Biliary Duct Cancer: Therapeutic Nihilism or Prospect

Abstract

Bile duct cancer is as frequent as cancer of the tongue. The number of cases detected each year is increasing. It is not clear whether this is a true reflection of increase in incidence or a consequence of better methods for imaging the biliary tree in obstructive jaundice. Benign tumors in the biliary tract do exist, but the overwhelming majority of tumors resulting in obstruction of the bile duct are malignant. In more than 90% of cases these tumors are cholangiocarcinomas and are often located at the confluence of the bile ducts. Its etiology is unknown, but the disease is frequently seen in patients with chronic suppurative cholangitis, in patients with biliary ductal parasites, in patients with sclerosing cholangitis, and in patients with chronic inflammatory changes and stasis for other reasons. In addition, a small percentage of patients with previous history of ulcerative colitis will sooner or later develop bile duct cancer. The disease is also said to be more frequent in patients with malformations of the bile ducts, especially with choledochal cysts. It is probably also worth mentioning that a large percentage of patients with bile duct cancer in the past have been employed in the rubber industry. The common denominators in the etiology thus seem to be infection, bile stasis, and bacterial degradation of bile salts.