatitis
Take hepatitis vaccine
4. Avoid exposure to certain chemicals
Avoid making contact with certain chemicals such as thorium dioxide, nitrosamines, dioxins and polychlorinated biphenyls can increase the risk if bile duct cancer. If occupation required, please take all necessary precaution.
5. Lose weight
Obesity is proven can cause hormonal changes that can cause bile duct cancer.
6. Avoid alcohol
Excessive drinking can cause cirrhosis and other liver diseases.
7. Etc.

B. Diet
1. Carrot
Carrot contains high amount of beta carotene which has shown to induce appotosis of cancer cells. In study of Cell Cycle Regulation and Induction of Apoptosis by β-carotene, researchers found that in vivo study warrants further confirmation that β-carotene acts as apoptosis agent in cancer cells particularly leukemia cells but not normal cells.

2. Garlic
An analysis of several case-controlled studies in Europe suggests an inverse association between garlic consumption and risk of common cancers.

3. Green tea
In some clinical studies researchers suggested that the polyphenols in green tea, may play an important role in the prevention of cancer by killing cancerous cells and stopping their progression.

4. Cabbage
Cabbage beside contains high amount of antioxidants, but also phytonutrients that have been shown to help prevent the onset and halt the progression of certain cancers.

5. Soy
In laboratory studies, saponins have shown the ability to inhibit the reproduction of cancer cells and slow the growth of tumors in several different tissues.

6. Etc.

C. Nutritional supplements

1. Antioxidants - free radical scavengers
Vitamin A, C, E are free radical scavengers enhanced the immune system against the forming of free radicals and prevent the alternation of cell DNA cause of abnormal cell growth. For more information of how antioxidants help to treat cancer, click here

2. Beta -carotene
In some laboratory, animal, and human studies, researchers found that vitamin A, certain retinoids may also inhibit cancer development.

3. Lycopene
Many studies showed that antioxidant lycopene in tomato inhibits cancer cell growth and exhibit apoptosis, causing cell death.

4. Omega 3 polyunsurated fatty acid
In a study of Cyclooxygenase-2–Derived Prostaglandin E2 Activates Beta-Catenin in Human Cholangiocarcinoma Cells: Evidence for Inhibition of TheseSignaling Pathways by W3 Polyunsaturated Fatty Acids by Kyu Lim, Chang Han, Lihong Xu, Kumiko Isse, Anthony J. Demetris and Tong Wu, researchers found that COX-2–derived PGE2 activates beta-catenin in human cholangiocarcinomacells and that N3-PUFAs inhibit cholangiocarcinoma cell growth by simultaneously blocking beat-catenin and COX-2 signaling pathways.Our findings provide important preclinical evidence and molecularinsight for potential utilization of omega 3-PUFAs in the chemopreventionand treatment of cholangiocarcinoma.

5. Selenium
Research showed that selenium has a protective effect on various stages of cancer, including both the early and later stages of the disease. In a study in large groups of people, researchers found that in areas of the world where selenium levels in the soil are high, death rates from cancer are significantly lower than in areas where selenium levels are low.

6.Etc.

Treatments
A. In conventional medicine
1. Surgery
a. The aim of the surgery is to cure, if the cancer is small, the bile duct is removed and replaced by making a new duct connect to the openings in the liver to the intestine. In case of cancer has spread to the liver then part of liver is removed as well, depending to the grade and stage and location of the cancer.
b. Risks and side effects
Surgical and anesthesia risks

2. Radiotherapy
a. Radiation may be used for stages II, III, and IV to kill any cancer cells remaining in the body. By using high-energy x-rays or other types of radiation, radiation therapy kills the cancer cells and keep them from growing or regrowing after surgery. Sometimes, radiotherapy is used instead of surgery under certain condition and situation.
b. Side effects
b.1. Fatigue
b.2. Chest pain
b.3. Heart problem
b.4. Short of breath
b.5. Skin discoloration or pinkness, irritation.
b.6. Etc.

c. Chemotherapy
Chemotherapy is most use to treat with advance stage of cancer combined with radio therapy, as it has spread to a distant parts of the body by using drugs taken by mouth or injected into a vein or muscle of the patient to stop the growth of or to kill cancer cells. In bile duct cancer, the cancer is not sensitive to chemotherapy, but it can be used as additional treatment after surgery.
b. Side effects
b.1. Nausea
b.2. Vomiting
b.3. Hair loss
b.4. Fatigue
b.5. Anemia
b.6. Mouth sores taste and smell changes
b.7. Infection
b.8. Etc.

