Tests for bile duct cancer

You usually have a number of tests to check for bile duct cancer. Bile duct cancer is also called cholangiocarcinoma. It is a rare type of cancer that develops in the bile ducts.

Diagram showing the position of the gallbladder and bile ducts

The tests you might have include:

  • blood tests
  • scans such as ultrasound scan and CT scan

Most people are diagnosed with bile duct cancer after they become unwell and go to A&E. Others start by seeing their GP if they have symptoms that could be due to cancer. Some people are also diagnosed after having tests for something else.

Tests you might have to find out the cause of your symptoms

The tests you have first depend on the symptoms you have. The tests you might have include:

  • physical examination
  • blood tests
  • ultrasound scan
  • CT scan
  • MRI scan
  • taking a sample of tissue called a biopsy

Physical examination

Your doctor feels your tummy for any areas that might be swollen or might not feel normal, including a lump. And if you have any pain, they will feel those areas. They can also listen to your tummy and chest to find out if they sound normal.

Blood tests

Blood tests can check your general health, including checking:

  • how well your liver and kidneys are working
  • the number of blood cells Open a glossary item such as red blood cells 

Ultrasound scan

Ultrasound scans use high frequency sound waves to create a picture of a part of the body. You usually have an ultrasound scan of your tummy (abdomen). This helps doctors look at your:

  • bile ducts
  • pancreas
  • liver

CT scan

A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.

You usually have a CT scan of your chest and tummy to look for:

  • any abnormal areas in your bile ducts and liver
  • any abnormal areas elsewhere in your tummy and chest

MRI scan

You might have an MRI scan and a type of MRI called an MRCP.

MRI stands for magnetic resonance imaging. It is a type of scan that creates pictures using magnetism and radio waves. MRI scans produce pictures from angles around the body and show up organs very clearly.

MRCP stands for magnetic resonance cholangio pancreatography. It is a special type of MRI that gives detailed pictures of the pancreas, gallbladder and bile ducts. You usually have an MRI scan of your tummy at the same time as the MRCP.


A biopsy means taking a sample of tissue and sending it to the laboratory so it can be looked at under a microscope. This is the only way to be certain whether a lump or growth in the bile duct is a cancer or not.

There are different ways to have a biopsy of the bile ducts. This includes having a biopsy:

  • during an endoscopic retrograde cholangio pancreatography (ERCP)
  • during a cholangiography
  • using an ultrasound or CT to guide the needle
  • during a percutaneous transhepatic cholangiography (PTC)
  • during an endoscopic ultrasound scan (EUS)
  • during an operation on your tummy called a laparoscopy


Your doctor puts a long, flexible tube called an endoscope down your throat to look at your pancreas and bile ducts.

The endoscope has a small camera and light at the end. Your doctor can look at the endoscope or pictures on a TV monitor. They can take x-rays and samples (biopsies) of any abnormal looking areas.

You usually have an injection of sedation first to make you very drowsy.


You might have a cholangiography at the same time you have an ERCP. You have an ERCP and your doctor puts a smaller tube called a cholangioscope down a channel in the endoscope. This smaller tube has a probe and camera attached.

The cholangioscope can go directly into the bile ducts. Your doctor can see if there are any abnormal areas and take samples of tissue.

Usually, you're awake when you have the test, but you can choose to have a medicine to relax you. This makes you drowsy (sedation).

Biopsy using an ultrasound or CT to guide the needle

Your doctor uses an ultrasound or CT scan to look at the bile ducts. You have a local anaesthetic Open a glossary item injection to numb the area.

Your doctor then uses the scan to guide a fine needle through the skin and into the bile ducts. They attach a syringe to the needle and draw up a sample of cells. This is called a fine needle aspiration (FNA).

Percutaneous transhepatic cholangiography (PTC)

A PTC is a way of looking at your bile ducts using x-rays.

Your doctor uses a small needle to inject some local anaesthetic into the right side of your tummy. Once the area around the injection site is numb, they use x-rays to guide where they put a long thin needle into your bile ducts. They then inject some dye into your bile ducts. The dye shows up any blockages on the x-ray. They can then take biopsies of any abnormal looking areas.

You usually have a PTC if you can't have an ERCP for any reason. 

Endoscopic ultrasound scan (EUS)

This test combines an ultrasound and an endoscopy to look at your food pipe, stomach, pancreas and bile ducts.

Your doctor uses a long flexible tube called an endoscope. It has a tiny camera and light on the end and an ultrasound probe attached. The ultrasound scan uses high frequency sound waves to create a picture of the inside of your body.

Your doctor can take biopsies of any abnormal areas during the test.

Usually you're awake when you have the test, but you can choose to have a medicine to relax you. 


Laparoscopy is a small operation to look inside your tummy. It is also called keyhole surgery. Your surgeon can look for any signs of cancer and whether it has spread. You might have it to help your doctor decide if surgery to remove the cancer is possible.  

You have this operation under general anaesthetic Open a glossary item. Your surgeon can take samples of tissue and fluid to send to the laboratory.

Scans to look at your tummy and rest of your body

If you have a biopsy that shows that you have bile duct cancer, then you usually have more tests to find out how big the cancer is and whether it has spread to other parts of the body. This is called staging the cancer.

The tests you might have include:

  • PET scan
  • PET-CT scan

PET scan

PET scans are a type of test that creates 3 dimensional (3D) pictures of the inside of your body. PET stands for positron emission tomography. It uses a mildly radioactive drug to show up areas of your body where cells are more active than others.

You might have a PET scan to:

  • help diagnose bile duct cancer
  • look for cancer in the lymph nodes Open a glossary item and other parts of the body

PET-CT scan

A PET-CT scan combines a CT scan and a PET scan. You might have a PET-CT scan to look for cancer in the lymph nodes and other parts of your body. This helps your doctor find out the stage of your cancer.

Tumour markers

Tumour markers are substances that might be raised if there is a cancer. They’re usually proteins. They can be found in the blood, urine or body tissues. 

Some tumour markers are only produced by one type of cancer. Others can be made by several types. Some markers are found in non cancerous conditions as well as cancer.

Doctors might use tumour markers to monitor how well your cancer treatment is working or check if the cancer has come back. 

Doctors usually check the following tumour markers for bile duct cancer: 

  • CA19-9
  • CA-125

These markers can also show up in other conditions. And some people with bile duct cancer don't have raised levels of tumour makers. So your doctor will use these results alongside other test results to decide if you are likely to have bile duct cancer. 


The tests you have help your doctor find out if you have bile duct cancer and how far it has grown. This is the stage of the cancer.

This is important because doctors recommend your treatment according to the stage of the cancer.

Coping with bile duct cancer

Coping with a diagnosis of bile duct cancer can be difficult. There is help and support available to you and your family.

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  • Cholangiocarcinoma
    BMJ Best Practice, Last updated February 2023

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  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up

    JW Valle and others

    Annals of Oncology, 2016. Vol 27, Supplement 5. Pages 28-37

  • Suspected cancer: recognition and referral
    National Institute for Health and Care Excellence (NICE), 2015. Last updated October 2023

  • Scottish Referral Guidelines for Suspected Cancer
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Last reviewed: 
01 Nov 2023
Next review due: 
01 Nov 2026

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