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Hoag Memorial Hospital Presbyterian

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Read our latest news and lifestyle articles about bile duct & gallbladder cancer at Hoag.
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Contact usBile duct cancer (also known as biliary cancer or cholangiocarcinoma) is cancer that occurs in the tubes that connect your liver, gallbladder and small intestine and which carry bile, a bodily fluid that helps our bodies digest food.
There are three main types of bile duct cancer:
The symptoms of bile duct cancer can be different for every patient, and can be similar to symptoms of other, less-serious conditions. Common symptoms can include:
There are a number of factors that are believed to increase your risk of developing bile duct cancers. These include:
Ways to reduce your risk of developing bile duct cancer include:
Gallbladder cancer is cancer that begins in the gallbladder, which is a small, pear-shaped organ located behind the liver that stores and releases bile. Produced in the liver, bile is a fluid that helps your body digest fats from the food you eat as it passes through the small intestine.
According to the American Cancer Society, the vast majority of gallbladder cancers are adenocarcinomas that begin in the glandlike cells that line the surface of the gallbladder.
Other, rarer types of gallbladder cancer include:
Gallbladder cancer often presents no symptoms in its early stages. However, some known signs of gallbladder cancer can include:
There are a number of factors that are believed to increase your risk of developing gallbladder cancer. These include:
Hoag Family Cancer Institute offers exceptional medical and surgical treatment for bile duct cancer. Our subspecialized team of medical oncologists and surgeons employ groundbreaking research and the latest diagnostics and therapies to give you the very best odds at beating cancer.
If you are experiencing any symptoms that might suggest bile duct cancer, your doctor will talk to you about your symptoms, likely followed by a thorough physical exam and bloodwork. Depending on the outcome of those tests, your doctor may refer you to a specialist for other tests that may include:
Checking for high levels of carbohydrate antigen CA 19-9 in your blood, which can sometimes suggest the presence of bile duct cancer.
Endoscopic Retrograde Cholangiopancreatography (ERCP): In this test, the doctor passes a long, flexible tube with a camera at the end through your mouth, through the stomach and into the bile ducts to visually examine them.
Liver function tests
Imaging tests that may include CT, PET or MRI scans.
Surgical biopsy
The Hoag Family Cancer Institute offers world-class programs to treat cancer of all types, including bile duct cancer, with multidisciplinary teams, state-of-the-art facilities and technology and the latest in cancer therapies.
Treatment options for bile duct cancer depend on many factors, including how advanced the cancer is when detected, your age and any other health issues you may have. Treatments for bile duct cancer vary from patient to patient, but may include:
Surgery
Biliary drainage
Liver transplant
Immunotherapy, which primes your immune system to fight the cancer
Hoag radiation oncologists and medical physicists work together with the Hoag team of bile duct cancer experts to develop an individualized treatment plan using the latest radiation therapy techniques
Image-Guided Intensity-Modulated Radiation Therapy (IG-IMRT)
Precision Medicine, in which Hoag physicians test the DNA of patients’ tumors, then develop treatments tailored specifically to the mutations that caused the cancer. This allows physicians to treat the cancer very precisely. Hoag is a national leader in the use of precision medicine in several types of cancer, including bile duct cancer.
Facing surgery can be a frightening prospect, but it is a vital component in the successful treatment of many cancers. The Hoag Family Cancer Institute’s medical team includes experienced, fellowship-trained cancer surgeons who utilize the latest techniques and technology in the surgical management of many different cancers, including bile duct cancer.
Hoag’s non-surgical options, including chemotherapy and radiation therapies, are world-class as well. Hoag was recently named a Radiopharmaceutical Therapy Center of Excellence (RTCoE) by the Society of Nuclear Medicine and Molecular Imaging (SNMMI), a distinction held by only 17 centers in the U.S. including Stanford Health Care, Harvard Medical School and the University of California — San Francisco.
Hoag Family Cancer Institute’s Radiation Oncology Program offers personalized services to treat cancers. Explore advanced treatment technologies for cancer treatment available at Hoag.
Hoag is committed to leading the way in state-of-the-art technologies and advanced treatment options. Part of this commitment includes clinical research with the goal of helping patients live longer, healthier lives. Through carefully planned clinical trials, researchers evaluate the safety and effectiveness of new ways to diagnose, treat and prevent diseases or conditions. Treatments studied in clinical trials might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. View clinical trials for biliary-gallbladder cancer here.
Hoag Family Cancer Institute offers exceptional medical and surgical treatment for gallbladder cancer. Our subspecialized team of medical oncologists and surgeons employ groundbreaking research and the latest diagnostics and therapies to give you the very best odds at beating cancer.
Currently, there are no blood tests or other non-invasive techniques that can definitively screen for gallbladder cancer. Because the disease usually presents no symptoms, gallbladder cancer is often found during unrelated abdominal surgery, gallstone-related surgery to remove the gallbladder, or after the cancer has spread and started to impact other organs.
After discussing your symptoms, your physician will likely give you a thorough physical exam and may order blood tests. While not able to show the presence of gallbladder cancer, these blood tests can show elevated levels of albumin, bilirubin, liver enzymes and other substances that may indicate problems in your gallbladder, bile ducts or liver.
Your blood will also likely be checked carefully for what’s called tumor markers, which are substances made by cancer cells.
Depending on the outcome of those blood tests, your physician may order imaging tests to get a look inside your body. These may include:
Abdominal ultrasound, which utilizes sound waves to create images of the organs and other structures inside the abdomen using a radio wave source outside the body.
