Surgery to remove distal bile duct cancer
Some people with early distal bile duct cancer can have an operation to remove it. This is called a whipple's operation.
Cancer that starts in bile ducts close to the pancreas is called distal bile duct cancer. Sometimes it is possible to remove all the cancer with an operation.
The surgeon will remove:
- the bile ducts
- the gall bladder
- part of the pancreas
- the part of the small bowel called the duodenum.
This is a major operation. It is only suitable for people with early-stage distal bile duct cancer. In some people, it may cure the cancer.
Only specialist surgeons who have experience in bile duct and pancreatic surgery will do this type of operation. You will be referred to a specialist centre for it.
It is important to discuss the benefits and risks with your surgeon before deciding to have surgery.
You may have one of the operations described below.
This is like a pylorus-preserving pancreato-duodenectomy (PPPD) operation. But the surgeon will also remove the lower part of the stomach (the pylorus). It is also called a Whipple’s operation.
The sections in white are the parts removed during a Whipple’s operation.
The surgeon attaches the remaining parts of the stomach, the remaining bile duct, and the tail of the pancreas to the small bowel.
You may need to replace the digestive juices (enzymes) that the pancreas normally makes. This will depend on the type of operation you have had and your ongoing symptoms.
Digestive enzymes help your body break down and absorb fats and protein. If you do not have enough of them, you may have diarrhoea. Your stools (poo) may float, look pale and smell bad. You will also find it difficult to put on weight because you cannot absorb nutrients from your food.
Pancreatic enzyme replacement therapy drugs
You can replace the digestive enzymes by swallowing capsules. You usually take these each time you eat or have a milky drink. Your surgeon, nurse or a dietitian will give you more information about how to take the capsules. You will need to take the capsules for the rest of your life.
These are some commonly used, pancreatic enzyme replacement therapy drugs:
Most replacement enzymes are made from pork. It is also possible to get enzymes made from beef. Vegetarian based enzymes are not available.
The most commonly used supplement is a tablet called Creon®, which is a pork-based enzyme replacement. There is no alternative that is not pork-based.
Creon® has been approved for Jewish patients to use by the Chief Rabbi. Previous rulings by Islamic scholars suggest that Muslim patients may use pork-based medicines if there is no alternative. If you are worried about this, speak to your religious leader.
Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
Valle JW, Borbath I, Khan SA, et al. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016; 27, suppl 5, v28-v37. Available from www.doi.org/10.1093/annonc/mdw324 (accessed October 2019).
Rizvi S, Khan A, Hallemeier C, et al. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Clinical Oncology, 2018; 15, 2, 95-111. Available from www.doi.org/10.1038/nrclinonc.2017.157 (accessed October 2019).
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.
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