Biliary tract cancer--treatment options

Cancers of the extrahepatic biliary tract are rare, but they pose great problems from diagnostic and therapeutic points of view. Surgical resection offers the only prospect of cure for patients with this type of cancer. The resectability rates vary from 50% for tumours in the lower common bile duct to only 10% for tumours in the upper third. For the first group of patients there is a 5-year survival rate of 20-30% in several reports and for the other 10-15%. The operative mortality is acceptable low. For tumours in the liver hilum a liver resection is recommended. Most patients can only be helped by a by-pass procedure. The operative by-pass procedure carries a significant morbidity and mortality and most patients should be drained by PTC or preferably endoscopically. The effects of radiotherapy and chemotherapy have so far been insignificant. The combined use of intraarterial chemotherapy combined with radiotherapy seems to offer some advantage and this treatment modality must undergo further trials.