This factsheet is for people who have bile duct cancer, or who would like information about it.
Bile duct cancer (also known as cholangiocarcinoma) is caused by an abnormal and uncontrolled growth of cells in your bile duct.
About bile duct cancer
Bile is a digestive fluid that helps to break down fats. It's made by your liver and stored in your gallbladder. Bile passes from your gallbladder into your small bowel to help break down fatty food when you eat. Bile ducts are tubes that connect your liver and gallbladder to your small bowel.
Bile duct cancer almost always starts in a type of tissue called glandular tissue and is therefore known as an adenocarcinoma. Bile duct cancer affects about 1,000 people each year in the UK.
Types of bile duct cancer
There are different types of bile duct cancer depending on where it originates.
- Intrahepatic bile duct cancer is where the cancer starts in the part of the bile duct inside your liver.
- Extrahepatic bile duct cancer is where the cancer starts in the area of the bile ducts outside your liver.
This factsheet is about extrahepatic bile duct cancer. Intrahepatic bile duct cancer is treated the same way as liver cancer.
Symptoms of bile duct cancer
Symptoms of bile duct cancer include:
- yellowing of your skin and the whites of your eyes (known as jaundice) – this happens when the tumour blocks the bile duct, which causes bile to build up in your blood and tissues
- dark yellow urine
- pale-coloured faeces
- pain or discomfort in your upper abdomen (tummy)
- a fever
- loss of appetite or feeling sick
- weight loss
- itchy skin
If you have any of these symptoms, see your GP.
Causes of bile duct cancer
The exact reasons why you may develop bile duct cancer aren't fully understood at present. However, there are certain factors that can increase your chances of getting it, which include:
- cholangitis – this is a liver condition that causes inflammation of the bile ducts
- ulcerative colitis – this inflammatory bowel disease causes swelling and irritation in your bowel
- choledochal cysts – you can be born with these cysts on your bile ducts
- bile stones – these are similar to gallstones but form inside your liver rather than inside your gallbladder
- exposure to certain chemicals such as those used in the metal or rubber industry
- infection with a parasite called the liver fluke – this is found in South Asia and Africa
Diagnosis of bile duct cancer
Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may refer you to an oncologist (a doctor who specialises in cancer care).
You may have the following tests to confirm your diagnosis.
- Blood tests can check how well your liver is working.
- An endoscopic retrograde cholangio-pancreatography (ERCP) test will take images of your pancreatic duct and your bile duct using an endoscope (a camera attached to a flexible tube), which your doctor or health professional will pass down through your mouth. You will have an anaesthetic spray to numb your throat and you may need a sedative.
- In a percutaneous transhepatic cholangiography (PTC) test, your doctor or health professional will inject a dye into your bile duct and take an X-ray image. You will need a local anaesthetic for this procedure.
- Biopsy – a biopsy is a small sample of tissue. These will be collected from your bile duct and sent to a laboratory for testing to determine the type of cells and if these are benign (not cancerous) or cancerous. This is usually done at the same time as an ERCP or PTC.
- Scans – these may include ultrasound, MRI or CT scans. These are done to check the liver, gallbladder and bile ducts.
If you're found to have cancer, you may need to have other tests to check if the cancer has spread. The process of finding out the stage of a cancer is called staging. The following tests can be used to diagnose bile duct cancer or to check if the cancer has spread.
- An endoscopic ultrasound scan (EUS) – in this test an endoscope with an ultrasound probe will be used to check your pancreas and the surrounding tissues.
- An angiogram – dye will be injected into the main artery leading to your liver to check the blood vessels close to your liver, gallbladder and bile ducts.
- A laparotomy – a small cut will be made in your abdomen to look directly at your bile duct and surrounding tissues. You will need a general anaesthetic – this means you will be asleep during the procedure.
Treatment of bile duct cancer
Bile duct cancer is usually treated with surgery, and occasionally, with chemotherapy, radiotherapy and photodynamic therapy. Your treatment will depend on the position and size of the cancer in your bile duct, how far it has spread, your age and your general health. Your doctor will discuss your treatment options with you.
Surgery can remove the cancer if it hasn't spread beyond your 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.
There are a number of options for surgery:
- Whipple's procedure – if the cancer has spread into nearby structures, your surgeon will remove your bile ducts, part of your stomach, part of your small bowel, your pancreas, gall bladder and the surrounding lymph nodes (glands that are found throughout your body that are part of your immune system).
- Partial removal of your liver – if the cancer has started to spread into your liver, your surgeon will remove the affected part, along with your bile ducts.
- Bypass surgery – if it's not possible to remove the cancer, your surgeon may suggest bypass surgery to relieve symptoms of jaundice. This will allow the bile to flow from your liver to your small bowel.
Non-surgical treatments include the following.
- Your doctor may insert a stent (a small hollow tube) to help relieve symptoms of jaundice. He or she will fit the stent into your bile duct to allow bile to drain away. This can be done using an ERCP or PTC procedure.
- Chemotherapy uses medicines to destroy cancer cells. They are usually injected into a vein but sometimes you may be given chemotherapy as tablets. You may have chemotherapy if surgery isn't possible to treat the cancer or after surgery if the operation couldn’t remove all the cancer. It may also be used if the cancer has come back after treatment. However, doctors are still assessing how effective chemotherapy is in bile duct cancer.
- Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. You can have radiotherapy externally from a radiotherapy machine, or internally by placing radioactive material close to the tumour (brachytherapy). Radiotherapy is sometimes used after surgery for bile duct cancer to destroy any remaining cancer cells. Occasionally, it may also be an option if surgery isn't possible. It can't cure bile duct cancer but it can shrink or slow the growth of the cancer. Chemotherapy and radiotherapy may be given together.
- Photodynamic therapy uses a light-sensitive medicine and a laser to destroy cancer cells. Your doctor will inject the medicine into a vein. This will get absorbed by cells around your body – the medicine will enter more cancer cells than healthy cells. He or she will then pass a laser over the cells to activate the drug, which will then destroy the cells. It's not yet clear how effective this treatment is.
You can take part in clinical trials as new treatments constantly become available and need to be assessed. Your doctor can give you more information about clinical trials.
After treatment for cancer, you will have regular check-ups with your doctor to see if there is any evidence that the cancer has returned. If the cancer has already spread, you will regularly see doctors or specialist nurses to get treatment for any symptoms you might have.
Help and support
Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the support you need, and may also visit you at home. If you have more advanced cancer, further support is available to you in hospices or at home, and this is called palliative care.
Produced by Stephanie Hughes, Bupa Health Information Team, July 2012.
For answers to frequently asked questions on this topic, see FAQs.
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