The patient pathway in Biliary Tract Cancer

Biliary tract cancer, which includes cancers of the bile ducts (cholangiocarcinoma) and gallbladder, is a rare but aggressive type of cancer. The patient pathway from diagnosis to treatment involves multiple stages, each requiring specialised care and a multidisciplinary approach.

In this informative article, leading senior medical oncologist Dr Shivan Sivakumar details why understanding this pathway can help patients and their families navigate the complexities of the disease and make informed decisions about their care.

Initial presentation and diagnosis

Biliary tract cancer, which is a type of GI tract cancer, often presents with nonspecific symptoms, which can delay diagnosis. Common symptoms include jaundice (yellowing of the skin and eyes), abdominal pain, unexplained weight loss, and dark urine. Due to the subtle nature of these symptoms, patients might initially consult their general practitioner (GP) or present at an emergency department.

If biliary tract cancer is suspected, the patient will undergo a series of diagnostic tests:

• Blood tests: To check for liver function abnormalities and tumour markers such as CA 19-9.
• Imaging studies: Ultrasound, CT scans, and MRIs are used to visualise the biliary system and detect any masses or obstructions.
• Endoscopic procedures: Endoscopic retrograde cholangiopancreatography (ERCP) or endoscopic ultrasound (EUS) may be performed to obtain tissue samples for biopsy and to assess the extent of the disease.

Multidisciplinary team (MDT) review

Once a diagnosis of biliary tract cancer is confirmed, the case is usually referred to a multidisciplinary team (MDT) for review. This team typically includes:

• Hepatobiliary surgeons
• Gastroenterologists
• Oncologists
• Radiologists
• Pathologists
• Specialist nurses

The MDT works together to formulate a comprehensive treatment plan tailored to the patient's specific condition, considering factors such as the tumour’s location, stage, and the patient's overall health.

Treatment planning and options

Treatment options for biliary tract cancer depend on the stage of the disease at diagnosis and may include a combination of surgery, chemotherapy, radiation therapy and palliative care.

• Surgery: For patients with early-stage cancer, surgery may be curative. Surgical options include resection of the affected bile ducts, gallbladder, or part of the liver. In some cases, a liver transplant may be considered.
• Chemotherapy: For patients with advanced or inoperable cancer, chemotherapy is often the mainstay of treatment. It may be used to shrink tumours before surgery or as a palliative measure to slow disease progression.
• Radiation therapy: This may be used in conjunction with surgery or chemotherapy to target any remaining cancer cells or to relieve symptoms.

Follow-up and palliative care

After initial treatment, patients will require regular follow-up to monitor for recurrence or progression of the disease. This typically involves periodic imaging and blood tests. For patients with advanced biliary tract cancer, palliative care plays a crucial role in managing symptoms and improving quality of life. This may include pain management, nutritional support and psychological counselling.

The importance of early detection

Early detection of biliary tract cancer significantly improves the chances of successful treatment. However, due to the often vague and late-presenting symptoms, the disease is frequently diagnosed at an advanced stage. Patients with risk factors, such as a history of primary sclerosing cholangitis (PSC), liver fluke infection, or chronic gallstones, should be vigilant about regular monitoring and seek medical advice if they experience any concerning symptoms.

Conclusion

Navigating the patient pathway in biliary tract cancer requires a coordinated approach involving various healthcare professionals. Early detection, prompt diagnosis, and a carefully tailored treatment plan are critical to improving outcomes for patients with this challenging disease. By understanding the steps involved in their care, patients and their families can better advocate for their health and make informed choices about their treatment options.

Are you looking for top Biliary tract cancer treatment? Arrange a consultation with Dr Sivakumar via his Top Doctors profile.