How is gallbladder and bile duct cancer treated?
Every patient at Miami Cancer Institute receives a personalized treatment plan put together by our team of medical oncologists, surgical oncologists, radiation oncologists and interventional oncologists.
Our philosophy is to find the plan that not only treats the cancer, but also fits you as a patient. Your care team will consider your specific diagnosis and type of tumor, the stage of disease, size and location of tumor and whether it has spread to other parts of your body. We also work closely with physical therapists, nurses, nutritionists and psychosocial experts to ensure we address any potential side effects of treatment.
Gastrointestinal oncologists at Miami Cancer Institute also participate in multidisciplinary liver boards, which allow them to collaborate with other specialists to determine the best treatment option for your cancer. With these expert opinions weighing in on your treatment, it is similar to having second and third opinions on your diagnosis – all under one roof.
Surgery is often the first step in treating gallbladder and bile duct cancer. If the gallbladder tumor has not spread far beyond the gallbladder, surgeons will use a procedure called a cholecystectomy. During this operation, surgeons remove the gallbladder, some of the tissues around the organ, and nearby lymph nodes. Doctors may also remove part of the liver if they believe the cancer has spread, or metastasized, there.
In the case of bile duct cancer, treatment also typically starts with removing the bile ducts and nearby lymph nodes.
Depending on the stage of the cancer, other surgical procedures may be used, including:
- Partial hepatectomy. This procedure removes part of the liver and some tissue around the diseased part of the liver. This type of surgery is typically used to treat bile duct cancers inside the liver.
- The Whipple procedure. During this procedure, surgeons remove the gallbladder, the bile duct, the head of the pancreas, and part of the stomach and small intestine. This type of surgery is typically used to treat bile duct cancers outside the liver.
In many cases, people with advanced gallbladder and bile duct cancers do not benefit from surgery to remove the tumor or organs. If that is the case, your care team may recommend surgery to reduce symptoms of the disease (palliative treatment). These procedures may include:
- Biliary bypass. During this procedure, a surgeon will cut the gallbladder or bile duct to relieve a blockage caused by a tumor. This releases bile that builds up in the gallbladder. The surgeon will reattach the gallbladder to the small intestine to go around the blockage.
- Endoscopic stent. This procedure involves inserting a thin tube (stent) into the bile duct to help drain bile that may be blocked by a tumor. The doctor may insert the stent with a catheter.
- Percutaneous transhepatic biliary drainage. During this procedure, doctors use an x-ray of the bile ducts to find a blockage caused by a tumor. Doctors then insert a stent through the skin and use an ultrasound to guide the placement. The stent helps the liver drain bile into the small intestine or in a collection bag outside the body.
If you undergo surgery to treat your cancer, our specialists will work with you to provide a faster, less painful recovery process that involves fewer tubes and drains. Miami Cancer Institute is well-known for this enhanced recovery program, which aims to improve the patient experience before and after surgery.
Chemotherapy and Radiation Therapy
If your cancer has spread, your team may consider other treatments, including:
- Chemotherapy – This treatment uses medicine – or several medicines – to kill cancer cells.
- Radiation therapy – This treatment uses image-guided radiation to kill cancer cells. Miami Cancer Institute has an advanced radiation oncology department that gives patients access to every form of radiation treatment available.
Miami Cancer Institute counts among world experts in interventional oncology and has the distinct advantage of bringing these specialists and world-renowned surgeons together to discuss cancer cases and treatment options to find the best therapeutic approach for each patient. Interventional oncologists use minimally invasive, image-guided techniques to treat your cancer. These techniques may include:
- Cryoablation (also called cryotherapy or cryosurgery) – A needle is inserted near the tumor, and gas is sent through the needle into the area around the tumor. The gas freezes the tumor and destroys cancer cells.
- Embolization – A thin tube is used to block the blood flow to a tumor, which causes the tumor to shrink. This procedure is also used during surgery to remove a tumor.
- Radioembolization (Yttrium-90 radioembolization) – During this procedure, interventional oncologists work with radiation oncologists to deliver high doses of radiation directly to tumors. Doctors insert a thin tube through an artery in the groin and guide it to the tumor. Radioactive beads are injected through the tube, or catheter, and into the tumor to cut off blood supply to the tumor. This procedure also helps target the tumor during radiation therapy.
- Radiofrequency ablation or microwave ablation – This procedure uses imaging technology and needle-like probes to deliver heat directly to the tumor. The probe uses radiofrequency or microwave energy to quickly and effectively destroy the cancer cells.
- Irreversible electroporation (IRE) therapy – This procedure, also called the NanoKnife, uses a CT scan to help doctors place needles near the tumor. Once the doctors place the needles, electricity is sent through the needles to kill the tumor.
- Chemoembolization – Doctors use a thin tube to inject chemotherapy directly into a tumor and cut off blood supply to the tumor.
- Portal Vein Embolization – This procedure is used to cause the liver to grow in patients who may not have enough liver to undergo surgery. The liver typically grows within a month of the procedure and is used for patients to get potential curative liver surgery.
A multidisciplinary team of cancer experts including surgeons, medical oncologists, radiation oncologists, plastic reconstructive surgeons, pathologists, radiologists, genetic counselors, medical geneticists, social workers, patient navigators and clinical trials staff meet weekly to discuss select complex cases and determine the best course of care. Stem cell transplantation experts and hematologic oncology experts are also available to discuss complex cases.
Miami Cancer Institute can provide access to clinical trials not widely available elsewhere. Clinical trials find new ways to treat and diagnose cancer and are ongoing. If an appropriate trial is available, we will talk to you about the benefits and risks.
South Florida's First Proton Therapy Center
Proton therapy is a highly specialized treatment that directs proton particles toward tumors to destroy cancer cells while largely sparing healthy tissue and decreasing the risk of side effects. This sophisticated treatment is used only for certain types of cancers and in a limited number of individuals.