Photodynamic therapy for bile duct cancer

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on photodynamic therapy for bile duct cancer.

Description

If cancer develops in the biliary tract, it may prevent bile flowing from the liver to the intestine. Early cancers are often asymptomatic but as the disease advances patients may experience symptoms such as jaundice, itchy skin, abdominal discomfort, loss of appetite, weight loss and fever.

Treatment options depend largely on the stage, size, position and type of the cancer. Bile duct cancer is not usually diagnosed before the symptoms of biliary obstruction occur, by which time the cancer may be too advanced for curative surgical resection. The standard options for palliative treatment include surgical bypass of the bile duct or the insertion of a stent using surgical, endoscopic or percutaneous techniques.

Photodynamic therapy (PDT) produces localised tissue necrosis by applying a photosensitising agent and then exposing the area to laser light of an appropriate wavelength. A photosensitising agent is used that preferentially accumulates in the tumour tissue rather than normal tissue.

Photodynamic therapy is usually administered in conjunction with a biliary stenting procedure. The photosensitising agent is injected intravenously and photoactivation is performed approximately 48 hours later. This is done by inserting a laser through a catheter situated close to the tumour or by placing the laser directly across the tumour. Patients remain in the dark for about 3 days after injection and are then gradually readapted to light.

OPCS code:

J41.4 Endoscopic retrograde photodynamic laser therapy of lesion of bile duct

or

J48.4 Percutaneous photodynamic therapy of lesion of bile duct

Note: The code assignment depends on whether the procedure is carried out with the use of an endoscope (J41.4) or percutaneously (J48.4).

In addition the ICD-10 code C24.0 Malignant neoplasm of extrahepatic bile duct or C78.8 Secondary malignant neoplasm of other and unspecified digestive organs is assigned.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG 134 Photodynamic therapy for bile duct cancer - guidance	27 July 2005
	IPG 134 Photodynamic therapy for bile duct cancer - information for the public	27 July 2005
	Interventional Procedures Consultation Document - photodynamic therapy for bile duct cancer	29 March 2005
	Interventional procedures overview of photodynamic therapy for bile duct cancer	29 March 2005