At the beginning of the month, British theater, film and television actor Ian Gelder died at the age of 74. Gelder, who starred in numerous movies and TV shows, gained international recognition for his role in HBO's fantasy series "Game of Thrones," where he portrayed Kevan Lannister. Gelder died after a tough battle with bile duct cancer, a rare and highly aggressive form of cancer.
His partner of 30 years, Ben Daniels, paid tribute to him on Instagram, sharing that Gelder's tumor was only discovered in December. "Neither of us had any idea everything would happen so quickly. He was my rock. He was the kindest, most loving person, an extraordinary actor whose heart and light were felt by everyone who worked with him," Daniels wrote.
Bile duct cancer is not common. According to the National Cancer Registry, only a few dozen to a few hundred new cases are diagnosed in Israel each year. Since most of the bile ducts are located between the liver tissues, the tumor is often mistakenly identified as a metastasis from another cancer.
Bile duct cancer can occur in men and women of various ages, but it is most prevalent among adults over 65. Additionally, there is a higher incidence of this cancer among patients with certain chronic inflammatory diseases, diabetes and ulcerative colitis.
What is the function of the biliary tract?
To understand bile duct cancer, it is essential to grasp the role of the digestive system. The digestive system comprises various organs, each with a distinct biological function. Bile, a greenish fluid rich in enzymes, aids in the breakdown of fats. This fluid is drained through the bile ducts, stored in the gallbladder, which is connected to the main bile duct, and then released into the digestive system. The liver, responsible for metabolism, removes toxins from the bloodstream. Bile juices play a crucial role in breaking down and absorbing fats.
Difficult to identify and has low survival rates
Bile duct cancer accounts for 10% to 15% of all liver tumors diagnosed each year. Clinically, it is considered a highly complex cancer with limited treatment responses. Consequently, statistics show that only 5% to 15% of patients survive more than five years after diagnosis. The high mortality rate is attributed not only to the tumor's complex biology but also to the challenges in diagnosing it. Many symptoms of bile duct cancer are nonspecific, leading to delayed suspicion and diagnosis. Possible symptoms include abdominal pain, sudden weight loss, and non-infectious jaundice.
Prof. Ravit GevaPhoto: Tel Aviv Sourasky Medical CenterNot all abdominal pain indicates cancer, but vigilance is crucial. Any concerning symptoms should prompt a medical evaluation. If necessary, a primary care physician will refer the patient to a specialist, such as a surgeon or gastroenterologist, for further tests. The diagnostic process usually involves imaging the abdominal area to identify the affected region, followed by a biopsy to confirm the diagnosis if required.
Are there treatments for bile duct cancer?
When a diagnosis of bile duct cancer is made, the patient undergoes a more detailed evaluation to determine whether the disease is in its early, localized stages, where surgery to remove the tumor is possible, or in its advanced, metastatic stages, where surgical treatment is not viable. Whenever feasible, the goal is to surgically excise the malignant tumor. This is typically followed by chemotherapy to eliminate any remaining microscopic disease and reduce the likelihood of recurrence.
Recent years have seen progress in understanding the unique biology of bile duct cancer. Treatments now include immunotherapy drugs, which stimulate the immune system to attack the tumor, often in combination with chemotherapy. Additionally, there are several biological drugs tailored to specific mutations found in metastatic bile duct tumors. Tumor sequencing to identify these mutations is covered by health insurance and should be performed at the time of metastatic diagnosis.
Looking ahead, there is hope that advancements in research, science, and technology will provide a wider array of treatment options, enabling us to better manage this disease and extend patients' lives. Many clinical trials are available, and patients should consult with their health care providers about the availability and suitability of these trials.