Table of Contents
Preface vii
Part 1 The Basics 1
Questions 1-5 Cover basic information about biliary cancers, including:
1 What is cancer?
2 What is bile and what are bile ducts?
3 What does the gallbladder do?
4 Are there different types of biliary cancers?
5 What is Next Generation Sequencing (NGS)?
Part 2 Risk Factors 11
Questions 6-11 Discusses risk factors for biliary cancers, including:
6 How common is cholangiocarcinoma, and what are the risks for developing it?
7 Can cholangiocarcinoma occur along with liver cancer?
8 How common is extrahepatic bile duct cancer, and what are the risks of developing it?
9 How common is gallbladder cancer, and what are the risks of developing it?
10 Should I have genetic germline testing to assess my risk of developing biliary cancer?
11 Does my family need to be screened for biliary cancers? Should my family members have their gallbladders removed if I have gallbladder cancer?
Part 3 Diagnosis and Staging 19
Questions 12-20 Describes the diagnosis and staging of biliary cancers, including:
12 What are the signs and symptoms of cholangiocarcinoma?
13 How is cholangiocarcinoma diagnosed?
14 What are the symptoms of extrahepatic bile duct cancer?
15 How is extrahepatic bile duct cancer diagnosed?
16 What are the symptoms of gallbladder cancer?
17 How is gallbladder cancer diagnosed?
18 What is a pathology report of a biopsy?
19 What is cancer staging, and why is it relevant?
20 How is staging performed?
Part 4 Coping with the Diagnosis 29
Questions 21-26 Discuss patients' support needs after a diagnosis of biliary cancers, including:
21 How long do people with biliary cancer live?
22 What is supportive care?
23 Should a patient get a second opinion?
24 Many people are volunteering different opinions. How should I handle that?
25 How should I manage my emotions now that I have been diagnosed with biliary cancer?
26 What insurance and financial concerns does a patient need to address after a diagnosis of biliary cancer?
Part 5 Treatment 39
Questions 27-75 Focus on treatments available for biliary cancers, including:
27 Which treatment options are available for intrahepatic cholangiocarcinoma?
28 What treatment options are available for extrahepatic bile duct cancers?
29 Which treatment options are available for gallbladder cancer?
30 What determines whether cholangiocarcinoma can be removed?
31 What determines whether my bile duct cancer can be removed by surgery?
32 What factors determine whether gallbladder cancer can be removed or not?
33 What is multidisciplinary care?
34 What preparations are made before a surgery?
35 What happens during a surgery?
36 How extensive is the surgery?
37 What happens in the hospital after surgery?
38 What are the risks of surgery for biliary cancer?
39 What is included in the pathology report from my surgery?
40 Will I be cured after a surgery?
41 What are neoadjuvant, adjuvant, and peri-adjuvant therapies?
42 Should I receive adjuvant chemotherapy and/or radiation therapy after surgery to prevent a recurrence of the tumor?
43 If the rumor cannot be surgically removed now, can I have chemotherapy first and then undergo surgery?
44 What happens if my biliary cancer returns?
45 Can liver transplantation be performed for cholangiocarcinoma?
46 Where do new livers for liver transplants come from?
47 What are the complications of liver transplantation?
48 What is tumor ablation, and can it be used for the treatment of cholangiocarcinoma?
49 What is hepatic artery embolization, and can it be used to treat cholangiocarcinoma?
50 What is radioembolization?
51 What are radiofrequency ablation and cryotherapy, and can they be used for the treatment of cholangiocarcinoma?
52 What is systemic therapy or chemotherapy?
53 Do I need to stay in the hospital to receive chemotherapy?
54 What are some of the general side effects of chemotherapy?
55 I am worried I may get nauseous or vomit. How are these symptoms prevented or treated?
56 The combination of gemcitabine plus cisplatin is a standard treatment for biliary cancers. How does this treatment plan work?
57 What is gemcitabine? And what are its side effects?
58 What is cisplatin? And what are its side effects?
59 How will I know that my treatment is working?
60 What kind of scan is best to assess a tumor response?
61 What are tumor markers?
62 If my cancer progresses on first-line therapy like gemcitabine and cisplatin, what should I do next?
63 What are FOLFOX and FOLFIRI therapies? And what are their side effects?
64 What are biological therapies? Are there any specific new biological drugs being tested for biliary cancers?
65 What are pemigatinib and infigratinib? And what are their side effects?
66 What about other targets and their therapies?
67 What is a clinical trial?
68 Where can I learn about clinical trials for biliary cancers, and how do I know which trial is best for me?
69 What is liver pump chemotherapy?
70 What is radiation therapy?
71 Can radiation be used for the treatment of biliary cancers?
72 Are there other uses for radiation?
73 What are complementary and alternative treatments? How do I decide whether I should use one of the complementary or alternative therapies that my family or friends are recommending?
74 What if my doctor recommends that no treatment should be performed?
75 How should I use the Internet to learn about my cancer? What about social media?
Part 6 Cancer-Related Practical Issues 101
Questions 76-83 Describe practical considerations for patients with biliary cancers, such as:
76 I feel overwhelmed by all of the information that I am receiving. How do I make any decisions regarding my treatment?
77 Will changing my diet affect my cancer?
78 I am concerned I am losing weight. Can I do something about it?
79 I feel tired. What can I do to help with fatigue?
80 I am experiencing pain. How can I stop it?
81 How do I prevent or relieve nausea and/or vomiting?
82 I cannot sleep at night. What can I do to sleep better and feel more rested?
83 What is a mediport?
Part 7 Biliary Cancer-Specific Issues 117
Question 84-89 Discuss issues specifically seen in biliary cancer, including:
84 I have been told I have jaundice. Why are my eyes and/or skin yellow?
85 What is the difference between a stent and a drain?
86 How is a mechanical bile duct blockage fixed?
87 What are the risks associated with a biliary catheter and how do I care for it?
88 My abdomen and/or legs are swollen. What is edema? What is ascites?
89 How do you treat edema and ascites? What is a paracentesis?
Part 8 Family, Social, and End-of-Life Issues 125
Questions 90-100 Explore key issues of managing family and social concerns, particularly end-of-life care, including:
90 I feel depressed. How can I get help?
91 Can I work during treatment?
92 What if my doctors suggest, stopping my current therapy?
93 What is palliative care?
94 What is hospice?
95 What are advance directives?
96 What is a healthcare proxy?
97 How can we prepare to die? Where can we find hope?
98 Where can I find additional information?
99 Should I still seek treatment for my biliary cancer even during the current COVID-19 pandemic?
100 Are there foundations that help or support patients with biliary cancers?
Glossary 137
Resources 145
Index 149
