Tumors of the gallbladder and bile ducts are quite rare oncological diseases, which are distinguished by late diagnosis due to pathological symptoms absence for a long time, as well as an unfavorable prognosis in many cases. As the tumor progresses, biliary obstruction develops, that is, a violation of bile outflow to duodenum. And only then specific symptoms to disease appear, but this often happens already in the late stages of biliary tract malignant lesion.
Biliary tract malignant lesions are complicated diseases, but detected in time, they are completely curable. It is necessary to begin active treatment immediately after the disease is detected, so do not delay a visit to your doctor who specializes in such health problems. Such specialists work in Oncology Department Maimonides Multidisciplinary Medical Center.
We closely cooperate with the best Israeli clinics. As an example of providing medical services, we chose Israeli medicine model, so it is one of the best in the world. Each individual clinical case is monitored not only by the attending oncologyst, but also by the head of the department – Dr. Iryna Stefanska together with responsible specialist oncologist directly from Israel. Thanks to such coordinated work in professional team, we manage to achieve significant success even in severe cases of biliary tract malignant diseases.
It is no secret that oncological problems treatment is a rather expensive process. That is why Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation. Thus, all our patients who need treatment, but are unable to afford it financially, can count on help.
One of the most important treatment advantages in our clinic is an individual approach to each patientDoctor does not use one examination plan or treatment regimen for everyone, as no two people and no two diseases are alike. Therefore, modern protocol for providing medical care for gallbladder and bile ducts tumors is modified, depending on each patient’s needs and his characteristics. Doctor must take into account patient's age, sex, type of tumor, its size, localization and distribution, the stage of disease, concomitant serious diseases presence, and patient’s wishes. Of course, all treatment measures comply with global clinical recommendations and standards of medical care in oncology, so patient may not worry about the quality of medical services.
In our Oncology Department, not only oncologists work, but a whole multidisciplinary teammultidisciplinary team. Patient is assisted by several narrow specialists – oncologists, surgeons, gastroenterologists, endoscopists, radiation therapists, chemotherapists, rehabilitation specialists, psychologists and others. All our specialists are highly qualified and have extensive experience working in an Oncology Department. Most of them have repeatedly completed internships at the best oncology centers in the world. Our medical center uses only modern and safe medical and diagnostic equipment of expert class. If a certain narrow specialist or rare medical and diagnostic equipment is not available, patient is referred to subsidiary institutions of Maimonides Medical Center or our Israeli partner clinics, where he is guaranteed to receive the full range of necessary medical services, where he is guaranteed to receive the full range of necessary medical services.
Causes and types of gallbladder and bile ducts tumors
Unfortunately, the exact causes of gallbladder and bile ducts tumors development are unknown. There are certain factors that increase developing risk of this pathology. They include:
- primary sclerosing cholangitis,
- non-specific ulcerative colitis,
- bile duct cysts,
- choledocholithiasis (gallstone disease),
- parasitic lesions of biliary tract (opisthorchiasis).
Depending on tumors location, the following are distinguished:
- intrahepatic bile duct cancer,
- extrahepatic bile duct cancer.
Cholangiocarcinoma is the most common type of malignant bile duct tumors (accounts for 95% of such lesions). Tumors occur quite rarely (1-2 cases per 100,000 people). Cholangiocarcinoma mainly affects extrahepatic bile ducts: 60 – 70% of cases arise in liver portal region (Klatskin tumor), about 25% –in ducts distal segments, in remaining cases liver is affected.
Gallbladder carcinoma is also rare (2.5 cases per 100,000 population). It develops more often in patients with large calculi (more than 3 cm) and gallbladder walls calcification against chronic cholecystitis background (porcelain gallbladder). Almost all patients with this malignant disease (70–90%) have stones in gallbladder. Treatment has a positive effect when cancer is detected early (for example, accidentally during a cholecystectomy).
Gallbladder polyps are usually asymptomatic and are benign neoplasms of gallbladder mucous membrane. They are detected in approximately 5% of cases during ultrasound. Small gallbladder polyps, which are discovered accidentally, do not require treatment. However, for polyps larger than 10 mm in diameter, surgery should be considered, as they may turn into malignant tumors.
Symptoms of gallbladder and bile ducts tumors
Most patients with cholangiocarcinoma do not have any symptomsfor a long time; in the later stages, the disease manifests itself with itching and obstructive (mechanical) jaundice appearance. Usually, tumor is diagnosed at the age of 50-70 years. Tumors located in hilum can cause only abdominal pain, anorexia and weight loss.
Other symptoms include persistent fatigue, colorless excrements, a palpable mass in abdomen, an enlarged liver, or an enlarged painless gallbladder (Courvoisier symptom) Pain can resemble biliary colic(sharp, very intense)or have a constant aching and progressive character over time.
Clinical manifestations of gallbladder carcinoma vary from occasional cases of tumor detection during cholecystectomy performed for gallstone disease to severe disease with persistent pain, weight loss, abdominal tumor, or obstructive jaundice.
Gallbladder polyps are mostly asymptomatic and are discovered accidentally during ultrasound diagnostics.
