Mo's Medical Moment: Bile duct cancer patients get new life from new light

By: Staff Email
By: Staff Email

A tiny, yet powerful beam of light may be buying Nancy Collins -- and patients like her -- precious time.

Nancy has bile duct cancer. It's hard to detect, and even tougher to cure. "It's bad," she says. "There's not much hope for you."

Bile ducts carry bile through the liver into the intestines to help the body digest food. When cancer develops here, they become blocked, causing infections and liver damage.

Surgery is the only cure.

But in two-thirds of all cases, the location of the tumor makes that impossible.

Surgeons at Thomas Jefferson University Hospital are using a new procedure for patients who can't have surgery.

During photo-dynamic therapy, patients receive an IV drug that makes the cancer cells sensitive to a laser. A scope goes from the mouth to the small intestine and into the bile ducts. Then doctors insert the laser which kills the cancer cells but leaves normal tissue intact.

"It keeps the bile ducts open longer," says David Loren, MD, Associate Director of Medical Endoscopy at Jefferson. "It kills some of the tumor. Sometimes we even see the tumor shrink. But it's not a cure."

The therapy gives patients back their quality of life -- and just might extend their lives.

For Nancy, that's time to see a granddaughter off to prom, spend another holiday with loved ones, and celebrate sixty years of marriage.

MO's MEDICAL MOMENT
RESEARCH SUMMARY

TOPIC: LASER ZAPS BILE DUCT CANCER
REPORT: MB # 3460

BACKGROUND: The bile duct is a thin tube, about four to five inches long, that reaches from the liver to the small intestine. The major function of the bile duct is to move a fluid called bile from the liver and gallbladder to the small intestine, where it helps digest the fats in foods. Bile duct cancer or cholangiocarcinoma is a cancerous (malignant) growth in one of the ducts. (SOURCE: www.ncbi.nlm.nih.gov, www.cancer.org)

Bile duct cancer is extremely rare, only two out of every 100,000 people are diagnosed with this disease, and most patients are over the age of 65. Both men and women can contract bile duct cancer. Based on its location, bile duct cancer is divided into three groups: Intrahepatic, Perihilar (also called hilar), and Distal. Intrahepatic bile duct cancers develop in the smaller bile duct branches inside the liver, Perihilar in the hilum, where the hepatic ducts have joined and are just leaving the liver, and Distal bile duct cancers are found further down the bile duct, closer to the small intestine. (SOURCE: http://www.cancer.org)

TREATMENT: The goal is to treat the cancer and the blockage it causes. Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts and relieve jaundice in patients. Laser therapy combined with light-activated chemotherapy medications is another treatment option for those with blockages of the bile duct. When possible, surgery to remove the tumor is the treatment of choice, and may result in a cure. Traditionally, the disease is treated with resection, surgically removing the tumor, but in many cases the cancer tends to continue to spread around the bile duct. In the past, patients with non-resectable bile duct cancer had little chance of survival. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth)

A TRANSPLANT FOR CANCER CURE: According to a study published in the American Journal of Gastroenterology, treatment of nonresectable bile duct cancer with photodynamic therapy results in improved patient survival. With this approach, a photosensitizing agent (an agent that makes cells sensitive to light) is applied to cancer cells. A laser light with a specific wave length can then be used to destroy the cells. The precancerous and cancerous cells bind to the drug, allowing doctors to target them. Then, carefully, a flexible fiber thread goes down through the intestines into the bile ducts and exposes the cells to a laser which destroys them. Over the subsequent days and weeks, the tumor cells die and the bile ducts are opened. Because the treatment is given from the center of the tumor, the laser cannot penetrate through the entire mass, so some tumor cells remain. Unlike radiation, patients can repeat the photodynamic therapy treatments as often as needed. (Source: American Journal of Gastroenterology, Jefferson University Hospitals)

FOR MORE INFORMATION, PLEASE CONTACT:
Joan Digneo
Thomas Jefferson University
joan.digneo@jefferson.edu


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