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About bile duct cancer

Can you tell me about bile duct cancer?

This page is about cancer of the bile duct, which is also called cholangiocarcinoma. Cholangiocarcinoma is pronounced col-an-jee-oh car-sin-oh-ma. 

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The bile ducts

Bile is a fluid which helps us digest food. The bile ducts are the tubes that carry bile. The liver makes bile and the gallbladder stores it.

Two bile ducts come from the liver, and one comes from the gallbladder. These join to form the common bile duct. This connects to the small bowel where it also meets the pancreatic duct.

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Types of bile duct cancer

Bile duct cancer is rare. Only about 1,000 people are diagnosed each year in England. This may not sound rare, but you can see it is when compared to more than 40,000 cases of bowel cancer diagnosed each year.

Bile duct cancer can develop anywhere along the bile ducts. It has different names depending on where it starts.

Intrahepatic bile duct cancer starts in the bile ducts within the liver. In the UK about 1 in 5 bile duct cancers (20%) are intrahepatic.

Common bile duct cancers (distal bile duct cancers) start in the common bile duct. About 1 in 5 (20%) are this type.

Klatskin tumours start where the right hepatic duct joins the left hepatic duct. About half (50%) of bile duct cancers are this type. They are also called perihilar cancers.

Multifocal cancer means that there is more than one tumour and they are in different parts of the bile ducts. About 1 in 20 (5%) are this type.

 

Causes of bile duct cancer

We don’t know the exact causes of bile duct cancers. But some factors can increase your risk of developing them. These include

  • Long term swelling and irritation of the bile ducts, known as cholangitis
  • A condition called ulcerative colitis, causing swelling and irritation of the bowel
  • Bile stones, which cause swelling and irritation of the bile duct
  • Infection with a parasite called the liver fluke
 

Symptoms of bile duct cancer

The first symptom most people notice is yellowing of their skin and whites of their eyes. This is called jaundice. It happens when the tumour blocks the bile duct. Bile then builds up in the blood and body tissues. Other symptoms include

  • Itchy skin
  • Pain in the tummy (abdomen)
  • Loss of appetite
  • A high temperature (fever)
  • Weight loss
 

Tests to diagnose bile duct cancer

You may have blood tests to check your general health, and how well your liver works.

Your doctor may recommend other blood tests. These tests look for a chemical that bile duct cancer cells sometimes make. Doctors call this chemical a tumour marker. If the level of the marker is high, it can be a sign of cancer.

You may also have

ERCP

The test looks for narrowing or blockage of the bile duct or pancreatic duct. It can help with planning surgery. It is a test to look at the area where your bile duct opens into the small bowel. (ERCP stands for endoscopic retrograde cholangiopancreatography.)

There is detailed information about having an ERCP in the section about cancer tests.

PTC

This is another way for your doctor to look at your bile duct. (PTC stands for percutaneous transhepatic cholangiography.)

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 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.

 

Stages of bile duct cancer

The staging of a cancer looks at the size of the cancer and whether it has spread. There are two ways of staging bile duct cancer

TNM (Tumour, Node and Metastasis) staging

TNM stands for 'tumour, node, metastasis'. This system looks at the primary tumour, whether there is cancer in nearby lymph nodes and whether the cancer has spread to any other part of the body. Doctors call cancer spread 'metastasis'.

T looks at the tumour (or tumours) in the bile ducts

  • TX means the doctor can’t tell what size the tumour is
  • Tis means very early stage cancer - the cancer cells are all within the lining of the bile duct
  • T1 means the cancer has started to spread into the wall of the bile duct
  • T2 means the cancer has spread beyond the wall of the bile duct, but not into nearby tissues or organs
  • T3 means the tumour has spread to organs closest to the bile duct, such as the liver, pancreas, gallbladder or nearby small blood vessels
  • T4 means the cancer has spread into major blood vessels close to the bile duct (the portal vein or the hepatic artery) or other organs such as the bowel, stomach or wall of the abdomen

N looks at the lymph glands (lymph nodes) nearest the bile ducts

  • NX means the doctor couldn’t tell whether the cancer has spread to the lymph nodes
  • N0 means there are no cancer cells in the lymph nodes
  • N1 means there are cancer cells in the lymph nodes

M looks at spread to more distant parts of the body

  • MX means the doctor can’t tell if the cancer has spread
  • M0 means there is no sign of cancer spread to other parts of the body
  • M1 means the cancer has spread to organs further away from the bile ducts

Number staging

This staging system uses numbers.

  • 1A means the cancer is only within the bile duct
  • 1B means the cancer has grown through the bile duct wall, but hasn’t spread further
  • 2A means the cancer has not spread to lymph nodes, but has spread to tissues close to the bile duct, such as the liver and gallbladder
  • 2B means the cancer has spread into tissues and lymph nodes around the bile duct
  • 3 means the cancer has spread into major blood vessels or nearby organs, such as the small bowel, gallbladder, large bowel, or stomach - it may also be in lymph nodes close by
  • 4 means the cancer has spread to organs close to the bile duct, such as the liver, and may also have spread to other organs that are further away.
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Updated: 16 May 2011