Gallbladder and bile ducts tumors diagnosing methods
The earlier diagnosis of biliary tract tumor is made, the better prognosis and treatment result. Therefore, high-quality and quick diagnosis is an extremely important stage. Maimonides Clinic uses only modern equipment of an expert class , all our doctors perfectly master all examining methods of a patient with suspected gallbladder and bile ducts malignant neoplasm, are able to correctly interpret received data, which helps them create a modern, individual and effective treatment plan.
The main method of biliary tract tumors diagnosing is ultrasound (sometimes endoscopic ultrasonography) followed by CT cholangiography or or magnetic resonance cholangiopancreatography (MRCP). Sometimes a CTscan is done, which can provide more information than an ultrasound, especially in diagnosing gallbladder carcinoma. If these methods do not give results or if damage to bile ducts is suspected, endoscopic retrograde cholangiopancreatography (ERCP) is performed).
Endoscopic retrograde cholangiopancreatography allows not only to detect a tumor, but also to perform a biopsy to confirm diagnosis. After biopsy we send all materials to the world's best pathogistological laboratories (Israel, Germany, USA).). Thanks to such double checks, we are absolutely sure of diagnosis correctness and effectiveness of selected treatment tactics.
Our patients also have access to innovative biopsy data (molecular genetic studies). This is a mandatory part of modern oncological diseases diagnosis. Thanks to molecular genetic diagnostics, we can choose the most effective treatment regimens for each individual patient. An example of such modern diagnostics are test systems for molecular genetic testing. Such as the Foundation One and Caris Molecular Testing.
Oncomarkers are also used to diagnose biliary tract cancer: when CA19-9 is detected with REA , study accuracy reaches 86%. Determination of these tumor markers in postoperative period makes it possible to assess treatment effectiveness and diagnose disease recurrence.
To determine process prevalence and disease stage, CT with contrast is performed, as well as diagnostic surgery – abdominal cavity open laparotomy and revision. Modern diagnostic procedures such as bone scintigraphy, PET-CT, PET-MRIare used to detect distant metastases. These examinations make it possible to choose the correct further treatment tactics.
Based on obtained data during diagnostic stage, doctor makes an accurate diagnosis indicating malignant process stage and formulates a treatment scheme, according to patient’s individual characteristics and modern clinical recommendations. All necessary diagnostic procedures can be performed directly in the clinic, without leaving Ukraine.
Gallbladder and bile ducts tumors modern treatment
One of the main treatment advantages of malignant diseases in our Oncology Department is a comprehensive treatment approach application. In the struggle against a malignant tumor, specialist uses the entire available arsenal of treatment methods. Therapy is always a combination of two, three or more methods. Typically, treatment regimen includes tumor surgical removal in combination with chemotherapy and/or radiation therapy. In some cases, certain innovative treatment methods are added to treatment program (targeted drugs, immunobiological drugs, etc.).
Surgical treatment for cholangiocarcinoma involves stenting (or other procedures to restore bile duct), occasionally tumor resection is performed. Intraductal cholangiocarcinoma is stented using percutaneous transhepatic cholangiography or endoscopic retrograde cholangiopancreatography (ERC). Distally located cholangiocarcinoma is an indication for endoscopic stenting during endoscopic retrograde cholangiopancreatography. If cholangiocarcinoma is localized, diagnostic procedure determines that it can be removed by surgical resection or pancreatoduodenectomy. These are very complicated surgical interventions, but our surgeons master all of above-mentioned surgical techniques.
Liver transplantation for localized cholangiocarcinoma in combination with preoperative radio chemotherapy and postoperative radiation therapy provides a good prognosis and high 5-year patient survival. This procedure is available at some transplant centers as part of a special protocol.
Chemotherapy can be used before or after surgery. Various chemotherapeutic treatment schemes are applied using only modern and safe drugs from the best global pharmaceutical companies. So we are sure of drugs quality for chemotherapy and their safety. Most often, the following drugs are used in treatment regimens: fluorouracil, mitomycin, methotrexate, doxorubicin, cisplatin, gemcitabine, oxaliplatin.
Radiation therapy is used in complex treatment. As a rule, it is prescribed after surgery. In our department, radiation is performed on modern new devices – linear accelerators. Such equipment allows the use of intensity modulated radiation therapy (IMRT), rotational (moving radiation) with beam intensity modulation (VMAT), as well as stereotaxic radiation therapy (SRT) and stereotaxic radiosurgery (SRS). Thanks to such modern technologies, we can fight cancer diseases that were previously considered incurable by purposefully delivering high doses of radiation directly inside the tumor, with minimal negative impact on healthy surrounding tissues, which guarantees patient high quality of treatment and minimal side effects.
Targeted and immunobiological drugs are also used in patients treatment with biliary tract malignant tumors, especially in the late stages, when it is not possible to completely remove the tumor, and only one chemotherapy and radiation treatment is not enough for patient’s survival. Such innovative drugs act purposefully only on malignant cells, while not harming the surrounding healthy tissues, and this is their main advantage and difference from classical chemo medicine.
The decision about certain therapy methods combination (which methods to start with, what to add next, at what stage of treatment to perform surgery, when and according to which scheme to apply chemotherapy, whether to use targeted drugs or other immunobiological drugs) is always made in consultation by a team of specialists. Doctors often have to go beyond standard protocols, change treatment regimens and doses of necessary drugs, and modify radiation technique to get the best possible results for their patients. . Thanks to this individual approach to each individual case, we manage to win over such serious diseases in most cases.