Bile duct cancer, also called cholangiocarcinoma, occurs when cancerous cells grow in the tubes that carry bile from your liver to your gallbladder and small intestine. The bile helps you digest fat in food.
Your doctor will use blood and imaging tests to diagnose bile duct cancer. These include a transabdominal ultrasound and CT or MRI scan, including a special type of MRI called magnetic resonance cholangiopancreatography (MRCP). You may also get tumor marker tests.
The bile duct system (the hepatobiliary tract) is made up of a series of tubes that carry bile, a fluid that helps the digestive system break down fats and digest food. Cancer of the bile duct (cholangiocarcinoma) occurs when a tumor forms in one of these tubes.
Most often, bile duct cancer grows for years before signs and symptoms appear. The first symptom may be jaundice, which is yellowing of the skin and whites of the eyes. You may also have pain in your abdomen or dark stool. If you have these symptoms, you should talk to your doctor right away.
Your doctor will order blood tests to check your liver function and the levels of certain chemicals in your body, such as bilirubin. They will also look for certain gene mutations that are linked to bile duct cancer. Your doctor may also order imaging tests, such as a CT scan or an MRI, to see the structure of your liver and bile ducts.
The most common type of bile duct cancer is hepatocellular carcinoma, which starts in the liver and can spread to the gallbladder or bile ducts. Another type is intrahepatic cholangiocarcinoma, which begins in the bile ducts inside the liver. Occasionally, cancer can spread from the bile ducts into other parts of the body, such as lymph nodes or the abdominal wall.
Staging is a way for doctors to describe how far bile duct cancer has spread. They use a combination of information about the cancer’s size, location, and whether it has spread to other organs to make treatment recommendations.
Your healthcare team may also use other treatments to help control your symptoms and prevent the cancer from returning (recurring). These might include chemotherapy, radiation therapy, or a combination of these therapies. You may also be able to participate in a clinical trial that is testing new ways to treat this cancer or other types of cancer.
After completing treatment, you will need regular follow-up appointments. Be sure to tell your doctor or specialist nurse if you have any new problems between appointments, such as new jaundice or changes in your weight.
Often, bile duct cancer is not diagnosed until it has spread to other parts of the body. Doctors use a combination of imaging tests and blood tests to find out the extent of the tumor.
X-rays, computerized tomography (CT) scans or magnetic resonance imaging (MRI) can help doctors see your internal organs and look for signs of a tumor in the bile ducts. These procedures use painless techniques that use sound waves or magnets to create detailed images of your body. Doctors also may use a special MRI technique called magnetic resonance cholangiopancreatography (MRCP). This uses a special dye to show the location of blocked or narrowed bile ducts.
Your care team may order other laboratory tests to check your general health, look for signs of a problem in the liver and gallbladder and assess how well your organs are working. These include a physical examination and lab tests to measure the levels of bilirubin, liver enzymes and other substances in your blood. High levels of bilirubin and enzymes like alkaline phosphatase, aspartate aminotransferase and carcinoembryonic antigen (CEA) can indicate a bile duct blockage or a tumor in the bile troughs. Your care team may also test your urine for certain compounds, including urobilinogen and a substance that indicates the presence of cancer cells.
A biopsy is a procedure to remove tissue from a bile duct or tumor for examination under a microscope. Your doctor may perform a needle biopsy or use a long, flexible tube, called a cholangioscope, to see inside the bile ducts and remove a small sample of any tumor. Your doctor may also do a procedure called endoscopic ultrasound cholangioscopy, which uses a cholangioscope and an ultrasound to obtain images of the bile ducts and tumors in them.
Staging is a way of describing how far cancer has spread at the time of diagnosis. Doctors determine the stage of a bile duct cancer by looking at its size, whether it has spread within your liver or to other places in your body and how fast it is growing.
OHSU experts are studying new treatments, including immunotherapies, that arm your own immune system against cancer cells. These therapies can help prevent or delay the return of bile duct cancer after surgery, radiation or chemotherapy.
A team of doctors and health professionals will discuss the best treatment plan for you. This is called a multidisciplinary team (MDT). Your provider may recommend surgery. If the cancer is in your bile ducts, doctors might be able to remove it completely. This is called resectable bile duct cancer. They might also be able to remove some of the surrounding tissue that doesn’t contain cancer cells. But surgery is a major operation, and so your doctor will only suggest it if you are fit enough to have it.
