Cholangiocarcinoma is cancer of the bile duct.
Extrahepatic cholangiocarcinoma originates from the part of the bile duct that is located outside of the liver and tends to be the most treatable form of the disease.
Hilar cholangiocarcinoma originates from where the right and left hepatic ducts join and is also called a Klatskin’s tumor.
Intrahepatic cholangiocarcinoma makes up about 5% to 10% of bile duct cancers and are located inside the liver.
Treatment recommendations by our cancer specialists at Onco Life Centre are tailored, personalized and depends on tumor stage, tumor genomics (IDH1, FGFR2, KRAS, NRAS, KRAS G12C HER2, PDL1, TMB, MSI, NTRK1-3 fusion, BRAF, BRCA1, BRCA2, PALB2 gene mutation status), pre-existing medical conditions, your overall health and nutritional status.
Targeted therapy and immunotherapy is the foundation of precision medicine. Our Oncologists at Onco Life Centre work in close collaboration with Cancer Genomics Experts in the US to perform cancer gene mapping and DNA sequencing on our patients’ cancer tissue. Regular teleconferencing and live exchange of information with the US Genomics Experts allows our Oncologists to specifically design unique treatment plans for our patients. By targeting specific genes and proteins that are involved in driving cancer survival and progression, our patients at Onco Life Centre are experiencing significant and sustained improvements in their cancer responses and living longer.
At Onco Life Centre, we have made it our mission to improve the everyday lives of our patients. Our Oncologists and Pharmacists will seek to identify Compassionate Drug Access Programs that allows pre-approved new drugs outside clinical trials (and prior to product launch) for our patients who do not have satisfactory therapy options available.
This is a treatment option if the tumor has not spread beyond the bile duct.
If the cancer is near the liver, the surgeon will remove part of the liver.
This type of extensive surgery is recommended if the cancer is near the pancreas. The surgeon removes part or all of the pancreas and part of the small intestine, bile duct and stomach. The surgeon then reconnects the digestive tract and biliary system.
The surgeon completely removes the liver and bile ducts. The surgeon then transplants a donor liver. However, bile duct cancer tends to recur very quickly after transplantation.
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. To match your cancer disease with the most effective treatment, our oncologist at Onco Life Centre may run tests to identify the genes, proteins, and other factors in your tumor.
The U.S. Food and Drug Administration (FDA) has approved FGFR2 inhibitors in previously treated, unresectable locally advanced or metastatic cholangiocarcinoma with an FGFR2 gene fusion. The FGFR2 protein, which is made by the FGFR2 gene, helps cancer grow and spread when it has undergone fusion and becomes overactive. FGFR2 inhibitors bind to the FGFR2 protein to shut down the hyperactivity of FGFR2 and slow down cancer cells from growing and spreading.
In 2021, the FDA approved IDH1 inhibitors in previously treated locally advanced or metastatic cholangiocarcinoma with an isocitrate dehydrogenase-1 (IDH1) genetic mutation. A mutation in the IDH1 gene helps cancer grow, and IDH1 inhibitors work by targeting and blocking this gene to slow down cancer growth and spread.
In 2022, the FDA approved BRAF inhibitor in combination with MEK inhibitor for inoperable or metastatic cholangiocarcinoma with BRAF V600E mutation. A BRAF V600 mutation is a specific change in the tumor’s BRAF gene. This combination works by targeting the BRAF mutation and MEK protein, which is involved in cancer growth and survival.
Immunotherapy is designed to boost the body's natural defenses to fight the cancer. In 2022, the FDA approved an immune checkpoint inhibitor combined with chemotherapy for locally advanced or metastatic cholangiocarcinoma. An immune checkpoint is a protein that can stop the body’s immune system from responding to cancer cells. By blocking the immune checkpoint PD-1, it allows the immune system to find and attack cancer cells.
Other immune checkpoint inhibitors are approved for all microsatellite instability-high (MSI-H) tumors, including for MSI-H cholangiocarcinoma. MSI is a genomic marker that indicates a flaw in a cell’s ability to repair damaged DNA, which can lead to an increase in genetic changes, or mutations. These mutations produce abnormal proteins on the tumor cells that allow immune cells to find and attack the tumor more easily.
Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide.
Combination treatments are usually best for patients who are able to carry out their usual activities of daily living without help.
Chemotherapy may be used before surgery to shrink the tumor. It may also be used when surgery is not an option. Chemotherapy should be given after surgery to help prevent a recurrence. Additionally, people with hilar cholangiocarcinoma and extrahepatic cholangiocarcinoma may also receive chemoradiotherapy after surgery to destroy remaining cancer cells when there is a "positive margin" that can be seen with a microscope.
If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. Your treatment plan may include a combination of the treatments discussed above. Talk to our oncologists about your first and second line treatment options, which can heavily depend on your overall health and preferences.
Palliative care will also be important to help relieve symptoms and side effects. For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear.
Patients and their families have opportunities to talk about the way they are feeling with our oncologists, nurses, counselors, or join our psychosocial program and support group at Onco Life Centre.
