Bile Duct Cancer: Radiation

What is radiation therapy?

Radiation therapy is a treatment for cancer that uses rays of energy. A machine directs the rays of energy to the area of cancer. Radiation therapy is also called radiotherapy. Its goal is to kill or shrink cancer cells. For bile duct cancer, radiation is often done along with chemotherapy.

When radiation therapy may be used

Radiation can be used before surgery to try to shrink the size of a tumor. This may make surgery easier and more effective. It may also be used after surgery to try to kill any cancer cells that were missed or could not be removed during surgery. If surgery is not possible, you may have radiation to help ease symptoms.

How radiation therapy is done

There are two main types of radiation therapy:

  • External radiation. The radiation comes from a machine and is pointed at the skin over the tumor.

  • Internal radiation (brachytherapy). Radioactive material is placed inside the body, near the tumor.       

External beam radiation treatment (EBRT)

When the radiation comes from a machine outside the body, it is called external beam radiation therapy. The experience is a lot like getting an X-ray, but it takes longer. For this treatment, you see a radiation oncologist. This doctor specializes in the use of radiation to kill cancer cells. He or she decides how often you need radiation and at what dose.

The types of external beam radiation that may be used with bile duct cancer are:

  • Three-dimensional conformal radiation therapy (3D-CRT). With 3D-CRT, radiation beams are shaped and aimed at the tumor from several different angles. This makes it less likely to damage normal tissues. Treatment is most often done for 5 days a week, not including weekends. It will usually last several weeks.

  • Intensity-modulated radiation therapy (IMRT). With IMRT, the radiation beams are also shaped and aimed from different directions. But the strength (intensity) of the beams is also adjusted to keep the highest doses only on the tumor. This lets doctors deliver an even higher dose to the cancer areas. Treatment is most often done for 5 days a week, not including weekends. It will usually last several weeks.

  • Stereotactic body radiotherapy (SBRT). SBRT uses very thin, focused beams of radiation. They are aimed at the tumor from many different directions. The radiation beam is strong, so the treatment can be given over fewer sessions than 3D-CRT and IMRT. A course of SBRT may take less than a week.

Internal radiation treatment (brachytherapy)

Brachytherapy is done by an interventional radiologist and a radiation oncologist. The oncologist inserts radiation seeds attached to a wire into the bile duct. The seeds are placed as close as possible to the tumor or into the tumor itself. This is so that fewer normal cells are exposed to radiation. 

A small tube called a percutaneous transhepatic bile duct stent is put in the bile duct through your skin. The doctor carefully inserts the wire through your skin. It’s guided down the stent to the area where the cancer is located. The doctor uses X-rays to guide the placement. The wire that extends outside your body is secured to your skin. After a period of time, the doctor carefully removes it using X-rays again as a guide. You will need to stay in the hospital while the radioactive seeds and wire are in place. 

Questions to ask your doctor about radiation therapy

Here are some questions you may want to ask your doctor about radiation therapy:

  • What is the goal of this treatment?

  • What will happen if I don't have radiation therapy? 

  • Are there other treatment options? 

  • Do I need a second opinion?

  • How will I get radiation?

  • How many treatments will I get?

  • Over what period of time will the treatment be?

  • When will the treatment begin?

  • When will it end?

  • How will I feel during radiation therapy?

  • What can I do to take care of myself during radiation therapy?

  • What kind of side effects should I tell you about?

  • Where can I get more information?

What to expect after radiation therapy

Radiation affects both normal cells and cancer cells. This means it can cause side effects. What the effects are depends on what part of your body is treated and what type of radiation you receive. If you have internal radiation therapy, you will be less likely to have side effects. Some common side effects of external radiation include:

  • Skin irritation in the areas getting radiation

  • Fatigue

  • Nausea

  • Diarrhea 

These often go away when your treatment ends. Always tell your doctor or nurse about side effects you have. They may be able to help ease them.