Your provider might be able to find out whether your bile duct cancer has spread to other parts of your body with diagnostic and staging tests. These include an abdominal ultrasound, CT scan or magnetic resonance imaging (MRI) of your abdomen. They might test your blood or urine for tumor markers, such as carbohydrate antigen 19-9 or carcinoembryonic antigen.
Targeted therapy can reduce the chance that your bile duct cancer will return after it has spread. The targeted drugs pemigatinib (Pemazyre), ivosidenib (Tibsovo) and futibatinib (Lytgobi) can stop the growth of cholangiocarcinoma cells by blocking the signals that these cancer cells need to grow. Your provider might prescribe these medicines with chemotherapy to give you the best chance of a cure.
Immunotherapy can help your body’s immune system fight bile duct cancer. It works by blocking the protein that your bile duct cancer cells use to avoid being attacked by immune cells. This allows your immune cells to attack the cancer cells and kill them. Your provider might give you immunotherapy with chemotherapy or radiation to treat bile duct cancer that has spread to other parts of your body.
Clinical trials are carefully controlled research studies that test the effectiveness of new treatments or combinations of existing ones. If your cancer is too far advanced to be removed surgically, your provider might recommend that you take part in a clinical trial.
You can help to prevent bile duct cancer by protecting yourself against viruses that can cause it, such as hepatitis B and C. You should also limit how much alcohol you drink.
The bile duct is a network of tubes that carry bile (a fluid made by the liver to help digest fats) in and out of the liver. The smallest tubes, called ductules, collect bile from the liver and then join together to form the right and left hepatic ducts, which drain bile out of the liver. The hepatic ducts connect with the cystic duct and then the common bile duct, which leads into the small intestine. Cancer that forms in the bile ducts is called cholangiocarcinoma.
Surgical removal of the tumor is the treatment most likely to cure bile duct cancer. This may be done alone or with other treatments, such as chemotherapy or radiation therapy. A surgery called a liver transplant may be an option for some people with advanced bile duct cancer.
If the bile duct cancer can’t be removed with surgery, it’s called unresectable. This can happen because the cancer has spread too far or it’s in a place that’s hard to reach with surgery. It can also happen because the person’s health isn’t good enough for surgery.
Treatment for bile duct cancer that can’t be removed depends on where the cancer is and whether it has spread. If the cancer is in a spot that can’t be removed, treatment is mainly palliative (aimed at relieving symptoms).
For bile duct cancer that hasn’t spread, the doctor can use radiation and chemotherapy to try to shrink or slow the growth of the cancer for a time. The drugs most often used are cisplatin and gemcitabine. Sometimes, doctors use targeted therapy with a drug that targets a specific gene mutation in the cancer cells.
In some cases, the doctor may put a stent in the bile duct to keep it open. The stent is a thin, flexible tube that is placed in the bile duct. When the doctor puts in the stent, they will test it to make sure it’s working. Then the doctor will do regular follow up with the person to watch for any signs or symptoms that come back.
Cancer cells can grow inside your bile ducts. These are thin tubes that move a fluid called bile from your liver to your gallbladder and then to your small intestine.
Symptoms often don’t appear until the cancer is advanced. Treatment can help control the disease and relieve symptoms. Your doctor may recommend surgery, chemotherapy or radiation.
A cancerous tumor can stop the liver from making bile and releasing it into the small intestine. This can cause jaundice, a yellowish color in the skin and the whites of the eyes. It may also stop the liver from working normally and lead to a build-up of a substance called bilirubin in the bloodstream. Your care team can check for a high level of bilirubin in your blood by taking a sample of your blood. They may also test for other substances that show how well your liver is working. They might also use a blood test for alpha-fetoprotein (AFP), which is often used to identify liver cancer and some types of bile duct cancer.
If a bile duct cancer blocks the release of bile and pancreatic juices into the intestines, it can also affect how fat is digested. This can result in stools that are unusually pale, bulky or greasy, and that float in the toilet. It can also affect your appetite and lead to unintended weight loss.
