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Palliative care is also called supportive care. This is treatment used to help control or reduce symptoms caused by cancer. It's not meant to cure the cancer.

When are palliative treatments used?

Palliative treatments can be used at any point during cancer. It can be used to lessen side effects caused by cancer treatments. Palliative care can also lessen pain or discomfort caused by the cancer. For example, pain medicines and drugs to control nausea or itching might be used to help you feel better.

Chemotherapy and radiation can also be used to relieve problems caused by the tumor(s). Sometimes, surgery or other treatments are used to help you feel better or to help prevent possible problems the cancer might cause.

If bile duct cancer has spread too far to be removed by surgery, doctors may focus on palliative treatments. Because bile duct cancers tend to grow and spread quickly, doctors try to use palliative therapies that are less likely to have unpleasant short-term side effects, whenever possible. Your cancer care team will talk with you about the benefits and risks of all the treatments that might help you.

Listed here are some examples of procedures that might be used as part of palliative care for bile duct cancer.

Biliary stent or biliary catheter

If cancer blocks a bile duct, it can lead to jaundice as well as other problems, like infection and liver failure. Jaundice is yellowing of the skin and eyes caused by a buildup of bilirubin in the blood. A small tube (stent) or a catheter can be put into the duct to help keep it open and relieve symptoms.

• A stent is a small metal or plastic tube that's put through the blockage in the duct. It keeps the duct open to allow bile to drain into the small intestine.
• A catheter is a thin, flexible tube that's put in through the skin of the abdomen (belly). One end of the tube is put into a bile duct, and the other end is attached to a bag outside the body. This allows the bile to drain into the bag. The bag can be emptied when needed. If you have a catheter, your care team will teach you how to care for it.

These procedures can be done as part of liver imaging tests. This imaging is called cholangiography. It can be done using a scope through the mouth (endoscopic retrograde cholangiopancreatography or ERCP). Or it can be done through a small cut in the belly (percutaneous transhepatic cholangiography or PTC). In some cases, these procedures can be done during surgery.

Learn more about these imaging tests in Tests for Bile Duct Cancer.

Stent or catheter placement are often done to help prevent or relieve symptoms from more advanced cancers, but they can also be done to help relieve jaundice before surgery to remove bile duct cancer. This helps lower the risk of complications from the surgery.

The stent or catheter might need to be replaced every few months to help reduce the risk of infection and gallbladder inflammation. It will also need to be replaced if it becomes clogged.

Biliary bypass

A surgery called a biliary bypass is another option to allow bile to go into the small intestine and not build up in the liver. To do this, the surgeon connects the part of the bile duct before the blockage with a part of the duct after the blockage. This creates a bypass around the tumor and connects the bile duct with the intestine itself. There are different types of biliary bypass, depending on where the blockage in the bile duct is:

• A choledochojejunostomy joins the common bile duct to the jejunum (the second part of the small intestine).
• A hepaticojejunostomy joins the duct that carries bile from the liver to the jejunum.
• A gastrojejunostomy, which joins the stomach directly to the jejunum might be done when advanced bile duct cancer blocks part of the stomach or small intestine. This causes a separate problem called a bowel obstruction. This procedure may be done at the same time as the biliary bypass to relieve it. This combination is sometimes called a "double bypass."

A biliary bypass is more likely to be done if you are already having surgery to try to cure the cancer by taking it out, but it turns out the cancer cannot be totally removed. A bypass is more invasive than placing a stent or catheter, but it has some advantages. It may last longer and infection is less likely to be a problem.

Find out more about biliary bypass in Surgery for Bile Duct Cancer.

Tumor ablation (radiofrequency ablation, cryosurgery, or alcohol ablation)

Tumors in the liver that can’t be removed (resected) can sometimes be destroyed with ablation. This is done by putting a long metal probe through a small hole in the skin and into the tumor. A CT scan or ultrasound is used to guide it to the right place. How the probe destroys the tissue depends on the type of ablation used.

• Radiofrequency ablation uses heat to destroy the tissue.
• Cryotherapy destroys the tissue by freezing it.
• Alcohol ablation injects alcohol into the tissue to kill the cancer cells.

Photodynamic therapy (PDT)

For photodynamic therapy (PDT), a light-activated drug is injected into a vein. Over time, the drug tends to collect in cancer cells more than in normal cells. A few days later, an endoscope (a long, flexible tube that can be used to look inside the body) is passed down the throat, through the stomach and intestine, and into the bile ducts.

A special laser light on the end of the endoscope is aimed at the tumor. The light turns on the drug, causing the cells to die. PDT can be helpful for people with bile duct cancer whose tumors can't be removed with surgery.

The drugs used for PDT can also collect in normal cells in the body, making a person very sensitive to sunlight or strong indoor lights. You'll need to stay out of any strong light for several weeks after the injection.