Bile duct cancer tests
This page tells you about the tests you may have for bile duct cancer (cholangiocarcinoma). You can find the following information
Tests for bile duct cancer (cholangiocarcinoma)
You usually start by seeing your GP, who will examine you and ask about your general health. They will ask about your symptoms, when you get them and if anything makes them better or worse. Your doctor will look at your skin and eyes. They may do blood or urine tests to check for jaundice. They will examine you to see if they can feel a lump in the area or an enlarged liver.
Your GP may refer you to hospital for tests and X-rays. Or you may see a specialist before having any tests. The specialist is usually a gastroenterologist, (gas-tro-enter-ol-o-jist) who is an expert in illnesses of the digestive system.
At the hospital
The specialist will examine you and ask about your medical history and symptoms. You may have blood tests and a chest X-ray to check your general health. Then your specialist will arrange some tests, which may include an ultrasound, CT scan, MRI scan with MRCP and tests using dye to show up the gallbladder and bile ducts (ERCP or PTC). You may go into hospital to have your tests. Or you may have them as an outpatient.
What will the tests show?
These tests might show an abnormality that could be caused by cancer of the bile duct. But the only way to be absolutely sure is to remove a piece of tissue to check under the microscope for cancer cells. This is called a biopsy. You usually have a biopsy during another test – CT scan, ultrasound, endoscopy (ERCP) or dye injection (PTC).
You can view and print the quick guides for all the pages in the diagnosing bile duct cancer section.
If you are worried about symptoms, start by seeing your GP. Your doctor will examine you and ask about your general health. They will also ask when you get symptoms, and if anything makes them better or worse. Your doctor will look at your skin and eyes. They may ask you to have blood tests and give a urine sample to check for signs of jaundice. It may be possible for your doctor to feel a lump in the bile duct area. Or your liver may feel enlarged.
After examining you, your doctor may refer you to hospital for tests and X-rays. Or you may have an appointment to see a specialist before any tests. The specialist is usually a gastroenterologist (gas-tro-enter-ol-o-jist), who is an expert in diseases of the digestive system.
At the hospital the specialist is likely to
- Ask about your medical history and any symptoms you have
- Check for signs of jaundice by looking at your skin and the whites of your eyes
- Arrange for you to have blood tests and a chest X-ray to check your general health
After examining you the specialist will arrange for you to have one or more of the following tests, usually as an outpatient
You will have blood tests to check your general health, including tests to see how well your liver is working (liver function tests). One of these is a test to find out how much bilirubin there is in your blood. Bilirubin is a chemical in bile. A small amount of bilirubin in your blood is perfectly normal. But a high bilirubin level could mean you have a problem with your bile ducts, gallbladder or liver.
Your doctor may also test for cancer markers. These are chemical substances that can show up in the bloodstream with some types of cancer. Bile duct cancers may produce 2 markers – CEA and CA19-9. But both of these can show up in a variety of other conditions. And some people with cancer of the bile duct don’t have raised levels of these markers. So your doctor will use the blood test results alongside the results of your other tests to decide if you are likely to have a bile duct cancer.
Doctors call this an endoluminal ultrasound or endoscopic ultrasound. Your doctor may call it by the initials EUS. After you have had some medication to make you drowsy, the doctor puts a flexible tube called an endoscope down your throat. The endoscopy tube contains a small ultrasound probe. The ultrasound picture helps the doctor to see any areas that might be cancer and guide a small needle into them to remove a sample of cells (a biopsy).
You may have a type of MRI scan called an MRCP. This stands for magnetic resonance cholangio pancreatography (col-an-jee-oh pan-kree-at-og-raf-ee). It uses magnetic fields to give detailed pictures of your pancreas, gallbladder and bile ducts.
You may have an MRI scan of your abdomen at the same time as the MRCP. You must not eat or drink for 4 to 5 hours before the scan. If you have just the MRCP, you can’t eat or drink for 2 hours before the test. You then have to lie very still inside an MRI machine for up to 30 minutes.
An MRCP is not usually uncomfortable so you don't need any painkillers or other medicines. And you don't need to swallow a dye or have a dye injected, as you do with a CT scan. But with an MRCP, doctors can't take samples of any lumps they find. And MRCP isn't available in all hospitals.
You may have a particular type of endoscopy called an ERCP if your doctor thinks you may have a bile duct cancer. ERCP stands for endoscopic retrograde cholangiopancreatography (ret-ro-grade col-an-jee-oh pan-kree-at-og-raf-ee).
You swallow a long, flexible tube so your doctor can look at the inside of your small bowel (duodenum). The doctor can take biopsies of anything that looks abnormal. They can squirt in some dye to help show if there is a narrowing or blockage of the bile duct or pancreatic duct. This can help with planning surgery. The whole test takes anything from 30 minutes to 2 hours.
There is detailed information about having an ERCP in our section about cancer tests.
You may hear your doctor call this test PTC. That stands for percutaneous transhepatic cholangiography (per-kew-tay-nee-us trans-hep-attic col-an-jee-oh pan-kree-at-og-raf-ee). This is another way for your doctor to look at your bile duct.
Before the test, you have an injection to make you sleepy. Then you have a local anaesthetic injection in the right side of your tummy (abdomen). Your doctor uses a needle to inject some dye into your bile duct. The dye shows up any blockages on X-ray. Your doctor can also take a biopsy while you are having this test.
You have the test in the X-ray department. The injections can make you drowsy. So you won’t be able to drive afterwards, and will need someone to take you home.
A biopsy means removing a sample of tissue and looking at it under a microscope. This is the only certain way to tell whether a growth is a cancer or not. But if your doctor is fairly certain from the results of your other tests that you have a cancer, you may not have a biopsy.
If you have a fine needle aspiration (FNA), you need to have an ultrasound scan or CT scan. The doctor uses the scan to guide a very thin needle through your skin and into the bile ducts. Once the needle is in the right place, the doctor draws a sample of cells into the needle. They then send the specimen to the laboratory to be looked at under a microscope.
After a biopsy you have to stay in hospital for a few hours, or overnight. There is a risk of bleeding afterwards and your doctor will want to keep an eye on you.
You won’t get the results of your biopsy straight away. It takes a while to prepare the samples before they can be checked for cancer cells. Don't forget to ask the doctor when the results will be ready and how you will get them.
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