To understand malignant (cancerous) hepatobiliary cancers, it’s first important to understand what cancer is: basically, the production of abnormal cells.
The body is programmed to routinely replenish cells in different organs. As normal cells age or get damaged, they die off. New cells take their place. Abnormal cell growth refers to a buildup of extra cells. This happens when:
- New cells form even though the body doesn’t need them or
- Old, damaged cells don’t die off.
These extra cells slowly accumulate to form a tissue mass, lump, or growth called a tumor. These abnormal cells can destroy normal body tissue and spread through the bloodstream and lymphatic system.
About The Hepatobiliary System
The hepatobiliary system includes the liver, gallbladder, and bile duct. These organs work together to make bile. Bile helps you digest food in the small intestine, specifically fats. The liver makes the bile. The bile duct is a tube that passes bile from the liver to the gallbladder and small intestine. The bile is stored in the gallbladder.
Hepatobiliary cancers include:
- Liver cancer
- Gallbladder cancer
- Bile duct cancer
The following sections include information on all the cancers listed above as well as liver tumors that began as primary cancer in other parts of the body.
The liver is an organ that many people don’t really understand. What is its job? It is one of your most important organs. It’s also the largest. It sits inside your abdomen, behind your ribs, on the right side of your body.
Your liver performs several important jobs:
- Removes harmful substances from your blood
- Makes enzymes and bile that help you digest your food
- Changes food into substances that your body needs to stay healthy
Your liver gets blood from 2 different vessels:
- Most comes from the hepatic portal vein
- The rest comes from your hepatic artery
Jaundice is common side effect when the liver is not working properly. Bilirubin (a product of bile) builds up in the skin instead of being removed by the liver. This build up causes a yellowing of the skin and eyes. Urine appears darker, and stool appears lighter.
Primary Liver Cancer vs. Liver Metastases
Cancer that starts in an organ is called primary cancer. For example, if cancer starts in the breast, it is called breast cancer. If cancer starts in the lung, it is called lung cancer. Liver cancer is unusual because primary liver cancer is not common. This means most cancer doesn’t start in the liver. Instead, your liver is a common place for cancer to spread. Cancer in the colon, lungs, breasts or other parts of your body commonly spreads to your liver. This spreading process is called metastasis. When this happens, the disease is not liver cancer. Instead, the cancer found in your liver is named for the organ or tissue where it started. For instance, if breast cancer spreads to your liver, it is metastatic breast cancer. It is not liver cancer. In the U.S., liver metastases are much more common than primary liver cancer.
Primary liver cancer cells start in hepatocytes. These are your liver cells. Primary liver cancer is also called hepatocellular carcinoma or malignant hepatoma.
It is important to know whether you have primary liver cancer or cancer that has spread to your liver from another organ (known as liver metastases) because this may affect your treatment plan.
Almost all gallbladder cancers start in the tissue on the inside wall of your gallbladder. As time passes, the cancerous cells grow deeper into the gallbladder wall. They push through the layers of your gallbladder.
To understand gallbladder cancer, it’s helpful to understand the organ itself. The gallbladder has several layers:
- The epithelium: thin sheet of cells closest to the inside of the gallbladder
- The lamina propria: a thin layer of loose connective tissue
- The muscularis: a layer of muscular tissue that helps the gallbladder contract, releasing bile into the bile duct
- The perimuscular: fibrous connective tissue
- The serosa: the outer covering of the gallbladder
Ninety percent of all gallbladder cancers are adenocarcinomas.
To better understand what an adenocarcinoma is, let’s look at the word. Adeno means gland. Carcinoma is a malignant (cancerous) tumor.
Although these tumors are malignant, they all generally start from adenomas. These are polyps that are not cancerous. The bigger the adenoma is, the more likely it is to become cancerous.
Six percent of all gallbladder cancers are papillary adenocarcinomas. These are also known as papillary cancer. These cancers have a better prognosis because they’re not as likely to grow into the liver or lymph nodes. A pathologist who looks at the cells in your gallbladder can spot a papillary adenocarcinoma because the cells are arranged in finger-like projections.
If it grows through the gallbladder wall, the tumor can invade nearby organs, such as your liver. Or it can enter the lymphatic or blood vessels in the gallbladder wall. This enables the cancer to spread to lymph nodes, liver, and other body parts.
Only one out of five gallbladder cancers are found before they have spread to other tissues and organs. Gallbladder cancer is hard to detect because the gallbladder is located deep inside your body. This makes it hard to feel or see during an examination.
There are no blood tests to reliably detect gallbladder cancer. For this reason, gallbladder cancer is usually found only when the cancer has grown enough to cause symptoms. In some people, gallbladder cancer is discovered after the gallbladder has been removed to treat gallstones or inflammation of the gallbladder.
Because gallbladder cancer cells can be difficult to find, your doctor may use a variety of tests to diagnose the cancer.
Bile duct cancer, also known as cholangiocarcinoma, is a rare cancer that begins in the bile duct. The bile duct is a thin tube that goes from the liver to the small intestine. It is about four to five inches long. The main role of the bile duct is to move bile produced in the liver to the gallbladder and to the small intestine. Once bile is in the small intestine, it helps the body digest fats in the foods we eat. Bile duct cancers may develop in and around the liver.