Endoscopic or laparoscopic ultrasound, in which an ultrasound generating device on a long, flexible cable is inserted down the throat or through small incisions made in the abdomen so the ultrasound device can be positioned closer to the gallbladder
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Cholangiography, which is an imaging technique that looks directly at the bile ducts
Biopsy, in which a small sample of tissue or bile fluid is painlessly removed so that it can be tested for the presence of cancer
Accurate diagnosis is a priority at Hoag. A more accurate diagnosis leads to better outcomes and fuller recoveries for patients. Among the advanced techniques Hoag uses to diagnose gallbladder cancer: Volume Rendering Computed Tomography, which creates highly accurate 3-D scans of the abdomen, allowing physicians to properly stage the cancer and determine whether surgery is a good option. Hoag is one of only a few centers in Southern California that have this advanced imaging technology.
If your doctor determines you have gallbladder cancer, the next step is to determine whether the cancer is limited to the gallbladder or has spread to other organs and structures inside the body. How much the cancer has spread will help determine a treatment path and priorities.
Diagnosis is key to your treatment and recovery, and no hospital in California is more committed to accuracy in diagnosis than Hoag. At Hoag Family Cancer Institute, our gallbladder cancer team includes medical oncologists, radiation oncologists, advanced endoscopists and surgeons, all work together to provide the right treatment for you. Learn more about Hoag’s specialized gallbladder cancer team.
At Hoag Family Cancer Institute, our multidisciplinary team offers globally-recognized options for those facing this challenging disease, with treatments tailored to meet each patient’s specific needs.
At Hoag, surgical options for gallbladder cancer may include:
Laparoscopy, which involves inserting a long, flexible camera through incisions in the abdomen to look for evidence of cancer that wasn’t revealed in previous scans, to plan for upcoming surgeries or to determine whether a patient’s cancer is resectable, meaning that it can be removed completely, or unresectable, which means it is too far advanced for surgery.
Simple cholecystectomy, which is an operation to fully remove the gallbladder. People can live long lives without their gallbladder and removal of the gallbladder is common in the treatment of conditions like gallstones. This procedure can either be performed “open” through an surgical incision in the abdomen, or laparoscopically, utilizing thin video devices and surgical tools inserted through very small incisions in the abdomen. However, in the case of known gallbladder cancer, a more extensive operation is usually performed, known as…
Extended (or radical) cholecystectomy, in which surgeons remove at least the gallbladder, liver tissue near the gallbladder and all nearby lymph nodes. Depending on how advanced the cancer is, the surgeon may also remove a larger portion of the liver, the common bile duct, the ligament that connects the liver and intestines, the pancreas, part of the small intestine or other organs that have been invaded by cancer cells.
According to the American Cancer Society, gallbladder cancer is rare, but only a small percentage of gallbladder cancers are considered curable when discovered. That said, there are widely-differing opinions on how advanced gallbladder cancer can be before surgery is no longer a good option.
For that reason, the ACS suggests getting a second opinion, particularly from a major, highly-experienced cancer center like Hoag Family Cancer Institute. Facing a gallbladder cancer diagnosis in Orange County? Then get a second opinion that could save your life. Trust Hoag.
The Hoag team performs more complex gallbladder cancer surgeries than any other surgical program in Southern California. We utilize state-of-the-art, robotically-assisted and minimally-invasive procedures that may not be available elsewhere. Being a high-volume gallbladder cancer surgical program enables the gastrointestinal experts at Hoag to achieve a technical skill level many other centers just can’t match.
At Hoag, we often combine techniques to address complex conditions like gallbladder cancer from all sides. In addition to surgery, non-surgical options for gallbladder cancer at Hoag may include:
Radiation therapy, which may be recommended either before or after surgery, often in combination with chemotherapy. Hoag is one of only two hospitals in California with the ViewRay MRIdian™ linear accelerator, the most advanced radiation treatment available in the United States for cancers of the abdomen. By utilizing MRI imaging with a linear accelerator, Hoag clinicians can obtain real-time, high resolution images of tumors and surrounding soft tissues. This allows for precise application of radiation during treatment, even if the tumor shifts due to breathing or other factors. That level of precision allows Hoag clinicians to deliver a higher, potentially more effective, radiation dose to the tumor with minimal impact on healthy surrounding tissue.
Hoag Radiation Oncology also offers other state of the art technologies such as Tomotherapy HD to provide for the most accurate image guided radiotherapy systems today. Explore more about Hoag’s state-of-the-art equipment here.
Chemotherapy uses drug therapy to help destroy cancer cells. Chemotherapy is often combined with radiation therapy to treat cancer that has spread beyond the esophagus to nearby organs. Chemotherapy and radiation may be used after surgery to reduce the risk that gallbladder cancer may recur. In individuals with advanced gallbladder cancer, chemotherapy may be used alone or it may be combined with targeted drug therapy.
Targeted therapy and precision medicine, utilizes DNA testing of patients tumors, to help select and formulate drugs that attack specific abnormalities within cancer cells. For example, the targeted drug erlotinib (Tarceva) blocks chemicals that signal cancer cells to grow and divide. This drug is usually combined with chemotherapy for use in people with advanced gallbladder cancer.
Hoag is committed to leading the way in state-of-the-art technologies and advanced treatment options. Part of this commitment includes clinical research with the goal of helping patients live longer, healthier lives. Through carefully planned clinical trials, researchers evaluate the safety and effectiveness of new ways to diagnose, treat and prevent diseases or conditions. Treatments studied in clinical trials might be new drugs or new combinations of drugs, new surgical procedures or devices, or new ways to use existing treatments. View clinical trials for gallbladder cancer here.

