Bile duct cancer

Introduction
Diagnosis
Treatment

Introduction

Cancer of the bile duct (cholangiocarcinoma) is a rare type of cancer that mainly affects adults aged over 65.

Bile ducts are small tubes that connect the liver and small intestine. They allow fluid called bile to flow from the liver, through the pancreas, to the gut, where it helps with digestion. Cancer can affect any part of these ducts.

Bile duct cancer can sometimes be cured if caught very early on, but it's not usually picked up until a later stage, when a cure isn't possible.

This page covers:

Symptoms of bile duct cancer

There aren't usually any symptoms of bile duct cancer until it grows large enough to block the bile ducts.

This can cause:

yellowing of the skin and whites of the eyes (jaundice)
itchy skin
pale stools and dark urine
loss of appetite and weight loss
persistent tiredness and feeling unwell
tummy (abdominal) pain and swelling - some people feel a dull ache in the upper right hand side of their tummy
high temperature (fever) of 38C (100.4F) or above
chills and shivering

See your GP if you have persistent symptoms that you're worried about - particularly if you have jaundice. These symptoms can have a number of causes, so it's important to get a proper diagnosis.

Causes of bile duct cancer

The exact cause of bile duct cancer is unknown. Most occur without a clear cause, although some things can increase your risk of getting it.

These include:

primary sclerosing cholangitis - a rare type of liver disease that causes long-term inflammation of the liver
bile duct abnormalities - such as cysts (fluid-filled sacs) in the bile ducts that are present from birth
biliary stones within the liver - hard stones, similar to gallstones, that form in the bile duct
infection with a liver fluke parasite (mostly a problem in Asia)
exposure to certain chemicals and toxins, including thorotrast (a special dye that used to be used in medical scans)

There may also be a link with long-term hepatitis B and hepatitis C infections, liver scarring (cirrhosis), diabetes, obesity, smoking and excessive alcohol consumption.

Tests for bile duct cancer

Several tests may be needed to help diagnose bile duct cancer. These will usually be carried out in hospital.

Tests you may have include:

blood tests to check for signs of cancer or a problem with your liver
scans, such as an ultrasound scan, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan
detailed X-rays taken after a special dye has been injected into your bile ducts to make them show up more clearly
a biopsy - where a small sample of tissue is removed so it can be looked at under a microscope for signs of cancer

Read more about how bile duct cancer is diagnosed.

Treatments for bile duct cancer

It's not usually possible to cure bile duct cancer because it's often only diagnosed after it has grown and spread.

But even in these cases, treatment can help control the symptoms for months or possibly years.

The main treatments for bile duct cancer are:

surgery to remove the affected area - this is only suitable for a small number of people, but could get rid of the cancer completely
inserting a hollow tube (stent) into the bile duct to stop it becoming blocked - this can help relieve symptoms such as jaundice
chemotherapy - where medication is given to stop the cancer cells growing and to relieve your symptoms
radiotherapy - where a beam of radiation is carefully aimed at the cancer cells to stop them growing and to relieve your symptoms

Read more about how bile duct cancer is treated.

Outlook for bile duct cancer

The outlook for bile duct cancer depends on which part of the bile duct is affected and how far the cancer has grown.

Even if it's possible to remove the cancer, there's a chance it could come back later.

Overall:

one in every two to five people (20-50%) will live at least five years if bile duct cancer is caught early on and surgery is carried out to try to remove it
one in every 50 people (2%) will live at least five years if it's caught at a later stage and surgery to remove it isn't possible

Cancer Research UK has more information about survival statistics for bile duct cancer.

Diagnosis

It can be difficult to diagnose bile duct cancer. You may need to have a number of different tests.

Some of the tests that may be carried out are described below.

Blood tests

In bile duct cancer, the cancerous cells may release certain chemicals that can be detected using blood tests. These are known as tumour markers.

But tumour markers can also be caused by other conditions, so this test can't be used to say for certain whether or not you have bile duct cancer.

Scans

Several scans can be used to examine your bile ducts in detail and to check for lumps or other abnormalities that could be the result of cancer.

These include:

an ultrasound scan - high-frequency sound waves are used to build up a picture of the inside of your body
a computerised tomography (CT) scan - a series of X-rays of your liver and bile duct are taken and a computer is used to assemble them into a more detailed three-dimensional image
a magnetic resonance imaging (MRI) scan - a strong magnetic field and radio waves are used to produce an image of the inside of your liver and bile duct

ERCP test

Endoscopic retrograde cholangio-pancreatography (ERCP) allows your bile ducts to be seen clearly on an X-ray scanner.

