Ray Manzarek Dies of Bile Duct Cancer

Venice Beach, California, 1965. By good fortune, Ray Manzarek runs into Jim Morrison, a former UCLA classmate, and the world is blessed with the music of The Doors. The band sells 100 million albums.

Rosenheim, Germany, 2013. Fortunes turn for Mr. Manzarek, as he passes away from cholangiocarcinoma, bile duct cancer, a rare cancer that afflicts less than 4,000 people a year in the U.S.

Cancer is never fair, but some are just cruel. Bile duct cancer is cruel. It starts small, in the tube that delivers bile from the liver and gallbladder into the intestine, helping digest fats and getting rid of waste products. By the time the tumor is discovered, it has often grown within the liver and spread (metastasized) both near and far. Often the first symptom is jaundice, the yellowish coloration of the skin that signals elevated bilirubin levels in the blood. Bile can't travel though the blocked bile duct and it backs up, causing inflammation of the liver and pancreas. Intense skin itching, or pruritus, accompanies the jaundice and is followed by nausea, diarrhea, and weight loss. Only one-third of affected patients develop early abdominal pain.

Cancers that "hide" (are hard to detect) delay diagnosis making it tough for surgeons to completely resect or cut out the tumor. Depending upon the location and growth pattern of the tumor, surgery may not even be an option. Instead, radiation and chemotherapy may be the treatment of choice. With cancers that are diagnosed late, the question becomes whether treatment is curative or palliative. The quality of life needs to be considered just as much as the quantity.

For bile duct cancers, quantity (how long people live and how long they can survive), depends upon exactly where in the bile duct the cancer is located. If it is within the liver itself, survival rates are dismal. If the cancer begins in the duct after it has left the liver on the way to the intestine, survival is marginally better. The more the cancer spreads beyond the bile duct, to tissue and lymph nodes, the tougher the cancer is to beat.

Intrahepatic (Within the Liver) Bile Duct Cancer
Stage 5-Year Relative Survival
Localized 15%
Regional spread 6%
Distant spread 2%

Extrahepatic (Outside the Liver) Bile Duct Cancer
Stage 5-Year Relative Survival
Localized 30%
Regional spread 24%
Distant spread 2%

The best cancer treatment is prevention. Breast cancer is curable if it is found early. Checking stool for blood and colonoscopies can detect early colon cancers. Pap smears can catch early cervical cancers. Bile duct cancers hide deep within the abdomen, hidden by the bulk of the liver, and are largely unable to be detected. With no screening exam, there is no prevention, and therefore, no best treatment.


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Still, there is hope. Aside from standard treatments with surgery, radiation, and chemotherapy, new and potentially beneficial therapies are being explored, and as this is being written, there are 127 clinical trials listed with the National Cancer Institute for potential therapies, looking to enroll patients.

Morning found us calmly unaware
Noon burn gold into our hair
At night, we swim the lapis sea
When summer's gone
The Doors. Summer's Almost Gone 1968.

"Bile Duct (Cholangiocarcinoma) Cancer." American Cancer Society. 14 June 2012.

"Extrahepatic Bile Duct Cancer Clinical Trials." National Cancer Institute.

Valle, J. W. "Advances in the treatment of metastatic or unresectable biliary tract cancer." Annals of Oncology. 21 Suppl 7 (2010): vii345-vii348.