Prognosis and survival for biliary tract cancers

A prognosis is the doctor's best estimate of how cancer will affect you and how it will respond to treatment. Survival is the percentage of people with a disease who are alive at some point in time after their diagnosis. Prognosis and survival depend on many factors.

The doctor will look at characteristics of the person and certain aspects of the cancer, such as its stage and grade and where in the biliary tract the cancer started. These are called prognostic factors. The doctor will also look at predictive factors, which influence how a cancer will respond to a certain treatment and how likely it is that the cancer will come back after treatment.

Prognostic and predictive factors are often discussed together. They both play a part in deciding on a prognosis and a treatment plan just for you. Only a doctor familiar with your medical history, the type, stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis and chances of survival.

The following are prognostic and predictive factors for biliary tract cancers.

Surgery is the most effective treatment for biliary tract cancers. This means that the most important prognostic factor for biliary tract cancers is whether a tumour can be removed completely through with surgery (called resectability). Tumours that can be completely removed with surgery (resectable) have a much more favourable prognosis than tumours that cannot be removed by surgery (unresectable). Early-stage cancers, smaller tumours, or those that have not spread to other organs or tissues are most likely to be resectable.

The stage describes how much cancer is in the body, where it is and how far it has spread. Biliary tract cancers start in the cells of the gallbladder (primary gallbladder cancer) or bile duct (primary bile duct cancer), but can grow into nearby tissue and destroy it. It can also spread (metastasize) to other parts of the body.

People with early-stage biliary tract cancers have a better prognosis than those with advanced biliary tract cancers. Tumours that are still in the innermost layer of the gallbladder or bile duct (the mucosa) have the most favourable prognosis. Tumours that have spread through the gallbladder or bile duct walls and into nearby lymph nodes or organs have a worse prognosis.

Tumours that are still localized to the gallbladder or bile duct have the most favourable prognosis. Prognosis is poor when tumours have spread to distant organs or into lymph nodes or blood vessels (called lymphovascular invasion).

Gallbladder tumours that are more differentiated and slow growing (low-grade) have a better prognosis than tumours that are fast-growing (high-grade).

Tumours that are located farther fom the liver typically have a better prognosis. Tumours in the distal part of the bile ducts usually have a better prognosis than intrahepatic or perihilar cholangiocarcinoma.

Papillary gallbladder adenocarcinoma usually has a better prognosis than other biliary tract cancers.