Some cancers elude early detection



September 17, 2018 - 8:59 AM

Dear Dr. Roach: A family friend has just been diagnosed with bile duct cancer. She is a breast cancer survivor and is 75 years old. The tumor is said to be the size of a quarter, and it was discovered after she complained of heartburn symptoms.
Are there screening tests that could have detected the condition before the heartburn symptoms? Are there things that she could have done to avoid the cancer? My family members are frightened and want to avoid her condition. —Anon.

Answer: Cholangiocarcinoma, cancer of the bile ducts, is a rare cancer that is, unfortunately, associated with a high mortality rate. There are no symptoms in most people until it is advanced. Since the cancer is in the bile ducts, the most common symptoms are caused by obstruction of the bile ducts: jaundice (yellow in skin/eyes), generalized itching, dark urine and light-colored stools. Abdominal pain, fever and weight loss are other symptoms.
Cholangiocarcinoma is not a disease that’s amenable for screening; it is rare in North America (it is more common in East Asia, where there are screening programs). Further, the available screening tests, such as blood tests and imaging studies, are not very sensitive, meaning the tests will miss cases. And they are not very specific — a positive result on the screening test does not necessarily mean cancer. For these reasons, screening is not currently recommended for people at average risk, although it may be considered in people at high risk, such as people with primary sclerosing cholangitis, a chronic liver disease that puts people at high risk for cholangiocarcinoma.
Other risk factors for cholangiocarcinoma are mostly beyond a person’s control: other liver diseases, parasites and genetic conditions. There is some evidence that obesity and diabetes increase the risk of this cancer; however, it does no good for you or your friend to look backward. Never blame the victim. She should concentrate on getting treated. I don’t have enough information to comment on her prognosis, but the fact that it was diagnosed early — apparently before obstruction of the bile ducts — and with a tumor only the size of a quarter, are favorable. Treatment may include surgery and chemotherapy (before or after surgery).


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