[Inaudible].
Taylor colon geo carcinoma means a
cancer of the bile duct and the bile duct is a small tube
attached to the liver that carries the fluid made by the liver that helps
digest your food. If we look at the poster here, this is your liver,
and it has a left lobe and a right lobe.
And that liver produces the bile and the bile has to get into the
intestine. It flows through this small green tube,
the bile duct down into the intestine.
And when you form a small tumor on the inside lining of that
little duct,
that is the collegial carcinoma or the bile duct cancer
that we're talking about today.
[Inaudible].
The bile. Duct is a very small structure. As you saw on the poster.
It only travels for about an inch between the liver
and the first portion of the small intestine.
And in that very small area is a whole compact
complex of blood vessels that feed both the
liver and the pancreas.
And so a very small tumor in that tight area can
involve blood vessels to critical structures.
And so it's tricky to remove that with surgery.
[Inaudible].
The most common way patients present when they have
a tumor of the bile.
Duct is what we refer to as painless jaundice.
Jaundice is when someone starts to turn yellow and they might look
in the mirror and notice that the whites of their eyes are slightly discolored,
or even when it progresses more.
You notice that the skin turns yellow.
That's John dis and John dis in the absence of
any associated pain is typically the presentation
of this sort of tumor.
The bile made by the liver cannot flow through the duct because it's
blocked up by the tumor.
It backs up into the liver and spills into the bloodstream and when it does,
so it gets carried all around your body.
Another symptom that people notice is their urine may turn
very dark colored.
And so people referred to tea colored urine.
This is because the bile,
which should be flowing into the intestinal track instead is in bloodstream.
And it's filtered out by the kidneys that excrete it in the urine.
So the urine gets dark while the bile normally goes into the
intestine,
it gives the dark yellow or Brown color to the stool.
And the last major symptom that people recognize is that the stool gets
light colored. And in fact, it might even look a gray or pale,
um, clay colored.
When bile gets deposited in the skin,
it actually has salt in it.
And the salt of the bile that's in the skin makes the skin itchy.
So if you have all the symptoms of a bile duct tumor,
then you may be jaundiced,
have yellow in the whites of the eyes, have itchy skin,
dark colored, urine, and light colored stuff.
[Inaudible].
The first step of diagnosis usually would be a blood test,
including liver function tests. And if those are elevated,
then the doctor has a clue that there may be something blocking the bile duct
imaging studies like a cat scan ultrasound or
MRI might then in fact,
usually show that there is a blockage. In fact,
there sometimes a gastroenterologists can do an
advanced procedure called an E R C P in
ERC P the endoscopy office is able to put a tiny probe
inside the bile duct and actually see with an X Ray or even
sometimes take a biopsy to prove that there is a tumor there.
[Inaudible].
Standard treatment options for cancer of the bile doc usually include
surgery as the best and most important option that can cure the
cancer chemotherapy is also sometimes used and can be given
before or after surgery.
If the tumor cannot be removed,
then radiation is also sometimes used to control or shrink the tumor.
[Inaudible].
The decision to proceed with surgery for cancer of the bile.
Duct is one that really must be made in consultation with your
surgeon.
These are tricky tumors and require a highly specialized
operation that should be done really in a special center,
not in small hospitals.
So surgery for this type of tumor is,
and as I showed you on the poster here,
the bile duct comes out of the liver and the liver
produces bile from both the left lobe and the right lobe.
This is a very small area.
If the tumor invades into one of the two lobes of the liver,
then not only the bile duct,
but that half of the liver may need to be removed
in total with the bile duct.
Now we reconstruct the other side of the liver and
amazingly the liver within six weeks to three months will grow back to normal
size. So it can regenerate like no other organ can,
but in order to do this,
we need a healthy underlying liver tissue.
So problems like cirrhosis may in fact,
interfere with our ability to remove a portion of the liver and the bile duct
and cure the tumor.
If the liver is not healthy and the bile duct tumor cannot
be removed,
then removal of the whole liver and replacement through a transplant might be
the only last option.
[Inaudible].
Transplantation is the last option that we might use to treat a colon
geo carcinoma.
And this is generally reserved for patients who have
disease that is limited or localized to the bile duct and
the liver.
But in whom we may not be able to remove a portion of the liver.
Liver failure can occur after a major
operation on the liver. If it's not healthy, for instance,
someone who has cirrhosis and then also has a cancer of the
bile duct,
other diseases like sclerosing cholangitis
are diseases that lead to bile duct cancer,
but also injure the liver. And in some cases like that,
we may in fact,
need to remove the entire liver and the bile duct and replace the liver
with a new one in order to cure the cancer. Now,
these are important details that really need to
be made in the setting of a center that both does
that cancer surgery and liver transplant.
[Inaudible].
The center for liver and pancreas surgery at Georgetown university hospital is
the largest program dealing with liver and bile duct tumors in the
Washington metropolitan area.
We see hundreds or thousands of new cases every year and have a large
with many different specialists.
Our team and our tumor board includes the input from us surgeons,
but also the medical specialists for the liver, a hepatologist,
radiologists, radiation, oncologists, medical oncologists,
and specialized gastroenterologists.
It's the input of all these people in a tumor board and a multidisciplinary
team that leads to the great care for them.