Our bile duct cancer expertise
The bile ducts are thin tubes that transport fluid called bile from the liver to the gallbladder to the small intestine to help digest fats. Bile duct cancer is a rare type of tumor that develops in the cells that line the inside of the bile ducts.
Most bile duct cancers fit into a category of cancers called adenocarcinomas. Bile duct adenocarcinoma forms in mucous glands lining the bile ducts. Bile duct cancer is also known as biliary adenocarcinoma or cholangiocarcinoma.
Bile duct cancers are all rare and classified according to their location.
- Intrahepatic bile duct cancer (intrahepatic cholangiocarcinoma) develops in tiny bile ducts inside the liver. There are approximately 6,000 new diagnoses of intrahepatic cholangiocarcinoma per year in the United States and 130,000 worldwide
- Extrahepatic bile duct cancer develops outside the liver. There are approximately 4,000 new diagnoses of extrahepatic cholangiocarcinoma per year in the United States and 80,000 worldwide:
- Perihilar bile duct cancer (Klatskin tumors), which affects the upper part of the large bile duct, near the liver
- Distal bile duct cancer, which affects the bottom part of the bile duct, near the pancreas and small intestine
- Gallbladder cancer develops in the gallbladder, which is connected to the large bile ducts underneath the liver. There are approximately 8,000 new diagnoses of gallbladder cancer per year in the United States and 115,000 worldwide
If you are having symptoms related to bile duct cancer, your primary care doctor will ask about your health history, your family's history of cancer and risk factors. To confirm a diagnosis and understand the extent to which the cancer has spread, your doctor may order imaging tests, such as a computed tomography (CT) scans, magnetic resonance imaging (MRI), or ultrasound. At Mass General Brigham, we are one of the few centers that also offers positron emission tomography-MRI (PET-MRI).
Other diagnostic tests for bile duct cancer available at Mass General Brigham include:
- Tumor markers (serum carcinoembryonic antigen [CEA] and serum carbohydrate antigen 19-9 [CA19-9])
- Tumor tissue genomic tissue sequencing and circulating tumor DNA (ctDNA) analysis
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Magnetic resonance cholangiopancreatography (MRCP)
- Percutaneous transhepatic cholangiography (PTC)
Innovative approaches to bile duct cancer treatment
Mass General Brigham delivers advanced care for patients with bile duct cancer and other gastrointestinal diseases. Our multidisciplinary treatment team includes surgeons, medical and radiation oncologists, radiologists, pathologists, endoscopists, anesthesiologists and gastroenterologists.
You will find all the latest treatments for bile duct cancer at Mass General Brigham. Your care team will meet weekly to share information about your unique cancer and discuss your treatment plan, which may involve one or more of the following options.
Treatment for bile duct cancer often involves surgery, with a precise surgical approach depending on the tumor location. Our surgeons are internationally recognized experts who have years of experience in bile duct cancer surgery and specialize in minimally invasive techniques.
In addition, our team has done pioneering work in identifying genetic mutations that may enable the use of novel therapies for this cancer type. This allows us to take a more aggressive approach to treatment (through chemotherapy, targeted therapy, immune therapy, embolization, and/or external beam radiation) before surgery. Shrinking the tumor up front often facilitates more complete removal of the tumor during the operation.
Mass General Brigham surgeons have perfected other aggressive surgical procedures, including:
- Bile duct removal: If you have a small perihilar bile duct tumor confined to the bile duct outside, but near, the liver, your surgeon may remove the entire bile duct and make a connection to your small intestine. This allows the bile to flow again. If the cancer has spread to nearby tissues, the surgeon may need to remove that tissue and nearby lymph nodes for testing
- Partial hepatectomy (liver resection): This procedure involves removing the part of your liver where the intrahepatic bile duct cancer is found. Surrounding normal tissue is also removed and tested to be sure the cancer is gone
- Whipple procedure (pancreaticoduodenectomy): If the bile duct cancer is close to your pancreas, your surgeon removes your bile duct and gallbladder, along with part of your pancreas, stomach and the first part of your small intestine
- Surgical biliary bypass: If your surgeon cannot completely remove the bile duct cancer, a bypass helps lessen symptoms. Connecting your bile duct to a piece of your small intestine creates a new pathway around the tumor to allow the bile to flow to your intestine for normal digestion of fats. This surgery does not cure the cancer but can relieve jaundice and other symptoms. It may precede other treatment
- Stent placement: If the cancer is blocking your bile duct, your doctor may place a thin tube called a stent into the bile duct. It helps keep the duct open and drains bile that builds up in the area. This prevents symptoms such as pain or jaundice
Chemotherapy uses drugs (given intravenously or orally) to destroy cancer cells. It may be employed before or after surgery for bile duct cancer.
Targeted therapy is a form of personalized medicine in which a drug is chosen based on the specific genetic mutation or alteration found in your own cells. It may be used before or after surgery. Some of the mutated proteins that are targeted by such therapies include IDH1, FGFR2, BRAF, and HER2.
Immune therapy is a form of (intravenous) medication that takes the brakes off from the immune system to enable it to attack cancer cells. It is used alone or in combination with chemotherapy to treat bile duct cancers, either before or after surgery.
