Robert Gehle loves classic cars, but recently, his life was turned upside down. Doctors diagnosed Robert with bile duct cancer. A tumor was blocking the tube that carries bile from the liver to the intestines for digestion. Chemotherapy and radiation wouldn't work. Surgery to remove the tumor was out of the question too. So, Robert was selected to try something new that could cure him.
"To me, it's an obvious answer," Robert Gehle told Ivanhoe. "I can die, or I can have a chance at life, based on you guys doing this surgery."
The University of Michigan is one of a handful of U.S transplant centers studying liver transplantation as a cure for bile duct cancer. He says for patients to be considered, doctors have to be sure the cancer has not spread.
"If someone has microscopic cancer anywhere, the anti-rejection drugs are like gasoline to that fire," Christopher Sonnenday, M.D., an assistant professor of surgery at the University of Michigan told Ivanhoe.
When a new liver became available doctors removed Robert's liver and the cancerous bile ducts, and replaced them with a healthy organ.
"The success that we've seen with liver transplantation for bile duct cancer has been pleasantly surprising," Dr. Sonnenday said.
Dr. Sonnenday tells us the three to five year survival rate is believed to be 60 to 70 percent, which is about the same for people who get liver transplants for other medical reasons. As for Robert, he's completely cancer-free and looking forward to a long life with his new liver.
"Just in general, I'm pretty lucky," Robert said.
The doctor says because of the scarcity of organs and the need that already exists, transplantation is only used when bile duct cancer patients do not have the option to have their tumor removed surgically.
CURING CANCER BY REPLACING LIVERS!
BACKGROUND: The bile duct is a thin tube, about four to five inches long, that reaches from the liver to the small intestine. The major function of the bile duct is to move a fluid called bile from the liver and gallbladder to the small intestine, where it helps digest the fats in foods. Bile Duct Cancer or Cholangiocarcinoma is a cancerous (malignant) growth in one of the ducts. (SOURCE: www.ncbi.nlm.nih.gov, www.cancer.org)
Bile duct cancer is extremely rare, only two out of every 100,000 people are diagnosed with this disease, and most patients are over the age of 65. Both men and women can contract bile duct cancer. Based on its location, bile duct cancer is divided into three groups: Intrahepatic, Perihilar (also called hilar), and Distal. Intrahepatic bile duct cancers develop in the smaller bile duct branches inside the liver, Perihilar in the hilum, where the hepatic ducts have joined and are just leaving the liver, and Distal bile duct cancers are found further down the bile duct, closer to the small intestine. (SOURCE: http://www.cancer.org)
SYMPTOMS: Symptoms for bile duct cancer may differ depending on the location, but people with bile duct cancer may experience some of these symptoms: clay-colored stools, fever, itching, loss of appetite, weight loss, pain in the upper right abdomen that may radiate to the back, and yellowing of the skin (jaundice). (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth)
TREATMENT: The goal is to treat the cancer and the blockage it causes. Endoscopic therapy with stent placement can temporarily relieve blockages in the biliary ducts and relieve jaundice in patients. Laser therapy combined with light-activated chemotherapy medications is another treatment option for those with blockages of the bile duct. When possible, surgery to remove the tumor is the treatment of choice, and may result in a cure. Traditionally, the disease is treated with resection, surgically removing the tumor, but in many cases the cancer tends to continue to spread around the bile duct. In the past, patients with non-resectable bile duct cancer had little chance of survival. (SOURCE: www.ncbi.nlm.nih.gov/pubmedhealth)
A TRANSPLANT FOR CANCER CURE: A liver transplant may be an option when bile duct tumors have not spread outside the liver but they cannot be completely removed by surgery. Radiation therapy and chemotherapy are usual treatments before a liver transplant. Although tumors can recur after transplantation, in some cases, liver transplantation is considered a cure. Because these patients don't have chronic liver disease like a typical transplant candidate, the United Network for Organ Sharing automatically gives them extra points on the liver allocation system so that they have a fair spot on the list, relative to the urgency of their disease. Typically, a liver is available within three to six months. During surgery, doctors remove all of the liver and bile duct and perform the liver transplant. Bile duct cancer patients who undergo traditional surgery have a 30% to 40% five-year survival rate. For patients who cannot have surgery, survival is only 5% to 10%. Early data for treatment with liver transplant suggests five-year survival of 75% to 85%, which is similar to overall liver transplant survival rates. (SOURCE: www.mayoclinic.org, University of Michigan Medical School)
FOR MORE INFORMATION, PLEASE CONTACT:
Christopher J. Sonnenday, MD, MHS
University of Michigan