New tool helps doctors spot bile duct cancer

LOS ANGELES Laura Davis knows a thing or two about winning family trivia games. But for the last seven years, she's been up against a different opponent -- breast cancer.

"Every day, I just try to be normal -- as normal as possible," said Laura Davis.

Laura's had surgery and chemo, but her cancer has come back three times. Doctors worried that her cancer might have spread to her bile duct.

Typically, they've relied on X-rays or biopsies for diagnosis, which can be inaccurate and painful. Dr. Michel Kahaleh uses a new technology called spyglass on Laura to see what was going on.

"The concept is what you see better, you can treat better," said Dr. Kahaleh.

A fiber optic probe with a miniature camera is placed down the patient's throat and travels all the way to the bile duct. It magnifies the area and allows doctors to see cancer, benign tumors and stones in real time.

"Now, we can finally see all those diseases that we were suspecting," said Dr. Kahaleh.

If cancer is present, doctors can immediately use a laser to destroy it. In a study, using spyglass with laser therapy more than doubled the survival rates for patients with bile duct cancer.

Luckily, Laura's tissue was clear of any cancer. Dr. Kahaleh was able to tell her the good news on the spot.

"The more information you can get, the better off you are as a patient," said Davis.

Now, she can enjoy time with her family knowing doctors are keeping a closer eye on her cancer.

The procedure is typically done as an outpatient. Doctors say this technology could soon be used to detect and treat cancers in the pancreas as well.

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Cancer of the liver bile duct is the second most common type of liver cancer. Of the 2,000 cases diagnosed each year, the majority of patients survive only four to six months with treatment. The bile duct is actually a thin tube that reaches from the liver to the small intestine. Its purpose is to transport bile from the liver and gallbladder to the small intestine, where it helps digest fats.

The bile duct is part of what is called the hepatobiliary system, which consists of the liver, gallbladder, bile duct and pancreas. Cancers of this area of the body are often referred to as hepatobiliary cancers, and every year, about 20,000 new cases of such cancer are diagnosed in the United States. These types of cancers have some of the lowest survival rates.

The overall survival rate of liver cancer, according to the American Cancer Society, is 10 percent. Numbers for bile duct cancer are more complex.

For bile duct cancers that start within the liver, survival after five years is between 20 and 40 percent; for cancers that start where the branches of the bile duct have just left the liver, the 5-year survival rate is 10 to 30 percent; for those cancers that start further down the bile duct, survival after five years is up to 40 percent. For bile duct cancers that cannot be removed through surgery, 5- year survival is 10 percent.


Traditional methods of viewing and treating the bile duct for cancer involves injecting contrast dye through a catheter. "You are basing your whole judgment on contrast injection, so depending on how well the contrast gets to the area, you can then see if there's something else or not," Michel Kahaleh, director of Pancreatico-Biliary Services at the University of Virginia in Charlottesville, told Ivanhoe.

Dr. Kahaleh is using a new technique to view and treat this type of cancer that involves using a miniature camera and laser. In the treatment process, called photodynamic therapy (PDT), doctors activate a chemical using light of a specific wavelength, which kills the cancer cells. One study at the University of Virginia found combining PDT with stent therapy doubled survival rates for patients with cancer of the liver bile duct.

After five years of treatment, those who received PDT combined with stents survived 16.2 months, whereas those treated with stents alone survived 7.4 months.

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