Know about Biliary tract cancer

Although biliary tract cancer is rare in the West, it occurs in 8 to 10 cases per 100,000 in the East. It is slightly more common in males than females, 1.3 to 1, and occurs frequently in people in their 40s and 60s.

According to its location, it is divided into intrahepatic biliary tract cancer and extrahepatic biliary duct cancer, and intrahepatic biliary duct cancer is classified into peripheral biliary duct cancer and hepatic portal biliary duct cancer. Extrahepatic biliary tract cancer According to the site of occurrence, it is divided into upper (proximal), middle, and lower (distal) biliary tract cancer, and there are slight differences in clinical features, treatment methods, and prognosis.

The known risk factors for biliary tract cancer include chronic hepatobiliary tract parasitic infection such as hepatochondrosis, biliary cyst, congenital anomaly with bile duct dilatation, chronic ulcerative colitis, and primary sclerosing cholangitis. If you have a job (those who work in rubber, aircraft, chemical, or automobile factories), your risk of developing biliary tract cancer is high. Ulcerative colitis or biliary cyst patients develop as early as 20 years.

The incidence of biliary tract cancer is quite high even with only biliary cysts, but the incidence is higher when biliary cysts and pancreatic duct confluence are present. In addition, if ulcerative colitis and primary sclerosing cholangitis coexist, the risk is 30 times higher than that of the general public. To prevent hepatoschizophrenia, a cause of biliary tract cancer, avoid eating raw freshwater fish, and if you are infected with hepatoschizophrenia, you should take treatment immediately.

Early diagnosis of biliary tract cancer is difficult because there are no specific symptoms in the early stages. When a tumor obstructs the part from the biliary tract to the duodenum, biliary obstruction blocks the flow of bile, resulting in jaundice, which is often asymptomatic until obstructive jaundice appears. Because biliary obstruction progresses slowly, when cancer is diagnosed clinically, it is often quite advanced. Because biliary obstruction progresses slowly, when cancer is diagnosed clinically, it is often quite advanced. Symptoms due to biliary obstruction include jaundice, pruritus, gray stools (white stools), fatigue, nausea, vomiting, and pain that is not clearly limited to the right upper abdomen or medius region.

For the diagnosis of biliary tract cancer, imaging tests such as abdominal ultrasound, abdominal CT, and abdominal MRI are used, and there is a local stenosis or mass and the upper bile duct is enlarged.

Treatment for the cure of biliary tract cancer

The only treatment for the cure of biliary tract cancer is surgical resection, and the treatment method is determined in consideration of the size, location, stage, age and health of the patient. At the time of diagnosis, only about 40-50% of cases can be resected, and only 25% of patients can be radically resected. The 5-year survival rate of all biliary tract cancer patients is only 5%. Lesions occurring in the bile ducts in the upper liver (hepatic biliary tract cancer) increase the likelihood of a cure when the liver is partially resected along with the bile duct and gallbladder. However, hepatic biliary tract cancer tends to infiltrate into the early surrounding blood vessels (portal veins, arteries) and bilateral hepatic bile ducts, so complete resection is often difficult. For lesions in the lower bile duct, pancreaticoduodenal resection is possible, and the resection rate is higher than in the upper bile duct.

Obstructive jaundice is the most problematic in patients with pancreatic and biliary tract cancer for which curative resection is not possible. Endoscopic retrograde biliary drainage (ERBD) is performed by inserting an endoscope up to the duodenum to directly check the stenosis and obstruction of the biliary tract, and inserting a stent into the biliary stenosis to allow the bile to drain well. If insertion of the stent is difficult due to the location of the lesion, transhepatic bile drainage is performed.

Chemotherapy is used to prevent recurrence after radical resection, or when complete resection of the cancer is difficult after surgery, advanced or metastatic cancer that cannot be operated on, or recurrence after surgery. Drugs include cytotoxic anticancer drugs and targeted therapeutics, either alone or in combination depending on the patient. These days, in order to increase the survival rate of pancreatic and biliary tract cancer, which has a poor prognosis compared to other cancers, personalized treatment using targeted therapeutics is being attempted.

