Liver Transplant for Cholangiocarcinoma - What are Your Options?

The third Thursday in February every year is World Cholangiocarcinoma Day. This day was created to bring awareness and understanding to this cancer diagnosis.

Mayo Clinic is one of the few centers in the United States that performs liver transplantation for cholangiocarcinoma (CCA). CCA is a cancer that forms in the slender tubes (bile ducts) that carry bile from the liver to the intestine. Cholangiocarcinoma obstructs the bile ducts and causes symptoms such as jaundice (yellow skin and eyes), abdominal pain, weight loss, generalized itching, and fever.

Doctors divide cholangiocarcinoma into different types based on where the cancer occurs in the bile ducts:

• Intrahepatic cholangiocarcinoma arises in the small bile ducts within the liver and is classified as a type of liver cancer. The standard treatment is resection, though sometimes transplant can be a treatment option also.
• Hilar cholangiocarcinoma occurs where the major bile ducts combine in the central portion of the liver and form the main bile duct that drains the liver.  Cancers arising in this location are treated with resection when possible. When resection is not possible, these cancers can be treated with transplantation using the Mayo Clinic protocol.
• Distal cholangiocarcinoma occurs in the portion of the bile duct that is nearest the small intestine. These cancers are best treated by surgical resection.

Your treatment options for your CCA will depend on the specifics of your cancer, such as the size, location and extent, as well as your health and personal preferences. At Mayo Clinic, your expert team works with you to find a treatment that meets your needs.

One of the risk factors for developing hilar CCA is primary sclerosing cholangitis (PSC), a liver disease that results in the narrowing and stricturing of the bile ducts. The 30-year risk of developing hilar CCA is about 20% in patients with PSC. Not everyone with PSC will get CCA and not everyone with CCA will qualify for liver transplantation. To be eligible for liver transplantation, patients with hilar CCA must have the cancer diagnosis before the disease spreads beyond the liver. Once the disease is elsewhere in the body, a cure through transplant is not possible, and the immunosuppressive medications that patients need after transplantation could speed up the spread of the cancer cells.

Once a patient has been diagnosed with hilar CCA and imaging shows that it has not spread outside the liver, and the patient is accepted as a candidate for liver transplant, the first step of the treatment process is radiation treatment with concurrent and continuous infusion of chemotherapy medications. Patients are then treated with oral medications while they await transplantation.

All patients require a staging operation to rule-out spread of cancer prior to transplantation. During this operation, doctors will check the patient for cancer elsewhere in the body.

Transplantation can be accomplished with either a deceased or living liver donor.  Patients being considered for a deceased donor liver transplant will be placed on the liver transplant list to wait until an acceptable matched liver can be identified for them. Patients will meet with their transplant team to determine which option may be best for them to consider.

Have you been diagnosed with CCA? What were your treatment options?

HELPFUL LINKS

• Learn more about cholangiocarcinoma at Mayo Clinic
• Explore Mayo’s Transplant Center.
• Request an appointment.