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Bile duct cancer is a rare malignancy which usually occurs in patients older than 50 years of age. It is a very aggressive cancer which is considered to be incurable and patients who develop this condition have a relatively poor prognosis if the primary tumour and any metastases are not removed surgically. No potential cure exists for this cancer, besides surgery, but by the time patients present to doctors with this issue it is inoperable and can then only be managed conservatively and symptomatically.
One of the largest hospital based studies was done in order to determine whether aspirin use had any significant effect in reducing the risk of developing gastrointestinal cancers.
Researchers used nearly 2,400 patients, who were diagnosed with bile duct cancer and seen at the Mayo Clinic in Rochester, New York between 2000-2004, as well as nearly 5,000 healthy people as the control group in the study who matched the patients' age, race, gender and area of residence.
Regarding the 3 subtypes of bile duct cancer, the following issues were noted:
- Primary sclerosing cholangitis was more strongly associated with perihilar than distal or intrahepatic or cholangiocarcinoma (CCA).
- Diabetes was more associated with distal than intrahepatic or perihilar CCA.
- Liver cirrhosis, not related to primary sclerosing cholangitis was associated with both perihilar and intrahepatic CCA.
- Isolated inflammatory bowel disease, without primary sclerosing cholangitis, was not associated with any of the cancer subtypes.
Bile duct cancers can develop due to chronic inflammatory conditions, such as those mentioned above, causing persistent inflammatory changes to the bile ducts. Since aspirin is an anti-inflammatory medication, use of this drug would then help to reduce the inflammation caused by the mentioned conditions and diseases. Besides this, aspirin is also known to block other biological pathways which are associated with the development of cancers.
The clinical significance
The suggestion of this study would then be that long term aspirin therapy would be beneficial in patients who are known to be high risk candidates to develop bile duct cancer.
The only issue that still needs to be addressed though is whether chronic aspirin use in these patients would be safe and cost effective, as this is the first study done to address this possibility. Further research is therefore necessary to answer this question.