Symptoms of Pancreatic Cancer

Symptoms of pancreatic cancer are non-specific, and symptoms seen in various pancreatic diseases may appear. Abdominal pain, weight loss, and jaundice are the most common.

In addition, it appears differently depending on the location, size, and metastasis of the tumor. Most patients with pancreatic cancer have abdominal pain and weight loss, and most patients with pancreatic head cancer have jaundice. 60-70% of pancreatic cancers occur in the head of the pancreas, with symptoms primarily related to obstruction of the adjacent common bile duct. Cancers of the body and tail of the pancreas often show no symptoms in the early stages and are often discovered later.

Jaundice

Jaundice is caused by a tumor located in the head of the pancreas that blocks the part from the common bile duct to the small intestine and blocks the flow of bile, resulting in an increase in the level of bilirubin in the blood.

Jaundice occurs in only 5-6% of cases with tumors on the trunk or tail, but when jaundice occurs, cancer cells have already spread throughout the pancreas and metastasize to the liver or lymph nodes.

When jaundice is caused by elevated levels of bilirubin in the blood, the skin and whites of the eyes turn yellow, the urine turns brown, and the skin becomes itchy.

Abdominal pain

The most important symptom of pancreatic cancer is pain. It occurs in about 90% of cases, but the initial symptoms are vague and often passed without treatment. Pain is most commonly felt at the tip of the medius, but it can be felt anywhere in the left, right, upper, lower abdomen.

When cancer cells have spread to the nerves surrounding the pancreas, severe pain is felt in the upper abdomen or back.

Weight loss

Weight loss over several months for no apparent reason is a common symptom in patients with pancreatic cancer, with a weight loss of 10% or more from the ideal weight.

Weight loss is caused by poor absorption of pancreatic juice due to decreased pancreatic secretion and decreased food intake. In patients with pancreatic head cancer, malabsorption is the main cause of weight loss, but decreased food intake also contributes to some extent. In patients with pancreatic and tail pancreatic cancer, decreased food intake is the main cause of weight loss.

Digestive disorders

If the carcinoma blocks the flow of digestive juices into the duodenum, it can cause problems with the digestion of fat. Incomplete digestion of fat results in a change in stool pattern, with unusually large amounts of pale, oily stools that float on water.

When cancer cells spread to the stomach, they experience unpleasant pain, vomiting, and nausea after eating.

Diabetes

Diabetes mellitus that has never existed before may appear, or existing diabetes may be exacerbated, and clinical symptoms of pancreatitis may be present. As already mentioned, diabetes may be the cause of pancreatic cancer, but it is thought to be the result of a tumor. Therefore, if a person over 40 years of age suddenly develops diabetes or pancreatitis, the development of pancreatic cancer may be suspected.

Other symptoms

Changes in stool and bowel habits are common, and although 62% of patients with pancreatic head cancer may have gray stools, some patients may experience constipation. Nonspecific symptoms such as nausea, vomiting, weakness, and anorexia occur frequently, and in less than 5% of patients, gastrointestinal bleeding, mental disorders such as depression or emotional instability, and superficial thrombophlebitis may also appear.

In addition to the above symptoms, when cancer develops in the islet of Langehans, which has an endocrine function, too much insulin and hormones are secreted and symptoms such as weakness, dizziness, chills, muscle cramps, and diarrhea appear.

How to prevent pancreatic cancer

Unfortunately, there are still no clear preventive measures or recommended screening standards to prevent pancreatic cancer. However, it is inevitable to prevent pancreatic cancer by avoiding what is pointed out as a risk factor for pancreatic cancer in daily life.

Smokers are 2 to 5 times more likely to develop pancreatic cancer than non-smokers, and because the risk of developing cancer in other organs is also increased, quitting smoking is essential to preventing pancreatic cancer as in other cancers. Avoiding a high-fat, high-calorie diet and obesity, centered on meat, and improving your diet centered on fruits and vegetables and moderate exercise are good ways to prevent cancer.

