Gallbladder/biliary duct cancers

Biliary tract cancers (BTCs) are comprised of gallbladder carcinomas and cholangiocarcinomas. The prognosis of BTCs is poor and most patients present with unresectable disease. For patients with early stage BTCs, surgery is the treatment of choice. Adjuvant chemotherapy with or without radiation should be considered if there is lymph node positive disease or positive resection margins given the increased risk of recurrence. Gemcitabine or fluoropyrimidine-based chemotherapy is the standard of care for advanced BTCs. Liver-directed therapies can have a complementary role to chemotherapy in selected cases. Molecular distinctions amongst the different types of BTCs are coming to light, providing a rationale for the use of targeted therapies and clinical trial enrollment should be encouraged.