B. Herb medicine

1. Tea
Tannins, a group of simple and complex phenol, polyphenols, and flavonoid compounds, once are considered anti nutritional but it is now known of their beneficial depending to their chemical structure and dosage for its anti-inflammatory, antibacterial, antiviral, and antiparasitic effects.
Theanine, an amino acid that produces tranquilizing effects in the brain, theanine found in green tea, has a significant clinical results for naturally calming as it promotes alpha brain waves, putting you in a state of relaxation without causing drowsiness. It also increases the dopamine levels in the brain, leading to a well-being feeling.

2. Celandine
Celandine is a herbaceous perennial plant, genus Chelidonium, belonging to the family Papaveraceae, native to Europe and western Asia and introduced widely in North America.
In a study of Ukrain (Ukrain is an anticancer drug based on the extract of the plant)– a new cancer cure? A systematic review of randomised clinical trials, researcher suggested, according to the data from randomised clinical trials that Ukrain to have potential as an anticancer drug. However, numerous caveats prevent a positive conclusion, and independent rigorous studies are urgently needed.

3. Curcumin
In laboratory and animal studies, researchers found that curcumin may slow the spread of cancer and the growth of new tumor blood vessels. It may also cause cancer cells to die.

4. Fenugreek
Fenugreek is used both as a herb (the leaves) and as a spice (the seed), genus Trigonella, belonging to family Fabaceae. Vitro studies have shown that fenugreek exhibits chemopreventive properties against certain cancers.

5. Etc.

C. Traditional Chinese medicine
1. Pu Kong Yin (Dandelion Root)
In a study of the efficacy of dandelion root extract in inducing apoptosis in drug-resistant human melanoma cells, researchers found that treatment with this common, yet potent extract of natural compounds has proven novel in specifically inducing apoptosis in chemoresistant melanoma, without toxicity to healthy cells. Po kung yin is one the best Chinese herbs to treat hepatistic virus infection.

2. Bai Hua She She Cao
In a study of Evidence for Oldenlandia diffusa-evoked cancer cell apoptosis through superoxide burst and caspase activation by Yadav SK, Lee SC, researchers found that the ethanol extract of the herb effectively evokes cancer cell apoptosis, possibly through burst-mediated caspase activation.

3. Huang qi and Dang qui
According to the report of 2007 Dr. Narda G. Robinson, DO, DVM, MS. huang qi (astragalus) and Dang qui (angelica) activate the immune system and display antitumor activity.
In study of Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials, researchers found that astragalus may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials.
According to the American Cancer Society, the substances, licochalcone-A, licocoumarone and glabridin, which are present in licorice root, may prevent mutations in the DNA and kill existing cancer.

4. Bai zhu
In a laboratory tests researchers found that neutral oil of the vaporizing oil bai zhu could inhibit esophagus cancer cells. 10mg/ml/hour could detach all the cancer cells. 5mg/ml/hour could detach most of the cancer cells and damaged the remaining cells. The nucleus became hazy and the cells became empty bubbles., according to Introduction of Research of Effect of Chinese Herbs on Cancer Cells.

5. Ling Zhi
Ling Zhi one of many herbs, has been used over thousands of year in treating abnormal cells growth in traditional Chinese and herbal medicine. In a study , researcher found that cancer cells responded to the herb much in the same way as they would react to chemotherapy drugs. Yet unlike chemotherapy drugs, which can also be toxic to healthy cells, herbal extracts were more deadly to cancer cells than to normal cells, indicating that they have some ability to specifically target cancer.

6. Etc.

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