Bile ducts have different types of tissue which can develop into cancer. Many bile duct tumors begin in glandular tissue found within the bile duct. This type of cancer is called adenocarcinoma. Squamous carcinoma and sarcomas are other bile duct cancer that develops in the tissue.
Cancer of the bile duct can start in the bile duct and spread to other areas of the body. Bile duct cancer can spread within the liver, and to the gallbladder and pancreas. It can also spread to lymph nodes and to other nearby organs or tissues, such as the colon, stomach, small intestine, or abdominal wall.
Bile duct cancers usually develop slowly and the signs and symptoms can be so minor that they are difficult to spot. Jaundice, bloating, weight loss, fever, nausea, and abdominal pain are all possible symptoms of bile duct cancer.
With Your Healthcare Team
When going through cancer treatment, your healthcare team is very important. Your healthcare team may include your oncologists, surgeon, nurse navigator, a dietitian, a social worker, or other medical professionals. Every member plays an important role. Use the tips below for talking with your healthcare team:
- Establish your main point of contact.
- Your main point of contact will probably be a nurse navigator, but it may be another member of your healthcare team. Who should you contact first with questions?
- It is important to always be open and honest with your healthcare team about your physical and emotional well-being.
- Do not be afraid to ask questions.
- Cancer is usually not a medical emergency. There is time to ask your healthcare team any questions you may have, and to consider your treatment options.
- Write your questions down before your appointments. Take a pen and paper to write down the answers.
Before beginning treatment, ask your healthcare team the following:
- What are all my treatment options?
- What are the long term and short term side effects of treatment, and how can I manage them?
- Will my fertility or ability to have children be affected?
- Am I eligible for clinical trials?
- If you develop any new problems or symptoms during treatment, tell your healthcare team immediately. You are not complaining. This is valuable information for your doctors.
- Do not change your diet, start an exercise program, or take any new medications, including vitamins and supplements, during treatment without talking to your healthcare team first
With Your Caregiver
Your primary caregiver may be with you when you receive your diagnosis. Your primary caregiver may be your spouse, partner, adult child, parent, or friend. Your primary caregiver is the person who may come with you to appointments, take care of you after surgery or treatment, and support you throughout your cancer journey.
- Everyone reacts to the news of cancer differently. You may feel upset, shocked, or angry. It may take you some time to process the information. Your caregiver may react the same way you do, or your caregiver may not. Even if your caregiver does not react the same way you do, it does not mean that he or she does not care deeply.
- Establish your role and your caregiver’s role early. For example, will your caregiver be the one scheduling most of your appointments, or do you prefer to take an active role? Find what works best for you and your caregiver.
- Be open and honest with each other about how you both feel. Overly positive attitudes may hinder honest communication. It’s okay to be upset.
- Encourage your caregiver to take time to care for his or her own physical and emotional well-being. Being a caregiver comes with its own hardships.
- If your primary caregiver is your spouse or partner, your intimate and physical relationship may change.
With Your Children
Children are very perceptive, no matter their age. While you may wish to protect your children by not telling them about your diagnosis, even young children may be able to tell that something is wrong. Not knowing what is wrong may cause them more stress and anxiety. Here are some tips to talk to your children and teens about your cancer diagnosis:
- Wait until your emotions are under control and decide what to say ahead of time.
- Tell the truth and answer questions honestly. Depending on your children’s ages, it may not be appropriate to give them all the details, but do be truthful.
- Let them know what to expect. For example, let them know that after surgery you will need a lot of rest and may need to stay in the hospital. If your chemotherapy may cause you to lose your hair, let them know. Keep your children in the loop as much as possible.
- Explain to your children, especially younger children, that they cannot “catch” cancer.
- Let your children know that it is okay to cry or be upset. This may be especially important for your teens to hear.
- Tell teachers, babysitters, and others with responsibilities with and around your kids about your diagnosis in case they see behavior changes you may need to know about.
- Maintain normal schedules as much as possible.
- Let your kids help. Allow them to help with chores, and let them know that their help is important. Teens may want to take an active caregiver role. Let them do so, at appropriate levels.
- Look for support groups in your area. Many places offer support groups for children and teens whose parents have a cancer diagnosis.
- Know when to seek professional help. If your child begins to demonstrate unusual behavior such as angry outbursts, nightmares, or poor grades in school, ask your healthcare team for a recommendation for a counselor.
With Family and Friends
You may choose to keep your cancer journey private, or you may choose to share your story with others. The choice is yours. Remember when family, friends, coworkers, or other acquaintances ask about your diagnosis, they are genuinely concerned about your well-being. You can share with them as much or as little information as you like. These suggestions may help you talk about your diagnosis:
- Decide how much information you want to share before you start telling people about your diagnosis.
- If you chose to keep your journey private, make sure to let people know that you appreciate their concern, but you hope they respect your privacy.
- Choose someone close to you, like your caregiver, to spread the word about updates and treatment progress. After a long day of treatment, you may not feel like calling and texting people, but your friends and family will probably want to know how you are.
- If you want to share your story, consider starting an email chain or a Facebook group. This way you can update everyone with one message instead of needing to answer a lot of emails and phone calls.
- You can also create your own private website at MyLifeLine.org.
- When people offer to help with things, let them. Your family and friends could cook dinner, drive you to an appointment, or babysit.
- If you lose your hair due to treatment or have visible surgical scars, strangers may ask about your diagnosis. Have a response prepared. Again, you may share as little or as much as you like.