Bile duct cancer

What is bile duct cancer?

Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in the lining of the bile duct.

Bile and the bile ducts

The bile ducts are part of the digestive system. They are the tubes that connect the liver and gallbladder to the small bowel. Bile ducts carry bile.

Bile breaks down fats in food to help us digest them. It is made by the liver and stored in the gallbladder. The bile ducts and gallbladder together are known as the biliary system (sometimes called the biliary tree).

Types of bile duct cancer

The types of bile duct cancer are named after the part of the bile duct where the cancer started.

Intrahepatic bile duct cancers

Intrahepatic bile duct cancers make up 1 in 10 of bile duct cancers (10%).

Extrahepatic bile duct cancers

There are two types of extrahepatic bile duct cancers:

perihilar bile duct cancers make up 5 in 10 bile duct cancers (50%)
distal bile duct cancers make up 4 in 10 bile duct cancers (40 %).

The bile ducts

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What is cancer?

Symptoms of bile duct cancer

Cancer in the bile ducts can block the flow of bile between the liver and the bowel. This causes bile to flow back into the blood and body tissues. This can cause jaundice. Symptoms of this include:

yellowing of the skin and whites of the eyes
your pee (urine) to become a dark yellow colour
pale, loose poo (stools) that is difficult to flush
itchy skin.

Other symptoms of bile duct cancer include:

discomfort in the tummy area (abdomen)
loss of appetite
tiredness
feeling generally unwell
high temperatures (fevers)
weight loss.

These symptoms can be caused by many things other than bile duct cancer. But it is important to get them checked by your GP.

Causes of bile duct cancer

Bile duct cancer is rare. The causes of most bile duct cancers are unknown. But there are some factors that can increase your risk of developing it.

We have more information about the causes and risk factors of bile duct cancer.

Diagnosis of bile duct cancer

You usually start by seeing your GP, who will examine you and may do a blood test. They will refer you to a hospital specialist. If your GP thinks you might have cancer, you will usually see a specialist within two weeks.

At the hospital, you may see a liver specialist (hepatologist). Or you may see a doctor who specialises in treating conditions of the stomach and bowel (gastroenterologist).

They will ask you about your symptoms and any previous medical problems. They will also examine you and take blood samples. This is to check:

your general health
that your liver is working properly.

You might also have the following tests.

A laparoscopy is a small operation used to look at the bile duct and the tissue around it. The surgeon uses a thin tube with a camera on the end, called a laparoscope. They may also take biopsies.

Ultrasound scan

An external ultrasound scan uses soundwaves to build up a picture of the bile ducts and surrounding organs.
MRI scan

An MRI scan uses magnetism to build up a detailed picture of areas of your body.
MRCP (magnetic resonance cholangiopancreatography)

Doctors may use a special type of MRI scan called an MRCP. This helps the doctor see the bile ducts.
CT scan

A CT scan scan takes a series of x-rays, which build up a three-dimensional picture of the inside of your body.
ERCP (endoscopic retrograde cholangio-pancreatography)

An ERCP allows the doctor to look at the bile duct, gallbladder and pancreas. They can take samples of tissue (biopsies). They can also treat a blockage in the bile duct to help with jaundice.
EUS (endoscopic ultrasound scan)

An EUS is similar to an ERCP, but uses ultrasound. It may also be used to take a sample of tissue (biopsy).
PTC (percutaneous transhepatic cholangiography)

A PTC is a test that uses x-rays to look at the bile duct. It can also be used to unblock the bile duct and help with jaundice.
Biopsy

A biopsy involves taking samples from the affected area of the bile duct to check for cancer cells. You may have a biopsy during an ERCP or PTC. You may have a CT or ultrasound scan at the same time. If you are having surgery as your main treatment, you may not need a biopsy.
Laparoscopy

A laparoscopy is a small operation used to look at the bile duct and the tissue around it. The surgeon uses a thin tube with a camera on the end, called a laparoscope. They may also take biopsies.