Most bile duct cancers grow for years before symptoms appear. They may look like other health problems, such as gallstones or hepatitis. If you have any of these symptoms, talk to your GP right away. They can help find out if they are caused by bile duct cancer and get you the treatment you need.
Your care team can also give you medicines to control pain and other symptoms. This might include painkillers, anti sickness tablets and a procedure to unblock the bile duct. Many hospitals have a specialist nurse to help with symptom control. They can also refer you to a physiotherapist for exercises to keep your muscles strong.
If the cancer blocks bile and pancreatic juices from getting to your small intestine, it can affect your appetite. You might not feel hungry and lose weight even though you’re eating enough. Undigested fat may pass through your bowel into your toilet, where it forms light-colored stools that look bulky and greasy.
Early bile duct cancers seldom cause pain, but bigger tumors can press on your stomach and gallbladder, leading to belly pain. This pain often starts below your ribs on the right side. It may get worse at night. You might also have a fever, which could be a sign of an infection (cholangitis) caused by bile duct blockage.
Your doctor might check your bile ducts for signs of cancer with imaging tests like an ultrasound or CT scan. They might also use a thin, flexible tube with a camera on the end of it to see your bile ducts and the area around them. They might also perform a procedure called percutaneous transhepatic cholangiography (PTC). This involves delivering a dye into your bile ducts to make any blockages show up clearly on an X-ray. Your doctor can then use a tube to drain the blocked bile duct.
You might need a biopsy to confirm a bile duct cancer diagnosis. During a biopsy, your doctor removes a small sample of tissue and checks it for cancer cells with a microscope. They can also use a needle to take a blood sample from your bile duct to measure your levels of bilirubin and other substances.
Your doctors can use these and other tests to stage your bile duct cancer, which helps them plan your treatment. Staging is based on the size of the tumor and how far it has spread.
Many conditions can cause pain in the abdomen, including infections or problems with your gall bladder or intestines. But sometimes pain in the belly can be a sign of cancer. Abdominal pain can feel like a stomachache, or it may be sharp and intense. It can also be hard to pinpoint where the pain is coming from. In some cases, abdominal pain can be a sign of bile duct cancer (also known as cholangiocarcinoma).
The bile ducts are tubes that connect the liver and gallbladder to the small bowel. They carry a fluid called bile, which helps break down fats in food so we can digest them. Bile duct cancer occurs when cells in the bile ducts grow and divide out of control. Over time, these cells can spread to healthy tissue and organs near the bile ducts. They can also spread to other parts of the body, such as the lungs or bones.
Doctors use tests to check for bile duct cancer. These include blood and urine tests, which look for signs of the disease, such as high levels of tumor markers. These are chemicals that may be released when cancer grows. Your doctor might also order imaging tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI). The latest MRI technology, called magnetic resonance cholangiopancreatography, can help doctors see bile duct tumors more clearly.
The test results can tell your doctor if you have bile duct cancer and how far it has spread. Your doctor will use the information to decide what treatment is best for you. They might suggest surgery, chemotherapy or radiation. They might also recommend a liver transplant.
Bile Duct Cancer is when abnormal cells grow out of control inside the bile ducts. These are thin tubes that move a liquid called bile from your liver to your gallbladder and then into your small intestine, where it helps digest fat in the food you eat.
Bile duct cancer can cause the skin and whites of your eyes to turn yellow (jaundice). It may also make your stools look light in color and greasy or oily. It can also cause pain in your abdomen, mainly underneath your ribs. You might also have extreme tiredness, itching, weight loss and a fever.
You might have a blood test to find out if you have bile duct cancer. This test is a measure of the levels of a substance in your body called alpha-fetoprotein (AFP). It can help doctors see whether you have a tumor or other disease that affects the liver and bile ducts.
If you have bile duct cancer, your healthcare team will use tests to figure out how far the disease has spread. The results from these tests help your doctor decide on a treatment plan. The first step is to decide if the cancer can be removed with surgery. If it hasn’t spread, your doctor might give you medicines to stop the cancer from growing and to relieve symptoms.
If your cancer has spread to other parts of your body, your doctor will treat you with chemotherapy and other medicines to keep the cancer from returning or spreading more. You might also need a liver transplant. This is a rare treatment that can cure bile duct cancer. But it can be risky.
