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Intrahepatic Cholangiocarcinoma

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Around 10 to 20% of cancers that start in the liver are called intrahepatic cholangiocarcinomas — cancers that begin in the cells lining the liver's small bile ducts, which are tubes that carry bile to the gallbladder

Most cholangiocarcinomas start outside the liver, in the bile ducts. Cholangiocarcinomas are often treated the same way as hepatocellular cancers.

Why Choose Sylvester Comprehensive Cancer Center?

Sylvester is an NCI-designated cancer center. The National Cancer Institute has recognized Sylvester for its outstanding work conducting research in its laboratories, treating patients in its clinics and hospitals, and reaching out to medically underserved communities with innovative prevention strategies.

Multidisciplinary care teams with nationally recognized expertise. Collaboration saves lives. Your care team is made up of experts in your exact type of cancer, and every single aspect of it.

Advanced radiation oncology tools. Sylvester was the first medical center in Florida, and the fourth in the country to offer resonance magnetic-guided radiation therapy. Our team is a leader in that domain. Our RapidArc® radiotherapy system delivers intensity-modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting and less damage to surrounding healthy tissue. Finally, our radiation oncology department also offers proton beam therapy in our state-of-the-art Dwoskin Proton Therapy Center.

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Tests


Determining treatment options and the best chances  of recovery depend on the stage of cancer. This means whether the cancer is confined to the liver or has spread. Choices are also based on recurrence/cancer returning after a past initial treatment program; and your general health. Besides a careful medical history and physical examination, procedures for diagnosing liver cancer may include the following:                            

  • Serum Tumor Marker Test 

    A blood sample is checked to gauge the levels of specific substances released into the blood, such         as alpha-fetoprotein (AFP). Elevated levels of this protein may be a sign of liver cancer or a noncancerous condition. In some cases, the AFP level is normal even when there is liver cancer.

  • Liver Function Tests

    Also called liver enzyme tests, this group of blood tests detects inflammation and damage to the liver. They can also check how well the liver is working.

  • CT Scan (CAT Scan) of the Abdomen 

    A series of detailed pictures of areas inside the abdomen, taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.

  • PET Scan (Positron Emission Tomography Scan) 

    The purpose of this procedure is to find malignant tumor cells in the body using radioactive glucose (sugar) injected into a vein. Cells that are malignant appear brighter in the picture because they are more active and take up more glucose than normal cells do.     

  • MRI (Magnetic Resonance Imaging) 

    An MRI combines the use of a magnet, radio waves, and a computer to produce a series of elaborate pictures of the liver. Dye is also injected into a vein to create pictures of blood vessels in and around the liver. 

  • Ultrasound Exam

    Using high-energy sound waves, called ultrasound, these are bounced off internal tissues or organs to form a picture of body tissues.

  • Biopsy 

    Often a sample of suspicious cells is surgically removed for viewing under a microscope. Tissue can be obtained using fine-needle aspiration, core needle, or laparoscopy (a minimally invasive procedure).  

Treatments


Intrahepatic cholangiocarcinoma has a variety of treatments that can be used alone or with other treatments to produce the best outcome for your specific cancer. That’s why careful diagnosis and staging are so important. Your specialist will explain your treatment choices, how successful they expect them to be, and the risks and side effects with each option.         

  • Surgery 

    Surgery is performed for primary tumors that start in the liver and secondary tumors (called metastatic) that have traveled to the liver from a different organ such as the colon, lung, or breast.

    • Partial hepatectomy: This procedure removes part of your liver The remaining liver tissue functions as if it were whole and will regrow in most cases to the size of the original liver.

    • Staged partial hepatectomy:  When tumors are large, or there are more than one, the surgery can be performed in two stages. A multi-disciplinary team that includes a surgeon and an interventional radiologist works together.

    • Liver transplantation: For certain patients with primary liver cancer that originated in the liver (and is confined to the liver), your   surgeon may recommend removing the whole liver and replacing with a healthy donor liver.
       

  • Ablation

    When surgery may be too risky, ablation has different techniques to destroy abnormal liver tissue, including:

    • Radiofrequency ablation: High-energy radio waves heat the tumor, killing cancer cells.

    • Ethanol (alcohol) ablation: Also known as percutaneous ethanol injection (PEI). Concentrated alcohol is injected into a tumor to kill cancer cells.

    • Microwave ablation: Microwaves are applied directly to the tumor, producing heat that damages/kills cancer cells, or makes them more responsive to radiation or medical therapy.

    • Cryoablation: Freezes and destroys cancer cells under ultrasound guidance.

  • Embolization 

    Embolization is an option for some patients whose larger tumors cannot be removed by surgery or ablation. Embolization tries to block or reduce the blood flow to cancer cells in the liver.

    • Chemoembolization: Delivers concentrated chemotherapeutic drug(s) to the tumor along with a blood vessel blocking agent – starving the tumor of its blood supply.

    • Radioembolization: This procedure is similar to chemoembolization but with radiation instead of drugs.

    • Portal vein embolization: Often used for borderline liver resection candidates. The blood supply is blocked on one side of the tumor, allowing the other side to grow to a fully functional size for surgery.

  • Radiation Therapy 

    Advanced technology tools working for you include RapidArc®, an external beam (delivered from a machine outside the body) technology delivering intensity modulated radiation therapy (IMRT). IMRT shortens treatment times to one-half to one-eighth that of conventional radiation therapy, resulting in better tumor targeting and less damage to healthy tissue.

  • Chemotherapy (Systemic Medical Therapy)

    Chemotherapy can be administered intravenously (infusion needle) or by a pill and is usually a combination of cancer-fighting drugs.  Chemotherapy is also sometimes given to surgical patients, after the procedure, to eliminate remaining cancer cells and reduce recurrence.

    • If you require infusion chemotherapy, you can receive it at the Comprehensive Treatment Unit (CTU) at Sylvester's main location in Miami. It's a 12,000-square-foot unit that includes 33 recliners and 11 private rooms. You can also have your infusion treatments at the Kendall, Plantation, Hollywood, Coral Springs, or Deerfield Beach locations.          

  • Targeted Therapy 

    These therapies are designed to attack the molecular changes that make cancer cells grow and spread. Some of these medicines are delivered in combination, and others individually. The purpose is to prevent cancer from growing and spreading. It may also be used to help chemotherapy get inside the tumor and be more effective.                  

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