Hepato billiary Cancer
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Our Treatments
Hepato-billiary cancer
Less common but aggressive, often linked to hepatitis infections and liver cirrhosis in India.
Types of Hepato-Biliary Cancers
Cancer Type
Site of Origin
Common Subtypes
Liver (hepatocytes)
Liver (hepatocytes)
Classical HCC
Cholangio carcinoma (CCA)
Bile ducts (intrahepatic or extrahepatic)
Intrahepatic, perihilar, distal
Gallbladder Cancer (GBC)
Gallbladder
Adenocarcinoma (most common)
Ampullary Cancer
Ampulla of Vater
Periampullary adenocarcinomas
Risk Factors
Cancer Type
Common Risk Factors
HCC
Chronic hepatitis B/C, cirrhosis, alcohol use, NAFLD, aflatoxin exposure
Cholangiocarcinoma
Primary sclerosing cholangitis (PSC), liver flukes (e.g., Opisthorchis), bile duct cysts
Gallbladder Cancer
Gallstones, chronic cholecystitis, porcelain gallbladder, female gender
Ampullary Cancer
Familial adenomatous polyposis (FAP), Lynch syndrome
Treatment Overview
Hepatocellular Carcinoma (HCC)
Stage
Treatment Options
Early/localized
Surgical resection or liver transplantation
Intermediate (BCLC B)
TACE (Transarterial chemoembolization)
Advanced
Systemic therapy: Atezolizumab + Bevacizumab, Sorafenib, Lenvatinib
Unresectable/local control
SBRT, RFA (Radiofrequency Ablation), TARE (Y-90 radioembolization)
Cholangiocarcinoma
Stage
Treatment
Early (T1a)
Simple cholecystectomy
T1b or higher
Extended cholecystectomy (liver bed resection + lymphadenectomy
Adjuvant
Capecitabine chemotherapy ± RT in high-risk cases
Advanced
Systemic chemo ± palliative RT or stenting for obstruction
Gallbladder Cancer
Stage
Treatment
Early (T1a)
Simple cholecystectomy
T1b or higher
Extended cholecystectomy (liver bed resection + lymphadenectomy)
Adjuvant
Capecitabine chemotherapy ± RT in high-risk cases
Advanced
Systemic chemo ± palliative RT or stenting for obstruction
Ampullary Cancer
Treatment
Details
Resectable
Whipple procedure (pancreaticoduodenectomy)
Adjuvant
5-FU or gemcitabine-based chemotherapy ± radiation in high-risk
Advanced/metastatic
Systemic therapy (based on histology: intestinal vs pancreatic type)
Role of Radiation Therapy
Cancer Type
RT Indications
HCC
SBRT for unresectable lesions or poor surgical candidates
Cholangiocarcinoma
Adjuvant RT after R1/R2 resection; definitive RT for unresectable cases
GBC
Adjuvant RT in margin-positive or node-positive disease
Ampullary
Adjuvant RT in high-risk cases (T3/T4, LN+)
Key Points
- Liver-directed therapies (TACE, RFA, SBRT) are central in HCC management
- Surgery is curative for early-stage biliary cancers, but often diagnosed late
- Radiation therapy plays a selective but important role in local control and palliation