Radiation therapy uses high-energy x-rays to kill cancer cells. The goal is to shrink or eliminate cancer cells without damaging healthy surrounding tissue. It may be employed before or after surgery. Radiation oncologists at Mass General Brigham use the most advanced therapies to treat pancreatic cancer, many of which are available at only a select few hospitals.
- External beam radiation therapy delivers high levels of radiation directly to the cancer cells.
- Interoperative radiation therapy (IORT) is an aggressive approach that delivers radiation inside the body at the time of the operation. It may be used with external radiation.
Proton beam therapy, an advanced form of radiation treatment, uses a high-energy, focused proton beam to target tumors with incredible precision. Compared with the use of X-ray beams, proton beam therapy reduces side effects because more radiation is deposited precisely in the tumor and less radiation is deposited into the surrounding normal tissues. This approach may improve tumor control and the chance of a cure.
Mass General Brigham is home to the only proton therapy site in New England, and our Radiation Oncologists possess unparalleled experience in treating tumors with this approach. In fact, we were the world's first center to harness the power of high-energy protons for medical care.
Interventional radiologists use multiple image-guided techniques to provide minimally invasive cancer treatment. These techniques can be used to help shrink tumors prior to surgery or treat cancers when surgery is not possible.
- Ablation: Using image guidance interventional radiologists guide a needle into your tumor, which can then be burned using microwave ablation or frozen using cryoablation.
- Radioembolization: Using x-ray guidance the interventional radiologist guides a thin catheter through the arteries of your liver to the arteries supplying tumor. There they inject very small spheres with a type of radiation (Y-90) directly into your tumor. This allows for a very high dose of radiation to your tumor while minimizing radiation to healthy surrounding liver.
- Chemoembolization: Similar in approach to radioembolization, but the injected spheres contain chemotherapy
A team of bile duct cancer experts all in one place
Meet Mass General Brigham's multidisciplinary team of bile duct cancer specialists.
- Jill N. Allen, MD
- David Berger, MD
- Thomas E. Clancy, MD
- Jeffrey William Clark, MD
- Nahel Elias, MD
- Haley Ellis, MD
- Mark Fairweather, MD
- Carlos Fernandez-del Castillo, MD
- Theodore (Ted) Sunki Hong, MD
- Kunal Jajoo, MD
- Sanjeeva Kalva, MD, MBBS
- Shoko Kimura, MD
- Miranda Lam, MD-MDA
- Kelsey Lau-Min, MD
- Linda Lee
- Keith D. Lillemoe, MD
- Harvey J. Mamon, MD-PhD
- Joseph D. Mancias, MD-PhD
- Neil E. Martin, MD-MPH
- George Molina, MD-MPH
- Aparna Parikh, MD
- Priya, Pathak, MD, MBBS
- Matthew P. Schenker, MD
- Michael S. Stecker, MD
- Kenneth Tanabe, MD
- Ritchell van Dams, MD-MHS
- Elizabeth Walsh, MD
- Jiping Wang, MD-PhD
- Colin Weekes, MD
- Edward Whang, MD
- Jennifer Y. Wo, MD
Members of our faculty conduct research – from basic laboratory science to clinical trial research – to improve our understanding of bile duct cancers. Some recent research highlights include:
- Laboratory principal investigator Nabeel Bardeesy, PhD, is currently utilizing genetically-engineered mouse models and single-cell gene expression profiling to optimize combinations of genomically targeted therapies and immune therapies.
- Gastrointestinal surgeon Cristina Ferrone, MD, is currently working on a CAR (chimeric antigen receptor) T-cell therapy that has shown promise in treating bile duct cancer in animal studies.
- Radiation Oncologists Jennifer Wo, MD, and Ted Hong, MD, are pioneering optimal radiation treatment strategies for intrahepatic cholangiocarcinoma and developing novel blood tests to predict how to use these therapies most effectively.
Bile duct cancer clinical trials
Through clinical trials available at Mass General Brigham, you may gain access to new drugs, new combinations of drugs or already approved drugs being studied to treat patients in new ways. Ongoing trials are focusing on innovations such as:
- Utilizing novel combinations of immune therapies and immune therapies combined with external beam radiation to treat advanced intrahepatic cholangiocarcinoma
- Utilizing novel, specific, genomically “targeted” therapies to treat subsets of cholangiocarcinoma
- Utilizing novel drug delivery technologies to deliver novel immune therapy drugs to the insides of tumors
Bile duct cancer care for international patients
Each year, thousands of patients from more than 120 countries travel to Mass General Brigham for medical care, second opinions and treatments unavailable anywhere else in the world.
Mass General Brigham is experienced in caring for bile duct cancer patients who are traveling great distances to our hospitals in Boston. Your cancer team here and our international patient services team will help you prepare for and plan the appropriate amount of time to stay in Boston for your appointments, treatments and any recovery time. During this recovery time in Boston or back home in your country, our clinical team will monitor your well-being and progressions to continuously optimize your treatment plan and symptoms.
Many of our international patients have questions about everything from travel and lodging to scheduling appointments. Our international patient services team is here to help. We look forward to making your Mass General Brigham experience as healing and stress-free as possible.
