Treatment options

Cholangiocarcinoma is serious illness and is relatively rare.  It is essential that patients are cared for by knowledgeable specialists so that they are properly assessed and offered the right treatment and management for their particular situation.

Second opinion: For information on requesting a referral for a second or further opinion to ensure a diagnosis is correct, and for reassurance that the treatments suggested are the best options available, click here

Current Treatment Options

Treatment of cholangiocarcinoma will depend on the position and size of the cancer and whether it has spread beyond the bile duct, as well as on general health. Currently, the main options are:

• Surgery
• Chemotherapy, targeted therapy and immunotherapy
• Radiotherapy (including SBRT and SIRT)

Surgery

Surgery to completely remove the cancer is currently the only potentially curative treatment for cholangiocarcinoma. This involves a major operation and, often, because the disease is too far advanced, or the patient is already too poorly, surgery is not possible. The decision about whether an operation to remove the cancer can be done depends on the results of the diagnostic tests, and on the patient’s general health.

If surgery is possible, the patient must be referred to a surgeon who specialises in biliary tract cancer surgery. The type of operation that is done depends on the size of the cancer and whether it has begun to spread into nearby tissues.

• Removal of the bile ducts
• Partial liver resection
• Whipple procedure
• Surgery to relieve obstruction (blockage)
• Liver transplantation
• Stent Insertion

Chemotherapy, targeted therapies (including molecular profiling) and immunotherapy

No two tumours are exactly the same. The genetic characteristics of a cancer will vary from one patient to the next, which means that even patients with the same type of cancer may respond differently to the same treatment.

Current scientific advances mean that treatments are moving towards those that more specifically target the tumour ‘drivers’, the various mutations that are now known to be to found in some cholangiocarcinomas. The presence of these mutations can be found through a test, known as molecular profiling.

There are a number of mutations founds in cholangiocarcinoma, including IDH1 and FGFR2, for which there are now approved therapies.

All those diagnosed with cholangiocarcinoma should discuss molecular profiling with their consultant to discover if they have a mutation within their tumour for which there is a suitable targeted therapy.

For more information on Molecular Profiling and Targeted Therapies including a short animated video and a booklet, click here

For information on therapy approvals by NICE (National Institute of Health and Care  Excellence (England and Wales)) and SMC (Scottish Medicines Consortium), click here

Patient Information – Chemotherapy, targeted therapy and immunotherapy

There are now a number of approved treatments for those with cholangiocarcinoma. For downloadable patient information on each of the treatments, giving an explanation of the treatment, how it is given, for how long, what side effects might occur and how to deal with them, simply click on the name. 

• Gemcitabine, cisplatin and durvalumab (GEM/CIS/DURVA)
• Gemcitabine and Cisplatin (Gem/Cis)
• Capecitabine
• FOLFOX
• CAPOX (Capecitabine and oxaliplatin)
• Gemcitabine (given alone)
• Ivosidenib (for those with an IDH-1 mutation)
• Pemigatinib (for those with an FGFR2 fusion)

Many of these patient information sheets are available in other languages, including Spanish, Italian, Bulgarian, Romanian, German, Bengali, Gujarati and Hindi.  To select the language you need, click here

Radiotherapy

• SBRT (Stereotactic Body Radiation Therapy)
• SIRT (Selective Internal Radiation Therapy)

Radiotherapy, which uses high energy x-rays to destroy cancer cells, is not routinely used to treat cholangiocarcinoma, although there may be occasions when it is used palliatively (to reduce symptoms).

Clinical trials

Clinical trials continue to investigate ways to better, more effective treatments. For more information on current trials, click here

Published Guidelines – Further information on cholangiocarcinoma diagnosis and treatment

To download the BSG (British Society of Gastroenterology) endorsed, “Guidelines for the diagnosis and management of cholangiocarcinoma”, published in September 2023, click here, and for further information on the guidelines go to: ammf.org.uk/guidelines

Referral Information 

For information on requesting a referral for a further opinion to ensure a diagnosis is correct, and for reassurance that the treatments suggested are the best options available, click here