Clinical Impact of Biliary Tract Cancer

This educational Medcast focuses on biliary tract cancers, featuring 2 clinical oncology pharmacists discussing the epidemiology and clinical characteristics of these rare malignancies. Biliary tract cancers represent a significantly less common cancer type compared with other major cancers, with approximately 41,000 new cases and 12,500 deaths projected for 2024 in the United States. This contrasts sharply with more prevalent cancers like lung cancer, which sees around 225,000 new cases annually. The rarity of biliary tract cancers contributes to limited awareness among health care professionals and the general public, though recent advocacy efforts have increased visibility, particularly following high-profile diagnoses of public figures like NFL player Randy Moss with cholangiocarcinoma.

The risk factors for biliary tract cancers are predominantly associated with chronic inflammatory conditions affecting the biliary system. For gallbladder cancer, gallstones serve as a primary risk factor, while cholangiocarcinoma is linked to conditions such as primary sclerosing cholangitis and inflammatory bowel disease. Additional risk factors include hepatitis B and C infections, as well as fatty liver disease. These inflammatory processes create an environment conducive to malignant transformation within the biliary tract structures.

Clinical presentation of biliary tract cancers poses diagnostic challenges due to the nonspecific nature of many symptoms. Patients commonly present with fever, unintentional weight loss, and abdominal pain, which can be attributed to numerous other conditions, potentially delaying accurate diagnosis. However, extrahepatic cholangiocarcinoma may present with jaundice, characterized by yellowing of the skin and sclera, which can serve as a more specific diagnostic clue. The prognosis for biliary tract cancers remains particularly concerning, with 5-year overall survival rates estimated at only 10% to 20% across all stages at diagnosis, emphasizing the critical importance of early detection and appropriate treatment strategies.