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Intrahepatic Bile Duct Cancer

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Subject: Intrahepatic bile duct cancer
Date: 04/14/2008

Mid february  my wife was looking real yellow and went to hospital for a ERCP to put a stent in to clear a bile duct blockage. The following day she had Post ERCP pancretitis which apparantly as we discovered later is not an unusal outcome. After 6 days of nil by mouth, then several xrays and MRI we were told she had a 1 cm tumor in the upper bile duct (refered to as intrahepatic) and she was refered to a different hospital. The stent wasn't working so this was taken out, by ERCP, and  PTC was done, inserting a drain in through the side and into the bile duct by going through the liver and into the bile duct from the top. This time she had a metal stent instead of the plastic one.

Now after nearly 6 weeks we are waiting for a hemihepatectomy (removal of the bile duct and 1/2 of the liver). We have read all the web literature about the survival rates, sucess or lack of re chemotherapy etc, etc but overall are still trying to get to grips with the fact this has come on reasonably fast.

Laproscopic surgery shows all clean and a suitable canditate for surgery but two facts we still cannot find, is a 1cm tumor a large or small one and what is the rate of growth of a tumor of this nature. With all the reading I have done, we are still not sure if this is a Klatskins tumor and the doctors haven't yet confirmed it. As we are from New Zealand, we are dependant on the public health system finding a gap in the surgery list so "hopeful" of a operation in 2-4 weeks.

Any comments appreciated.  

Subject: RE: Intrahepatic bile duct cancer
Date: 04/14/2008
I had a one-centimeter liver tumor imaged by CT scan in June of last year shortly after cholangiocarcinoma was diagnosed in both my intrahepatic ducts via ERCP brushings.  I was told that this is considered "small," but that size really doesn't matter.  [Where have I heard that before?]  The cancer cells in the ducts were what mattered, since they were going to metasticize elsewhere, and quickly.  The tumor might, too, but my docs weren't nearly as concerned about it as they were about what was found in the ERCP brushings.
I wasn't a candidate for surgical resection like your wife since both of my ducts were involved.  However, due to the small size of the tumor and the lack of mets anywhere else, I was a candidate for orthotopic liver transplant, which I received 8 months ago yesterday.  All of the CT scans that I've had subsequently including one about a month ago have been negative for cancer.  Have your wife's doctors discussed doing any chemo/radiation prior to surgery?  I had a five-week course prior to mine, as it is required before transplant.  If your wife's surgery is only two weeks away, then maybe there'd be no benefit to it, but if there's going to be any significant delay then I would think they'd want to do something to keep the cancer at bay in the interim.
Best wishes to you and your wife.
Subject: RE: Intrahepatic bile duct cancer
Date: 04/15/2008
My sister also has a klatskins bile duct cancer (cholangiocarcinoma). The drs were very very optimistic based on the CT scans that they could resect.In reality when they opened her up, they were unable to do anything for her. So, firstly, be prepared for anything surgery-wise. Also, when the stents or drains are properly put in, the bile should flow again and you will have relief.  Sorry to hear your sad news, from down under and hope things work out for you. 
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