Just five years ago, many Oklahoma patients with a particularly aggressive form of cancer called hilar cholangiocarcinoma had no choice but to go out of state for a liver transplant. Today, OU Health Stephenson Cancer Center has become one of about 20 programs in the country able to perform this rare, complex transplant, and its first recipient is beating the odds of surviving more than a year later.

Of the various cancers associated with the liver, some of the most dangerous and difficult to treat are cholangiocarcinomas, or cancers of the bile ducts. These ducts are tubes carrying bile from the liver, where it’s created, to the small intestine, where it’s used by the body to digest fat. 

These cancers are usually not detected until they’re far advanced and can occur at different points along the length of the duct, explains Dr. Ajay Jain, OU’s G. Rainey Williams Chair in Surgical Research and chief of the OU College of Medicine’s Division of Surgical Oncology.

The prognosis for hilar cholangiocarcinoma is poor, with a five-year survival rate of only 10% without surgery, he explains. Tumor removal surgery can be perilous.

“Tumors can arise within the liver, they can arise at the ‘gateway’ of the liver, where the bile ducts enter, or they can arise from the bile duct that’s outside the liver,” Jain says. When a tumor develops at the ‘gateway,’ it’s called hilar cholangiocarcinoma. 

He demonstrates the tumor’s location by holding up one hand with fingers spread to represent the branching, tree-like structure of the bile duct.

“Hilar cholangiocarcinoma occurs at the intersection where the trunk of the tree and the canopy of the tree meet,” Jain says, pointing at his wrist. “Being at that location, there are major blood vessels going to the liver. If a tumor invades the trunk where it starts dividing into the major branches of the canopy and you cut it out, you can kill the tree.”

Because many hilar cholangiocarcinoma tumors don’t cause symptoms until they’re inoperable, about 70% of patients are never candidates for tumor removal surgery, which involves excising a majority of the liver after a drug regimen that stimulates the remainder of the organ to grow. 

“Historically, if I had patients I couldn’t operate on, I would have to send them to the Mayo Clinic in Minnesota in hopes of transplantation,” he says.  

However, multiple studies have shown that patients who undergo successful transplants to treat hilar cholangiocarcinoma have a hugely increased five-year survival rate of 65 to 68%, says Dr. Narendra Reddy Battula, associate professor and chief of the transplant surgery division in the OU College of Medicine. 

While transplantation offers hope to patients facing such a rare and lethal cancer, facilities able to undertake transplants for the condition remain few. OU’s ability to offer the procedure is a huge advantage for Oklahoma patients faced with this frightening diagnosis.

The surgery’s availability means Oklahomans won’t be faced with traveling out of state for medical treatment, which is an emotional and logistical burden for patients and their loved ones. It also can be difficult to coordinate insurance benefits across state borders. And as Jain points out, a transplant of any kind isn’t “one and done”—it requires extensive follow-up appointments that could pose additional hurdles. 

“Offering treatment involves a lot of different specialties coming together,” Battula says, including medical oncology, radiation oncology, hepatobiliary surgery, transplant surgery and transplant medicine. All such specialties collaborate through Stephenson Cancer Center’s unified team approach.

It is due to the center’s interdisciplinary model of care that OU experts can accomplish more complex treatments—like liver transplantation for bile duct cancer, Jain says.

“Not every cancer is treated the same way. A lot of factors can play into what decides the best course of treatment. At Stephenson Cancer Center, we all get together in a room, we hear each other’s perspectives, and then we chart the best treatment course for that individual.” 

Anna Andersen is a freelance writer living in Wichita, Kan.

To comment on this story, click here.