Bile Duct and Gallbladder Cancer
Cholangiocarcinoma and gallbladder cancer treated by a hepatobiliary specialist
Cancers of the bile ducts and gallbladder are uncommon, which is exactly why they should be treated by a surgeon who sees them regularly. Dr. Papenfuss has a particular clinical and research focus on cholangiocarcinoma and practices at a high-volume hepatobiliary referral center in Milwaukee that serves patients from across Wisconsin.
What it is
Bile is made in the liver and travels through a tree of ducts to the gallbladder and small intestine. Cancer can arise anywhere along that path.
Intrahepatic cholangiocarcinoma, in the small ducts inside the liver, often found as a liver mass.
Perihilar cholangiocarcinoma (Klatskin tumor), where the right and left ducts join just outside the liver. The most technically demanding to remove.
Distal cholangiocarcinoma, in the lower duct near the pancreas, treated much like pancreatic head cancer.
Gallbladder cancer, sometimes discovered unexpectedly after a routine gallbladder removal, and sometimes found on imaging for other reasons.
Jaundice (yellowing of the skin and eyes), itching, dark urine and pale stools are the usual first signs.
How it is treated
Surgery is the only curative treatment, and the operation depends entirely on location: a liver resection for intrahepatic tumors; removal of the bile duct together with part of the liver and reconstruction of bile drainage for perihilar tumors; a Whipple procedure for distal tumors; and for gallbladder cancer, removal of the gallbladder bed of the liver and surrounding lymph nodes, which is more than the original gallbladder operation. Chemotherapy before or after surgery is common, and newer targeted drugs matched to the tumor's genetic profile (FGFR2, IDH1 and others) have changed the picture for many patients. For intrahepatic tumors that cannot be removed, histotripsy or ablation may be options.
Before surgery, many patients need a stent to relieve jaundice and detailed imaging to map the ducts and vessels. Getting that sequence right is part of the surgery.
Dr. Papenfuss's approach
Dr. Papenfuss maintains an active research program in cholangiocarcinoma and reviews every case at the combined HPB conference with transplant surgeons, hepatologists, gastroenterologists, oncologists and interventional radiologists. Patients whose tumors cannot be removed are evaluated for transplant and for clinical trials. Every tumor is sent for molecular profiling so targeted therapy is not missed.
When to get a second opinion
An incidental gallbladder cancer found after routine surgery almost always needs a second operation, and that decision deserves a hepatobiliary surgeon. If you have been told a bile duct tumor is inoperable, ask for a review. Patients come to Milwaukee from across Wisconsin; a records review can happen before you travel.
Call 414-649-3240 to request a consultation.
This page is general information, not medical advice for any individual patient.