And if you work in a job that exposes a lot of chemicals, such as solvents, gasoline, and related substances, which are known risk factors for pancreatic cancer, you should reduce your exposure to these substances as much as possible by wearing protective equipment or by following safety rules.

Pancreatic cancer is related to diabetes or pancreatitis, so if you suddenly develop diabetes, have diabetes, or have acute or chronic pancreatitis, you should receive regular clinical care and avoid risk factors for pancreatic cancer as much as possible.

Site of gallbladder cancer

The path through which bile secreted from the liver flows into the duodenum is called the biliary tract, and the gallbladder is a storehouse that temporarily stores bile through a thin spiral tube called the gallbladder duct. do. The gallbladder is attached to the underside of the liver and is connected to the extrahepatic biliary tract.

Gallbladder Cancer Risk Factors

Currently, the exact mechanism of gallbladder cancer is not known, and it is thought that environmental and genetic factors are involved in a complex way. Diseases such as gallstones and chronic cholecystitis are known to have a significant impact on carcinogenesis, but the process is unclear.

Gallbladder Cancer Risk Factors and Prevention

There are no clear guidelines or recommended screening criteria to help prevent gallbladder or biliary tract cancer.

Gallbladder Cancer early screening

Although there is no specific recommended early screening method, it is important to avoid the risk factors in daily life and to receive regular health check-ups to detect cancer early. When symptoms such as abdominal bloating and digestive disorders appear, it is necessary to identify which part of the digestive system is abnormal through medical treatment.

Gallbladder Cancer symptoms

Since gallbladder cancer has no symptoms in its early stages, early detection is very difficult. In the case of early cancer, there are no symptoms of jaundice, and there are cases where a patient who came to the hospital because of abdominal pain or abnormal liver function test was mistaken for having a gallstone and had the gallbladder removed. Non-specific symptoms of gallbladder cancer include weight loss, fatigue, loss of appetite, nausea, vomiting, pain in the upper abdomen or stomach, jaundice, and sometimes accompanied by obstruction of the duodenum or large intestine.

Gallbladder Cancer Diagnostic method

Clinically used tests for the diagnosis of gallbladder cancer include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and percutaneous transhepatic cholangiography ( PTC), endoscopic ultrasonography (EUS), proton emission tomography (PET), and serum tumor marker tests. Cancer is suspected when a lump is found in the gallbladder through ultrasound or CT scan. Cancers in other areas can be biopsied, but surgery for gallbladder cancer is often difficult. Therefore, if cancer is suspected by radiological examination, many patients go directly to surgery, without biopsy.

Treatment of gallbladder cancer

The primary treatment for gallbladder cancer is surgical resection. Which surgical method to choose depends on how advanced the cancer is. When cancer cells are localized within the mucous membrane or muscle layer of the gallbladder, cholecystectomy is known to be sufficient. In the case of advanced gallbladder cancer, such as when cancer cells have invaded the gallbladder subserosal connective tissue, directly infiltrated the liver or metastasized to the surrounding lymph nodes, extensive resection, including partial liver resection and peripheral lymph node dissection, is performed.

Hepatopancreaticoduodenectomy and hepatoligamentous pancreaticoduodenectomy are attempted in some cases with advanced stages, but the cure rate is not high.

Gallbladder cancer side effects of treatment

The most common complications after surgery are liver dysfunction, bile leakage, and fluid retention in the abdominal cavity. With the development of postoperative patient management and non-surgical treatment techniques, most can be improved with conservative treatment, and the possibility of fatal complications is very low.

Relapse and metastasis

The risk of recurrence increases depending on how advanced the cancer is at the time of surgery. Recurrent patients often have systemic metastases, so treatment is not easy. Although the disease progression is the biggest factor in recurrence and metastasis at the time of initial treatment, regular follow-up examinations are necessary even for patients who receive early treatment because the biological characteristics of cancer are very diverse.

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