What is bile duct cancer?

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.

The position of the bile ducts

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.

Symptoms of bile duct cancer

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
  • 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 doctor.

Causes of bile duct cancer

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 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:

  • Ultrasound scan

    An ultrasound scan uses sound-waves 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.

    Doctors may use a special type of MRI scan called an MRCP (magnetic resonance cholangiopancreatography).

  • 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 is when the doctor passes a thin flexible tube (endoscope) down your throat into your stomach and the small bowel beyond it to look at the bile ducts.

  • EUS (endoscopic ultrasound scan)

    An EUS is similar to an ERCP, but an ultrasound probe is attached to the endoscope. This takes an ultrasound scan of the gall bladder and surrounding areas.

  • PTC (percutaneous transhepatic cholangiography)

    A PTC is a test that uses x-rays to look at the bile duct.

  • Laparoscopy

    A laparoscopy is a small operation used to look at your gall bladder, liver and other organs close to the gall bladder. The surgeon uses a thin tube with a camera on the end, called a laparoscope.

  • 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, 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 and grading of bile duct cancer

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.

Treatment for bile duct cancer

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:

  • Surgery

    Surgery is one of the main treatments. It can be used to remove the cancer. It is also often used to relieve symptoms caused by a bile duct cancer blocking the bowel or bile duct.

  • Chemotherapy

    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.

    The drugs cisplatin and gemcitabine (Gemzar®) are often used to treat bile duct cancer.

  • Radiotherapy

    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.

After bile duct cancer treatment

After your treatment has finished, you will have regular follow-up appointments. You will usually talk with someone from your healthcare team at the appointment. This may be your surgeon, cancer doctor, specialist nurse or another health professional.

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: 

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.

Reviewed: 30 November 2019
Reviewed: 30/11/2019
Next review: 30 April 2022
Next review: 30/04/2022