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Staging and grading of bile duct cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage of the cancer helps the doctors decide on the best treatment for you.

Cancer can spread through the bloodstream or the lymphatic system. The lymphatic system is part of the body’s defence against infection and disease. It is made up of a network of lymph nodes that are connected by thin tubes (lymph vessels). Doctors usually look at lymph nodes close to the bile ducts to find out the stage of the cancer.

There are different ways of staging cancers. The number staging system and the TNM staging system are usually used for bile duct cancer. We have more information about staging and grading for bile duct cancer.

Treatment for bile duct cancer

A team of doctors and healthcare professionals who specialise in treating bile duct cancer work together to plan your treatment. This is called a multidisciplinary team (MDT).

The treatment you have depends on:

the type of bile duct cancer you have
the size of the cancer
whether the cancer has spread to other areas of the body
your general health
your preferences.

Some people may be offered treatment to try to cure the cancer. This involves surgery, often followed by chemotherapy. If it is not possible to cure the cancer, you can have treatment to control the growth and help with symptoms. This may be with chemotherapy and sometimes radiotherapy.

Your cancer doctor or nurse will talk to you about your treatment options:

Sometimes radiotherapy is given on its own or in combination with chemotherapy to reduce the risk of cancer coming back after surgery. It may also be used to treat symptoms caused by bile duct cancer.

Surgery

Surgery is often used to relieve symptoms caused by a bile duct cancer blocking the bowel or bile duct. It may also be used as a main treatment for people who can have surgery to remove the cancer.
Chemotherapy

Chemotherapy may be given after surgery to help reduce the risk of the cancer coming back. If surgery is not possible, you may be offered chemotherapy to shrink or slow down the growth of the cancer.
Radiotherapy

Sometimes radiotherapy is given on its own or in combination with chemotherapy to reduce the risk of cancer coming back after surgery. It may also be used to treat symptoms caused by bile duct cancer.
Treating a blocked bile duct

Bile duct cancer often blocks the bile ducts. This can cause jaundice (yellowing of the skin and eyes). Doctors usually treat it by putting a tube (stent) into the blocked bile duct.
Treating a blocked small bowel

Sometimes a part of the small bowel called the duodenum can get blocked. The stomach empties into the duodenum, so if it is blocked this can cause sickness (vomiting). Putting a tube (stent) into the blockage can help. It allows food to pass through and helps with sickness.

The doctor puts the stent in with a long, flexible tube that has a camera on the end (an endoscope). If a stent cannot be put in, you may be offered an operation to bypass the blockage. The surgeon connects the stomach to the next section of small bowel (the jejunum).

You may also have treatments as part of a clinical trial.

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After bile duct cancer treatment

Follow-up care

You will have regular check-ups during and after your treatment. Tell your doctor or specialist nurse as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

Your feelings

You may have many different emotions, including anxiety, anger and fear. These are all normal reactions. They are part of the process that many people experience when dealing with cancer.

Everyone has their own way of dealing with illness and the emotions they have. You may find it helpful to talk to family and friends or to your doctor or nurse.

Macmillan is also here to support you. If you would like to talk, you can:

Call the Macmillan Support Line on 0808 808 00 00.
Chat to our specialists online.
Visit our bile duct cancer forum to talk with people who have been affected by bile duct cancer, share your experience, and ask an expert your questions.

A UK based charity called AMMF also support people with bile duct cancer.

Well-being and recovery

Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment.

Making small changes such as eating well and keeping active can improve your health and wellbeing and help your body recover.

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Finishing treatment

About our information

References

Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

Valle JW, Borbath I, Khan SA, et al. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016; 27, suppl 5, v28-v37. Available from www.doi.org/10.1093/annonc/mdw324 (accessed October 2019).

Rizvi S, Khan A, Hallemeier C, et al. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Clinical Oncology, 2018; 15, 2, 95-111. Available from www.doi.org/10.1038/nrclinonc.2017.157 (accessed October 2019).

Reviewers

This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.