Chemotherapy (or chemo) uses strong medicines to kill cancer cells. The medicines affect and kill cells that divide and grow quickly, like cancer cells. But some normal cells also divide and grow quickly. Because of this, chemotherapy can also affect these cells, which can lead to side effects.

Chemotherapy can help some people with bile duct cancer. It may be used for these reasons:

• After surgery, often with radiation therapy, to kill any cancer cells left in the body and help lower the risk that the cancer will come back
• Before surgery to shrink tumors so they're easier to remove
• To slow cancer growth and shrink tumors to relieve symptoms and help people live longer. This may be done if you can't have surgery or if you have advanced cancer that has spread.

Chemo medicines are injected into a vein or given by mouth. They then go into the bloodstream and reach all parts of the body. This is called systemic treatment.

Sometimes chemo is given right into the main artery that goes into the liver. This treatment is called hepatic artery infusion. It focuses the chemo on the tumors in the bile duct, and then the healthy liver gets rid of most of it. This limits the amount of chemo that goes to the rest of the body. Chemo is not often given this way, but it may help people who can't have surgery live longer.

These are the medicines most often used to treat bile duct cancer. They might be given alone, or two or more may be used at the same time:

• Fluorouracil, 5-FU
• Capecitabine
• Gemcitabine
• Cisplatin
• Oxaliplatin

Researchers are looking for new and better ways to treat bile duct cancer with chemotherapy. These treatments are tested in clinical trials. Ask your doctor if you should think about being part of a clinical trial.

Immunotherapy drugs may be added along with chemo to treat cancer that has spread to other parts of the body or can't be removed by surgery. Targeted drug treatments that work directly on the changes that occur in cancer cells may work if standard chemotherapy does not.

Side effects are common with chemotherapy. But it's important to know that they can often be controlled or even prevented. Most chemo side effects usually go away over time after treatment ends. Side effects depend on the type and dose of chemo you're getting. They vary from person to person.

Some common side effects include:

• Nausea and vomiting
• Diarrhea
• Skin irritation or rash
• Loss of appetite
• Extreme tiredness
• Hair loss
• Mouth sores
• Increased chance of infection
• Increased chance of bleeding or bruising
• Numbness, tingling, or pain in the hands or feet (neuropathy)
• Damage to organs

It's important to know which medicines you're taking. Write down the names of your medicines. Ask your health care team how they work, what they're for, and what side effects you could have.

Talk with your doctors about what side effects to watch for and when to call them. Be sure you know how to get help any time, including after office hours and on holidays and weekends.

It may be helpful to keep a diary of your side effects. Write down physical, thinking, and emotional changes. A written list will make it easier for you to remember your questions when you go to your appointments. It will also make it easier for you to work with your medical team to make a plan to manage your side effects.