Ronald Wolf, M.D., F.A.C.S., is a board-certified surgical oncologist who specializes in treating liver, bile duct and pancreatic cancer at Hoag Family Cancer Institute. His clinical interests include pancreatic adenocarcinoma, colon and rectal cancers that have metastasized to the liver, surgical treatment for bile duct tumors and cysts and surgery for soft tissue sarcoma. Previously, Dr. Wolf served as Professor of Clinical Surgery in the Department of Surgery, Division of Hepatobiliary & Pancreas Surgery/Islet Cell Transplantation at UC Irvine School of Medicine and Long Beach Memorial Medical Center. Prior to that, he served as Medical Director of Hepatic and Pancreatic Surgery at Legacy Good Samaritan Medical Center in Portland, Oregon, and as the Medical Director of Liver and Pancreas Surgery at Providence Cancer Center, also in Portland. Dr. Wolf received his medical degree from Oregon Health & Science University in Portland, followed by an internship and two residencies in general surgery at UC Davis. He then completed a fellowship in surgical oncology at Memorial Sloan Kettering Cancer Center in New York, where he also served as a clinical research fellow. Later, he helped direct surgical resident and fellowship-level postgraduate training programs in Portland. Dr. Wolf has co-authored more than 80 clinical presentations throughout his career and is a committee member of several national organizations including the American College of Surgeons, the Society of Surgical Oncology and the AHPBA Americas Hepatopancreatobiliary Association.