During the test:

an endoscope (a small, flexible tube with a camera at the end) is passed down your throat to the opening of your bile duct - the X-ray scanner helps guide it to the right place
a special dye is injected into the bile duct, so it shows up clearly on the scanner and any abnormal areas are easier to spot
a small sample of tissue may be removed (a biopsy) so it can be checked under a microscope for signs of cancer
a stent (hollow tube) may be inserted to hold the bile duct open and stop it becoming blocked

You'll be awake while the test is carried out, but you'll normally be given an injection of sedative medication to make you very drowsy and your throat will be numbed with local anaesthetic spray.

PTC test

Percutaneous transhepatic cholangiography (PTC) may also be used to get a detailed image of your bile duct.

During the test:

a needle is passed through your skin and used to inject a special dye into your bile duct
detailed X-rays are taken of your bile duct
a small sample of tissue from your bile duct may be removed so it can be studied under a microscope
a stent may be inserted to hold the bile duct open

You'll be awake while this is carried out, but you'll usually have sedative medication to make you drowsy and local anaesthetic to numb the area where the needle is inserted.

Stages of bile duct cancer

If you're diagnosed with bile duct cancer, it will be possible to give your cancer a "stage". This is a number that indicates how far the cancer has spread.

Doctors use a system called the TNM system to stage bile duct cancer. This consists of three numbers:

T (tumour) - describes the size of the tumour
N (node) - describes whether the cancer has spread to nearby lymph glands
M (metastases) - describes whether the cancer has spread to another part of the body

Knowing the stage of your cancer will help your doctors decide on the best treatment for you.

Cancer Research UK has more detailed information about the stages of bile duct cancer.

Treatment

Treatment for bile duct cancer usually aims to control the symptoms for as long as possible. But if it's caught early enough, there's sometimes a chance it could be cured.

The main treatments are:

surgery to remove the affected area
stent insertion - an operation to widen and unblock the bile duct
chemotherapy - where medication is used to kill the cancer cells
radiotherapy - where a beam of radiation is used to kill the cancer cells

In early stage bile duct cancer, a cure may be possible by removing the affected part of the bile duct and gallbladder, and usually some of the liver or pancreas.

A cure is unlikely to be possible in more advanced cancer, but stenting, chemotherapy, radiotherapy and surgery can help relieve the symptoms.

Surgery

If it's possible to cure your cancer, surgery to remove the cancerous tissue will be recommended.

Depending on exactly where the cancer is, it may be necessary to remove:

the part of your bile duct that contains cancerous cells
your gallbladder
nearby lymph glands
part of your liver
part of your pancreas

Surgery may be carried out through a single large incision (cut) in your tummy, or occasionally by using special surgical instruments inserted through smaller incisions (called "keyhole" or laparoscopic surgery).

It's possible to live a normal life after surgery. You can live without a gallbladder, and surgeons can often reconstruct bile ducts. Your liver should still work even if part of it was removed.

Overall, around one or two in every five people who have surgery for bile duct cancer live at least five years or more after their operation.

Unblocking the bile duct

If your bile duct becomes blocked as a result of cancer, treatment to unblock it may be recommended.

This will help reduce symptoms such as:

yellowing of the skin and the whites of the eyes (jaundice)
itchy skin
abdominal (tummy) pain

The bile duct can be unblocked using a small hollow tube called a stent, which widens the bile duct and keeps it open.

The stent can be inserted using either a long, flexible tube (endoscope) passed down your throat, or by making a small incision in your skin.

Occasionally, a stent can become blocked. If this occurs, it will need to be removed and replaced.

Chemotherapy

Chemotherapy is used to relieve the symptoms of bile duct cancer, slow down the rate it spreads and prolong life.

It's used when the cancer is unsuitable for surgery but you're in good enough general health to have chemotherapy.

It's usually given through a drip into a vein in your arm.

Side effects of chemotherapy can include:

tiredness
feeling and being sick
hair loss
a higher chance of picking up infections

The side effects should pass once the course of treatment has finished.

Radiotherapy

Like chemotherapy, radiotherapy is occasionally used with the aim of relieving symptoms, slowing the spread of the cancer and prolonging life, although it's not clear how effective it is in bile duct cancer.

It's usually given using a machine that carefully aims a beam of radiation at the cancerous area.

Side effects of radiotherapy can include:

tiredness
feeling and being sick
diarrhoea
reddening of the skin and loss of hair in the treatment area