The first 60 days: Cystic duct carcinoma
Cystic duct carcinoma is a bile duct cancer arising in the short tube that joins the gallbladder to the main bile duct. It is staged as a gallbladder cancer under the AJCC system, and behaves better when it stays inside the duct than when it grows beyond it. It is so rare that its treatment borrows from gallbladder and bile duct cancer. Below, week by week, is what OnCo's record of Cystic duct carcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Resectable disease.
- Medical oncologistNamed in the standard of care for: Advanced disease.
- Palliative and supportive care teamNamed in the standard of care for: Resectable disease.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Extrahepatic bile duct resection with regional lymphadenectomy, with cholecystectomy and liver bed resection as for radical cholecystectomy when the gallbladder is still present.
As for biliary tract cancer.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Extent: confined to the duct or beyond it, T category by the gallbladder scheme, Bile duct margin status, Bile cytology in remnant duct cancer), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Cystic duct carcinoma confined within the cystic duct, Cystic duct carcinoma extending to the gallbladder neck or common bile duct, Carcinoma arising in the remnant cystic duct after cholecystectomy.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Resectable disease
- For my situation (resectable disease), which of the standard options do you recommend and why?Guideline options include: Extrahepatic bile duct resection with regional lymphadenectomy, with cholecystectomy and liver bed resection as for radical cholecystectomy when the gallbladder is still present.
Advanced disease
- For my situation (advanced disease), which of the standard options do you recommend and why?Guideline options include: As for biliary tract cancer.
- Am I a candidate for Gemcitabine + cisplatin, Durvalumab, Pembrolizumab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Cystic duct carcinoma: the full pageCystic duct carcinoma is a bile duct cancer arising in the short tube that joins the gallbladder to the main bile duct. It is staged as a gallbladder cancer under the AJCC system, and behaves better when it stays inside the duct than when it grows beyond it. It is so rare that its treatment borrows from gallbladder and bile duct cancer.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Intrahepatic, perihilar, distal and gallbladder cancer: Bile duct cancers are named by where they start: inside the liver, at the hilum where the ducts join, in the lower duct near the pancreas, or in the gallbladder.
- Cystic duct margin: The cut end of the short duct that joined the gallbladder to the main bile duct, examined by the pathologist after a gallbladder is removed.
- Radical (extended) cholecystectomy: The cancer operation for gallbladder cancer: the gallbladder (if still present) is removed together with a rim of the liver it sits against and the lymph nodes along the bile duct and liver blood vessels.
- Obstructive jaundice and biliary obstruction: Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
Every term links to the glossary.