Medical Director of Cancer Research for Hoag Family Cancer Institute

<p>Tara Seery, M.D., attended University College Dublin School of Medicine followed by an internship at Mater Misericordiae Hospital as well as an internship and residency at Caritas St. Elizabeth Medical Center in Boston. She then completed fellowships in hematology/oncology at both Caritas St. Elizabeth Medical Center and University of Illinois at Chicago. Dr. Seery is board certified in Medical Oncology and Hematology.</p><p>Dr. Seery is particularly interested in GI oncology, including hepatobiliary cancers such as pancreatic, liver and bile duct cancers.</p><p>She has served as the primary investigator on several clinical research trials, co-authored numerous medical publications and abstracts, and edited multiple peer-reviewed journals. Additionally, she has given clinical presentations both across the U.S. and abroad. </p><p>Dr. Seery’s teaching experience spans the areas of medical and graduate level courses including a Hematology/Oncology Fellowship Annual Lecture Series on Pancreatic Cancer, Liver Cancer and the Management of Unresectable Hepatocellular Carcinoma at UC Irvine’s 5th Annual Gastroenterology and Hepatology Symposium. In addition, she oversaw a group of Hematology/Oncology Fellows at the University of California Irvine Outpatient Clinic.</p><p>Dr. Seery is a member of the American Society of Clinical Oncology and the American Society of Hematology.</p>

Medical Director of Hoag Advanced Endoscopy Center, Gastroenterologist

Dr. Kankotia is a board-certified gastroenterologist at the Hoag Digestive Health Institute. His focus is in advanced endoscopic procedures, and his clinical interests include pancreaticobiliary disease, tissue resection, Barrett’s esophagus, and bariatrics. Other services offered include luminal stenting, radiofrequency ablation, endoscopic mucosal resection, esophageal pH monitoring (Bravo), liver biopsy, portal pressure measurement, and endoscopic suturing. He strives to provide his patients and their families with personalized care plans that help each patient reach their health goals. At the Hoag Digestive Health Institute, Dr. Kankotia works with a team of digestive health experts to provide a comprehensive approach to wellness. Dr. Kankotia earned his medical degree at the Keck School of Medicine of the University of Southern California in Los Angeles. He completed internal medicine residency and gastroenterology fellowship at University of Southern California/LAC+USC Medical Center. He then completed an additional fellowship in advanced endoscopy at the University of Michigan in Ann Arbor, where he developed expertise in ERCP (endoscopic retrograde cholangiopancreatography), diagnostic and therapeutic EUS (endoscopic ultrasound), and other techniques while garnering experience managing complex cases. Dr. Kankotia is a current member of the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy. Additionally, he has contributed to several publications on topics such as gastric cancer, biliary disease, pancreatic cysts, and luminal strictures.

Paul J. Korc, M.D. serves as medical director of the Hoag GI Lab and is a board-certified gastroenterologist with fellowship training in advanced endoscopic procedures. After completing his residency and fellowship at USC, he went on to spend a year at Indiana University, one of the nation’s top programs for biliary and pancreatic disorders. There, he received training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS), gaining extensive experience in the management of complex cases. Dr. Korc’s expertise also includes removal of large polyps and early stage cancers of the gastrointestinal tract, using endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). He spent time in Seoul, Korea learning ESD, a cutting-edge technique in which pre-cancerous lesions and superficial cancers are removed en bloc (in one piece), avoiding the need for surgery. Additionally, Dr. Korc performs peroral endoscopic myotomy (POEM), a specialized procedure that restores the ability to eat and drink for people with achalasia, an esophageal motility disorder. Dr. Korc brings to Hoag his expertise in these procedures, some of which are available at only a handful of medical centers in Southern California. Dr. Korc offers patients compassionate, personalized care along with the very best advances in endoscopic treatment.
Hoag’s Precision Medicine Program combines genomics and genetics to diagnose, treat, and prevent diseases. Using the latest advances in genomic technologies, targeted therapies and research, our precision medicine program brings together a multidisciplinary team, including a robust genetic counseling group of experts, to provide patients with the latest in innovation and technology.
Being diagnosed with cancer can feel overwhelming at times. Many patients and their families need help with coping and can benefit from supportive counseling. Oncology Clinical Social Workers are available to provide emotional and practical support during all stages of cancer including diagnosis, treatment and post-treatment survivorship.
Hoag Family Cancer Institute dietitians work closely with patients’ physicians, nurses, therapists, and social workers to ensure complete care.