People with bile duct cancer may vomit more often. This is because cancer cells can block bile flow from the liver and gallbladder, or cause other problems that lead to vomiting. If you’re vomiting, ask your doctor what’s causing it. They might prescribe medicines to help. Or they might suggest a procedure to drain or reroute your bile duct to relieve symptoms.
Your doctor will use imaging tests to check for a bile duct tumor, and to find out how far the cancer has spread. They might do an ultrasound, or a CT scan of your abdomen, or a magnetic resonance cholangiopancreatography (MRCP) test. They might also do a needle biopsy of suspicious areas. For this, a doctor puts a thin needle into the bile duct or other body part without cutting the skin. The doctor uses ultrasound or CT scans to guide the needle. Then they take a sample of tissue from the area and send it to a lab for testing.
Tumor marker tests might show high levels of the substances made by cancer cells, called carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9. But these levels can be high for many reasons, including other types of cancer and some health conditions.
Early bile duct cancers don’t cause any symptoms, except jaundice and tummy pain. But as the cancer gets bigger, it may grow into the liver or into other organs and make them ache. And it can block the release of bile and pancreatic juices into your small intestine. This makes your stools lighter and can cause itching.
Staging is a way for doctors to describe how far a bile duct cancer has spread. They use information about the size of the tumor, whether it has spread, and other factors.
Your treatment options depend on whether your cancer is inside the bile ducts in your liver (intrahepatic) or outside them (extrahepatic). You might have surgery, chemotherapy and radiotherapy. You might also have a procedure to open a blocked bile duct or take part in a clinical trial.
At OHSU, we have experts to help you with treatments that won’t cure your cancer but can relieve symptoms and improve your quality of life. These might include stent placement and internal radiation therapy.
Surgery is the main treatment for bile duct cancers that start in the liver or gallbladder (intrahepatic) or outside the liver and gallbladder (extrahepatic). It can be used to remove part or all of your bile duct, or just the part with the tumor. Surgery is more effective when the cancer has not spread. It’s important to go to a specialist center with expertise in removing bile duct tumors from the liver and abdomen.
Your doctor will check your general health before recommending surgery, and may run tests to help identify bile duct cancer. These include blood and urine tests, an ultrasound of your abdomen and a computed tomography (CT) scan or magnetic resonance imaging (MRI). You might also have a test that measures the level of a protein in your body called alpha-fetoprotein (AFP). This can help diagnose bile duct cancer.
A cholangiocarcinoma often forms in the ducts that carry bile from your liver to the small intestine. To see these ducts, doctors can use an endoscope (a thin, flexible, lighted tube) or a specialized procedure with an image-guided tool called a cholangioscope. Your doctor might also do a percutaneous radiological diagnosis, which uses a needle to get images of your bile ducts.
Your care team may recommend radiation therapy to shrink a bile duct tumor before surgery or treat the area where the tumor once was to reduce your risk of cancer coming back (recurrence). This treatment can be given on its own or with chemotherapy. We’re a national leader in hepatic arterial infusion (HAI) therapy, which delivers powerful medication into the hepatic artery that supplies blood to most bile duct tumors. We also offer targeted therapies and immunotherapies that are being studied in clinical trials.
During chemotherapy, doctors use anti cancer drugs to kill cancer cells. They may also use medicines to help your immune system kill cancer cells, which is called immunotherapy.
Your doctor will check your health, take a blood sample and do imaging tests to look for bile duct tumors. Imaging tests include ultrasound, computed tomography (CT) scans and magnetic resonance cholangiopancreatography (MRCP). During a MRCP, your doctor inserts a thin tube into your bile duct. Then, they inject a dye that highlights the bile ducts and other structures in your liver and gallbladder. They may also do a biopsy to remove a small piece of tissue for testing.
Surgery is the main treatment for bile duct cancer and is often curative when it’s localized in the bile ducts inside your liver (intrahepatic) or in the gallbladder (extrahepatic). Your surgeon will try to remove the tumor and a large area around it that doesn’t have cancer. If a bile duct cancer has spread to other parts of the liver or gallbladder, or to distant sites in the body, it isn’t curable.
Some bile duct cancers can be treated with medications that target a specific mutation. These medications destroy the cancer cells but leave healthy cells alone. We’re one of the few cancer centers in the country to offer hepatic arterial infusion (HAI) therapy, which delivers a powerful dose of chemotherapy directly into the hepatic artery that supplies most bile duct tumors. Our team includes specialists in hepatology, medical oncology and radiology.
