Treatment Options: Chronic Lymphocytic Leukemia

Inside the hollow area of the bones is a spongy core called bone marrow. It is here, that stem cells are produced. Stem cells are immature cells that can develop into components of blood: red blood cells, which carry oxygen to the body; white blood cells or lymphocytes, which fight infection; and platelets, which helps blood to clot. Chronic Lymphocytic Leukemia (CLL) is a type of cancer in which the bone marrow produces too many lymphocytes. The term “chronic” means the cancer cells multiply slowly, and the disease takes a long time to develop. In CLL, the lymphocytes produced are abnormal and are not able to fight infection. As the number of these abnormal lymphocytes increase in the blood and bone marrow, fewer healthy white blood cells, red blood cells, and platelets are produced. This can cause the symptoms of fatigue, recurring infection, anemia, and easy bruising. Chronic Lymphocytic Leukemia usually does not produce symptoms in the early stages. Treatment and prognosis depend on the stage and extent of the disease. Standard therapy includes “watchful waiting,” chemotherapy, radiation therapy, surgery, and monoclonal antibody therapy. Bone marrow stem cell transplantation is another type of therapy that is being tested in clinical trials. Chronic Lymphocytic Leukemia is the second most common leukemia in adults, and most often develops after middle age. CLL is not common in children. Your doctor is the best source of information regarding treatment for your condition. It is important to discuss with your doctor which therapy, if any, is most appropriate for you

Noam Z. Drazin (Hematologist & Oncologist, Cedars-Sinai Medical Group)

What is "chronic lymphocytic leukemia" (CLL)?: Noam Z. Drazin (Hematologist & Oncologist, Cedars-Sinai Medical Group)

What Is Bile Duct Cancer?<br />Cancer starts when cells in the body start to grow out of control. Cells in nearly any part of the body can become cancer, and can spread to other areas of the body. To learn more about how cancers start and spread, see What Is Cancer?<br /><br />Bile duct cancer starts in a bile duct. To understand this cancer, it helps to know about the bile ducts and what they normally do.<br /><br />About the bile ducts<br /><br />color illustration of the digestive system which shows the location of the esophagus, stomach, pancreas, rectum, colon, small intestine, gallbladder and liver<br />The bile ducts are a series of thin tubes that go from the liver to the small intestine. Their major job is to move a fluid called bile from the liver and gallbladder into the small intestine, where it helps digest the fats in food.<br /><br /><br />illustration showing the location of the common bile duct, liver, pancreas, pancreatic duct, ampula of vater, duodenum, gallbladder, cystic duct, right hepatic duct, left hepatic duct and common hepatic duct<br />Different parts of the bile duct system have different names. In the liver it begins as many tiny tubes (called ductules) where bile collects from the liver cells. The ductules come together to form tubes called small ducts. These merge into larger ducts and then the left and right hepatic ducts. All of these ducts within the liver are called intrahepatic bile ducts.<br /><br />The left and right hepatic ducts exit the liver and join to form the common hepatic duct in an area called the hilum. Lower down, the gallbladder (a small organ that stores bile) is joined to the common hepatic duct by a small duct called the cystic duct. This combined duct is called the common bile duct. The common bile duct passes through part of the pancreas before it joins with the pancreatic duct and empties into the first part of the small intestine (the duodenum) at the ampulla of Vater.<br /><br />Types of bile duct cancers by location<br />Cancer can start in any part of the bile duct system. Based on where the cancers are (see the picture below), they're grouped into 3 types:<br /><br />Intrahepatic bile duct cancers<br />Perihilar (also called hilar) bile duct cancers<br />Distal bile duct cancers<br />Another name for bile duct cancer is cholangiocarcinoma.<br /><br /><br />illustration showing the location of the common bile duct, intrahepatic bile ducts, perihilar bile ducts and distal bile ducts in relation to the liver, pancreas, gallbladder and duodenum (intestine)<br />Cholangiocarcinomas in these different groups cause different symptoms.<br /><br />Intrahepatic bile duct cancers<br />These cancers start in the smaller bile duct branches inside the liver. Sometimes they're confused with cancers that start in the liver cells, which are called hepatocellular carcinomas , which are often treated the same way.<br /><br />Perihilar (also called hilar) bile duct cancers<br />These cancers start at the hilum, where the left and right hepatic ducts have joined and are just leaving the liver. These are also called Klatskin tumors. These cancers are grouped with

Treatment Options Based on the Extent of Bile Duct Cancer<br />The extent of bile duct cancer is an important factor in deciding on treatment options. Whenever possible, surgery is the main treatment for bile duct cancers. It offers the only realistic chance for a cure. Because of this, doctors generally divide bile duct cancers into:<br /><br />Resectable cancers, those that doctors believe can be removed completely by surgery, based on the results of imaging tests and other tests.<br />Unresectable cancers, those that have spread too far or are in too difficult a place to be removed entirely by surgery.<br />Most bile duct cancers are unresectable by the time they're found.<br /><br />Resectable bile duct cancers<br />Most stage 0, I, and II cancers and possibly some stage III cancers are potentially resectable -- it might be possible to completely take out the cancer with surgery. But other factors can impact whether this is a good option, such as where the cancer is and whether the patient is healthy enough to have major surgery.<br /><br />Surgery to remove the cancer completely is the preferred treatment if it's possible. If surgery is being considered, a staging laparoscopy may be done first. This allows the doctor to look inside the abdomen (belly) for any spread of the cancer that could make it unresectable. (Laparoscopy is described in Tests for Bile Duct Cancer)<br /><br />Types of surgery<br />The type of surgery done to remove the cancer depends on the location and extent of the cancer. (See Surgery for bile duct cancer for more details.)<br /><br />Other treatments that may be used with surgery<br />If the patient has jaundice (yellowing of the skin and eyes) before surgery, a stent or catheter may be put in the bile duct first. This allows the bile to flow the way it should. It can help relieve symptoms over a few days and might help make a person healthy enough to have the operation.<br /><br />Radiation therapy and/or chemotherapy (chemo) may be given after surgery to try to lower the risk that the cancer will come back. This is called adjuvant therapy. Doctors aren’t sure how helpful adjuvant therapy is. It's more likely to be used if there’s a higher chance that the cancer wasn’t removed completely (based on looking at and testing the tissue removed during surgery). If it's clear that some cancer was left behind, a second surgery to take out more tissue may also be an option in some cases.<br /><br />Sometimes it isn’t clear from imaging or other tests whether the cancer can be removed completely. These cancers may be called borderline resectable tumors. Some doctors may recommend treatment with radiation and/or chemo before surgery to try to shrink the tumor. (This is called neoadjuvant treatment.) Then, if the cancer shrinks, surgery can be done to try to remove all of it.<br /><br />Unresectable bile duct cancers<br />These cancers cannot be removed with surgery, which includes most stage III and IV cancers. It may also include earlier stage cancers if a person isn’t healthy enough for surgery.<br />

Bile Duct Cancer (Cholangiocarcinoma) Treatment with Liver Transplant