Bile duct cancer

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have bile duct cancer, or who would like information about it.

Bile duct cancer is rare; about 1,000 people in the UK get it each year. Bile duct cancer most commonly affects people over 65. It's usually treated with surgery, and more rarely, with chemotherapy, radiotherapy and photodynamic therapy.

How cancer develops

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About bile duct cancer

Bile is a digestive fluid that helps to break down fats. It's made by the liver and stored in the gallbladder. Bile then passes from the gallbladder into your small bowel to help break down fatty food. The bile ducts are the tubes connecting the liver and gallbladder to the small bowel.

Bile duct cancer almost always starts in a type of tissue called glandular tissue and is then known as adenocarcinoma. If the cancer starts in the part of the bile duct inside the liver, it's known as intra-hepatic bile duct cancer. If it starts in the area of the bile ducts outside the liver, then it's known as extra-hepatic bile duct cancer.

This factsheet is about extra-hepatic bile duct cancer. Intra-hepatic bile duct cancer is treated the same way as liver cancer.

Symptoms of bile duct cancer

Symptoms of bile duct cancer may include:

• yellowing of the skin and the white of your eyes (known as jaundice)
  
• dark yellow urine
  
• pale coloured faeces
  
• mild pain in the upper abdomen
  
• a high temperature
  
• loss of appetite or feeling sick
  
• weight loss and tiredness
  
• itchy skin

These symptoms aren't always due to bile duct cancer but if you have them, visit your GP.

Causes of bile duct cancer

Doctors don't fully understand why bile duct cancer develops. However, certain factors make bile duct cancer more likely.

• Age - it's most common around age 65.
  
• Cholangitis with or without ulcerative colitis - it causes inflammation in the bile ducts.
  
• Choledochal cysts.
  
• Chronic gall stones.
  
• Exposure to certain chemicals used in the metal or rubber industry.
  
• Infection with a parasite called the liver fluke - found in South Asia and Africa.
  
• Smoking.

Diagnosis of bile duct cancer

Your GP will ask about your symptoms and examine you. You may then be referred to a doctor specialising in cancer (an oncologist).

You may have the following tests to confirm diagnosis.

• Blood tests to check your liver function.
  
• Endoscopic retrograde cholangio-pancreatography (ERCP) - images of the pancreatic duct and the bile duct are taken using an endoscope (a camera attached to a flexible tube) passed down through your mouth. You will have an anaesthetic spray to numb your throat and you may need a sedative.
  
• Percutaneous transhepatic cholangiography (PTC) - a needle is passed through the skin to the liver and a dye is injected into the bile duct and X-ray image is taken. For this procedure you will need a local anaesthetic.
  
• Biopsy - a sample of cells or tissue is removed from the bile duct and sent to a laboratory for diagnosis. This is usually done when the ERCP or PTC is performed.
  
• Scans - these may include ultrasound, MRI or CT scans. These are done to check the liver, gallbladder and bile ducts to see if the cancer has spread.

Other tests to determine how far the cancer has spread may include the following.

• An endoscopic ultrasound scan (EUS) - an endoscope with an ultrasound probe is used to check the pancreas and the surrounding tissues.
  
• An angiogram - dye is injected into main artery leading to the liver to check the blood vessels close to the liver, gall bladder and bile ducts.
  
• A laparotomy - a small cut is made in your abdomen to look directly at the bile duct and surrounding tissues. For this procedure you will need a general anaesthetic.

Treatment of bile duct cancer

Treatment depends on the position and size of the cancer in the bile duct and how far it has spread. Your doctor will discuss your treatment options with you.

Surgery

Surgery may be used to remove the cancer if it hasn't spread beyond the bile duct. This option isn't always suitable as the bile duct is in an awkward position and it may not be possible to remove all of the cancer.

If it's not possible to remove the cancer, your surgeon may suggest bypass surgery to relieve symptoms of jaundice. This allows the bile to flow from the liver to the small bowel.

Stent insertion

A stent insertion may be used to help relieve symptoms of jaundice without having to perform surgery. A stent (a small hollow tube) is fitted into the bile duct to allow bile to drain away. This can be done using ERCP or PTC procedure.

Non-surgical treatments

• Radiotherapy - radiation is used to kill cancer cells. It isn't generally suitable for bile duct cancer. It's occasionally given at the same time as chemotherapy.
  
• Chemotherapy - anti-cancer drugs are used to destroy cancer cells. They are usually injected into a vein but sometimes you may be given tablets. Doctors are still assessing how effective chemotherapy is in bile duct cancer.
  
• Photodynamic therapy - a light-sensitive drug is injected into a vein and this travels around the body and is taken up by cells. The drug enters more cancer cells than healthy cells. A laser is then passed over the cells to activate the drug which then kills the cells. It's not yet clear how effective this treatment is.

Living with bile duct cancer

After treatment for cancer, you will have regular check ups with your doctor to see if there is any evidence of the cancer returning. If the cancer has already spread, you will be seen regularly by doctors or specialist nurses for treatments to deal with any symptoms.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There are support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.