Some people with bile duct cancer have a recurrence after treatment. They may have more symptoms or the cancer might spread to other places in the body. If this happens, your doctor will recommend treatment to control the cancer or relieve symptoms.
The bile ducts connect the liver and gallbladder to the small intestine. They carry a fluid called bile that breaks down fat in food to help us digest it. Cancer forms when abnormal cells grow out of control in the bile ducts and spread into nearby tissues or organs.
Your doctor may use tumor marker tests to look for signs of bile duct cancer. These include blood tests for carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA). You’ll also need imaging scans to find the location of a tumor in your bile ducts, such as an abdominal ultrasound or computed tomography (CT) scan. Your provider may also use magnetic resonance imaging (MRI) to visualize your bile ducts, including a special type of MRI called magnetic resonance cholangiopancreatography (MRCP).
You might have other diagnostic tests, such as positron emission tomography (PET) or endoscopic ultrasound. In a PET scan, your doctor injects you with a low dose of a radioactive sugar that concentrates around abnormalities, such as tumors. A PET scan can help detect bile duct cancer and other types of cancer.
If your bile duct cancer is unresectable, you might have hepatic arterial infusion (HAI) therapy. OHSU is a national leader in HAI therapy, which uses a pump to deliver chemotherapy directly into the artery that supplies blood to most bile duct cancers. This can help shrink the tumor and relieve symptoms.
Your team might recommend a clinical trial, which is a carefully controlled research study that looks at promising new ways to treat cancer. We offer a wide range of clinical trials, including ones designed specifically for people with bile duct cancer. These trials give you a chance to try cutting-edge treatments that might extend your life.
The bile duct system runs from the liver to the small intestine, where it is important for fat digestion. Often, cancers in this system grow for years before symptoms appear, which may resemble common problems such as gallstones. Your care team will ask about your symptoms and do tests to find out if you have a bile duct tumor. These tests can include measuring the buildup of bile, which shows up as a yellow color in the stool, and imaging studies such as a CT scan or an ultrasound. Your doctor may also check your blood for markers of bile duct cancer or gene mutations.
Doctors divide bile duct cancers into stages based on the extent of their growth and spread. Staging is used to plan treatment and predict survival.
Surgery can remove the bile duct tumor and may cure you if the cancer is in your bile ducts inside the liver (intrahepatic) or outside the bile ducts in the liver (extrahepatic). However, doctors are unlikely to be able to completely remove a bile duct tumor if it has grown into other organs around it or into the main blood vessels of the liver. This is called advanced bile duct cancer.
If your bile duct tumor is unresectable, your doctors can still help control your symptoms with medicine and radiation therapy. These treatments can include a procedure to open a blocked bile duct or putting in a stent.
The bile ducts carry a fluid called bile from the liver and gallbladder to the small intestine, where it breaks down fat to help you digest food. Cancer that starts in the bile ducts is called cholangiocarcinoma. If the cancer hasn’t spread beyond the bile ducts, your doctor can remove it surgically. They may also use chemo or radiation therapy to control symptoms and extend your life.
The first step in treating bile duct cancer is to talk with your doctors about what your prognosis is. They will explain the types of treatment they recommend and what to expect. They will consider the type of bile duct cancer you have and whether it’s at an early or advanced stage. They will then decide what your treatment plan will be.
Your team will give you regular checkups and tests during your treatment. You may have surgery, chemotherapy, radiotherapy or immunotherapy. You might also have medicines that won’t cure the cancer but can help ease symptoms, such as nausea or pain.
Some bile duct cancers have mutations that can be treated with medication that targets these specific gene changes. These medications are more likely to target the bile duct cancer and leave healthy cells alone. OHSU is a leader in these next-generation treatments.
Some immunotherapy drugs rev up your immune system, so you might feel like you have the flu. You might have fever, chills, fatigue, muscle and joint aches or pain, nausea and vomiting and loss of appetite (anorexia). Take acetaminophen to relieve these side effects. They should go away as your body gets used to the drug. You might also get a shot of steroids before or after your immunotherapy to help ease these symptoms.
