Liver transplantation has been used to help a small proportion of people with CCA in the USA and a few other countries. Liver transplantation is now available to some (not all) people with CCA in the UK, depending on the size and nature of the cancer.
There are three types of CCA, and only some can be treated with liver transplantation:
- Intrahepatic CCA (iCCA) originates in the bile ducts inside the liver
- Hilar or perihilar CCA (pCCA) originates just outside the liver, where the left and right hepatic ducts join together
- Extrahepatic or distal CCA (dCCA) originates in the common bile duct
Liver transplantation is part of the treatment available for some people with iCCA or pCCA.
pCCA (perihilar CCA)
Only some people with pCCA will be suitable for a liver transplant. Your doctor will discuss this with a team of experts before proposing transplant as a possible option. We expect only 8-10 people a year will be suitable.
When someone has a liver transplant for pCCA in the UK, they also have a new type of radiotherapy called PBT (Proton Beam Therapy) and chemotherapy before the transplant.
PBT is a very precise form of radiotherapy that only delivers the radiation in the tumour, avoiding the healthy parts of the liver around it. PBT is thought to improve the chances of success and keep the tumour under control.
There are two state-of-the-art centres in the UK that offer PBT (Manchester and London). The PBT will last for three weeks and accommodation will be offered to those who do not live close by.
Having a liver transplant for pCCA in the UK is very new and will only be available as part of a research study called EMPHATIC. This is so evidence can be built up about how effective it is.
iCCA (Intrahepatic CCA)
Only some people with iCCA will be suitable for a liver transplant. Your doctor will discuss this with a team of experts before proposing transplant as a possible option. We expect only 8-10 people a year will be suitable.
To be eligible for a liver transplant, those with iCCA must have background chronic (long-term) liver disease and not be suitable for a resection (surgery), and the tumour should be less than 3cm in size.
If your doctor thinks transplant might be an option for you, your suitability will be assessed at one of the seven UK liver transplant centres.