From the Guidelines
Yes, liver cancer can block the gallbladder ducts, as evidenced by the most recent and highest quality study 1, which highlights the importance of addressing bile duct obstruction in the management of liver cancer. This occurs when tumors in the liver grow large enough to compress or invade the bile ducts, which are the channels that carry bile from the liver and gallbladder to the small intestine. When these ducts become blocked, bile cannot flow properly, leading to a condition called cholestasis. Patients with bile duct obstruction may experience jaundice (yellowing of the skin and eyes), dark urine, light-colored stools, itching, abdominal pain, and digestive problems. The blockage can occur in different parts of the biliary system, including the hepatic ducts within the liver, the common bile duct, or at the junction where these ducts meet. Some key points to consider in the management of liver cancer and bile duct obstruction include:
- The importance of comprehensive staging to screen for metastatic disease, as highlighted in 1
- The role of surgery in the treatment of liver cancer, including the potential need for lymphadenectomy and vascular resections, as discussed in 1
- The use of endoscopic and percutaneous procedures for the management of biliary obstruction, as outlined in 1 and 1 Treatment typically involves addressing the underlying cancer through surgery, chemotherapy, or radiation, while also managing the blockage. This might include placing stents to keep the ducts open, performing bypass procedures, or draining bile externally. Prompt medical attention is essential as bile duct obstruction can lead to serious complications including infection (cholangitis), liver damage, and nutritional deficiencies. In terms of specific management strategies, the most recent evidence suggests that:
- Endoscopic internal biliary catheters with removable plastic stents are often appropriate for initial therapeutic procedures in patients with dilated bile ducts from choledocholithiasis or suspected sclerosing cholangitis, as noted in 1
- Percutaneous internal/external biliary catheters may be used in patients with hilar biliary obstruction from malignant etiology, as discussed in 1
- Liver transplantation may be considered in locally unresectable cases, as explored in 1
From the Research
Liver Cancer and Gallbladder Ducts
- Liver cancer, specifically hepatocellular carcinoma (HCC), can invade the bile ducts, leading to obstructive jaundice 2.
- The invasion of the bile ducts by HCC can cause malfunction of drainage tubes due to hemobilia and/or tumor emboli, making effective biliary drainage difficult 2.
- Photodynamic therapy (PDT) has been shown to improve biliary patency and prolong survival in patients with unresectable HCC and bile duct invasion 2.
Gallbladder Cancer and Jaundice
- Jaundice is a common presenting symptom of gallbladder cancer and is often associated with advanced disease and poor outcome 3, 4.
- However, some patients with jaundice due to gallbladder cancer may still undergo resection with curative intent, especially if they have low CA19-9 levels and no lymphovascular invasion 3.
- The presence of jaundice does not preclude resection, but it is a poor prognostic factor, and the overall survival rate for patients with jaundice is lower than for those without jaundice 4.
Bile Duct Invasion and Resection
- Gallbladder cancer can invade the extrahepatic bile ducts, and the incidence of this invasion is relatively high, especially in patients with advanced disease 5.
- Resection of the extrahepatic bile ducts and lymph nodes may be necessary to achieve complete resection of the tumor, especially in patients with locally advanced gallbladder cancer 5.
- The pattern of invasion of the hepatoduodenal ligament can affect the survival rate, with patients having types II, III, and IV spread having better survival rates than those with type I spread 5.