Cholangiocarcinoma is cancer that forms in the bile ducts that carry the digestive fluid bile. Bile ducts connect your liver to your gallbladder and to your small intestine. Bile duct cancer is an uncommon form of cancer that occurs mostly in people over 50. This is a very difficult cancer to treat. The disease is divided into three different types based on where in the bile ducts the cancer occurs:
- Intrahepatic cholangiocarcinoma occurs in the parts of the bile ducts within the liver and is sometimes classified as a type of liver cancer.
- Hilar cholangiocarcinoma occurs in the bile ducts just outside of the liver. This type is also called perihilar cholangiocarcinoma.
- Distal cholangiocarcinoma occurs in the portion of the bile duct nearest the small intestine.
Factors that may increase your risk of cholangiocarcinoma include:
- Primary sclerosing cholangitis (causes hardening and scarring of the bile ducts)
- Chronic liver disease
- Bile duct problems present at birth. People born with a choledochal cyst, which causes dilated and irregular bile ducts, have an increased risk of cholangiocarcinoma.
- A liver parasite. In areas of Southeast Asia, cholangiocarcinoma is associated with liver fluke infection, which can occur from eating raw or undercooked fish
- Older age
- Smoking
Signs and symptoms of cholangiocarcinoma include:
- Yellowing of your skin and the whites of your eyes (jaundice)
- Intensely itchy skin
- White-colored stools
- Fatigue
- Abdominal pain
- Unintended weight loss
According to the Mayo Clinic, there was a study published in 2016 that showed aspirin use may help reduce the risk of developing cholangiocarcinoma. The study involved data on nearly 4,800 people. Further study is needed to be certain that long-term aspirin use is safe for cancer prevention.
Treatments for cholangiocarcinoma may include:
Surgery – for very small bile duct cancers, this involves removing part of the bile duct and joining the cut ends (resection). For more-advanced bile duct cancers, nearby liver tissue, pancreas tissue or lymph nodes may be removed as well.
If lymph nodes are removed, the patient will be at risk for torso and lower extremity lymphedema. Lymphatic drainage exercises, a slow, gradual warm-up, and a slow gradual progression of cardiovascular and strength training exercises will be necessary to prevent and monitor for lymphedema.
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Liver transplant – surgery to remove the liver and replace it with one from a compatible donor may be an option in certain cases for people with hilar cholangiocarcinoma. For many, a liver transplant is a cure for hilar cholangiocarcinoma, but there is a risk that the cancer will recur after a liver transplant.
After a transplant, the patient will be on immunosuppresive drugs. This will make them more susceptible to infection. The exercise environment should be impeccably clean and sessions should be cancelled if the CES is sick because of the patient’s diminished ability to fight infection. There may also be side-effects from the immunosuppressive drugs that should be considered when formulating long-term exercise program.
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Chemotherapy – uses drugs to kill cancer cells. Chemotherapy may be used before a liver transplant. It may also be an option for people with advanced cholangiocarcinoma to help slow the disease and relieve signs and symptoms (palliative treatment).
During and for months after treatment, the patients immune system will be compromised. The same precautions will need to be taken as were mentioned previously. Patients should not exercise within 24-36 hours of vomiting and/or diarrhea and should rest, re-hydrate, and replenish electrolytes. Patients may also suffer from peripheral neuropathy (burning, tingling, and numbness of the hands and feet). Modifications to workouts that include high impact, fine motor skills, and balance will need to be made to ensure the patients safety. Patients will also have a higher risk for diabetes, osteoporosis, and damage to the heart and lungs.
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Radiation therapy – uses high-energy sources, such as photons (x-rays) and protons, to damage or destroy cancer cells. This may be external beam radiation, or seed implantation radiation (brachytherapy).
During external beam radiation the patient may experience sensitive skin, burns, or blisters. If the skin opens, this can increase the risk of infection. With the patients immune system in a compromised state, they are more susceptible to infection. They will also be at risk for lymphedema in the the treated area. The same precautions will need to be taken as were mentioned previously.
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Photodynamic therapy – light-sensitive chemical is injected into a vein and accumulates in the cancer cells. Laser light directed at the cancer causes a chemical reaction in the cancer cells, destroying them.
During photodynamic therapy, the patient will need to avoid sunlight as well as bright indoor light. They should cover exposed skin, wear a wide-brimmed hat, and sunglasses. There may also be temporary side-effects that can prevent them from being able to exercise safely. Exercise should be postponed until side-effects subside.
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Biliary drainage – is a procedure to restore the flow of bile. It can involve bypass surgery to reroute the bile around the cancer or stents to hold open a bile duct being collapsed by cancer. Biliary drainage is a palliative treatment that helps to relieve signs and symptoms, making the patient more comfortable.
Adequate time should pass following surgery and patient must have doctor’s permission to begin exercising.
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The information provided in this post is general and should not be applied without further education in the area of Oncology Exercise. To learn more about becoming a Cancer Exercise Specialist please visit CETI.teachable.com