Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in the lining of the bile duct.
The bile ducts
The bile ducts are part of the digestive system. They are the tubes that connect the liver and gall bladder to the small bowel. Bile ducts carry bile, which breaks down fats in food to help us digest them. Bile is made by the liver and stored in the gall bladder. The bile ducts and gall bladder together are known as the biliary system.
Bile duct cancer can affect any part of the bile ducts. These ducts are named depending on their position in the body:
- intra-hepatic – the bile ducts inside the liver
- extra-hepatic – the bile ducts outside the liver.
The extra-hepatic bile ducts are divided into two parts:
- hilar – where the left and right hepatic ducts meet, just below the liver
- distal – the lower part of the bile ducts, nearest to the bowel.
Cancer in the bile ducts can block the flow of bile from the liver to the bowel. This means that the bile flows back into the blood and body tissues. The main symptoms of this can include:
- the skin and whites of the eyes turning yellow (jaundice)
- urine turning dark yellow
- stools (bowel motions) looking pale
- itchy skin.
Other possible symptoms include:
- discomfort in the tummy area (abdomen)
- loss of appetite
- 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 doctor.
The causes of most bile duct cancers are unknown. But there are some factors that can increase your risk of developing it.
You usually begin by seeing your GP, who will examine you and may take a blood test. They will refer you to a hospital specialist.
At the hospital
The doctor will ask you about your symptoms and any previous medical problems. They will also examine you and take blood samples to check your general health and that your liver is working properly.
The doctor might use the following tests to diagnose bile duct cancer:
ERCP (endoscopic retrograde cholangio-pancreatography)
EUS (endoscopic ultrasound scan)
PTC (percutaneous transhepatic cholangiography)
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, to make sure the biopsy is taken from the right place. If you are having surgery as your main treatment, your doctor may not need to take a biopsy.
Waiting for test results can be a difficult time, we have more information that can help.
Staging of bile duct cancer
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the stage of the cancer helps the doctors plan 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 connected by thin tubes. Lymph nodes are small bean-shaped structures. Your doctors will usually examine the lymph nodes close to the bile ducts. This helps them to find out the stage of the cancer.
There are different ways of staging cancers. The TMN staging system is the one usually used for bile duct cancer.
TNM staging system
- T describes the size of the tumour
- N describes whether the cancer has spread to the lymph nodes
- M describes whether the cancer has spread to another part of the body (known as metastatic or secondary cancer).
This system gives detailed information about the tumour stage.
The staging of the cancer is different depending on the part of the bile duct where the cancer started. Your doctor will be able to tell you more about your situation.
Grading of bile duct cancer
Grading gives an idea of how quickly a cancer may develop. It is based on the way cancer cells look under a microscope:
- In low-grade tumours, the cancer cells look very much like normal cells. They are usually slow-growing and are less likely to spread.
- In high-grade tumours, the cells look very abnormal. They are likely to grow more quickly and are more likely to spread.
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).
Your cancer doctor or specialist nurse will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
The treatment you have will depend on:
- the position of the cancer
- the size of the cancer
- whether it has spread beyond the bile duct
- your general health.
Bile duct cancer treatments include:
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have chemotherapy if you cannot have surgery or if cancer comes back after surgery.
The aim is to try to shrink or slow the growth of the cancer and to relieve symptoms. Sometimes chemotherapy may be given after surgery to reduce the risk of cancer coming back.
Radiotherapy uses high-energy rays to destroy cancer cells. It is not often used to treat bile duct cancer. Your doctor will talk to you about possible benefits and disadvantages if you are offered this treatment.
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.
Selective internal radiotherapy treatment (SIRT) is one way of giving radiotherapy from inside the body to help relieve symptoms of bile duct cancer.
You may also have treatments as part of a clinical trial.
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. You can also call our cancer support specialists free on 0808 808 0000. A UK based charity called AMMF also support people with bile duct cancer.