Chemotherapy for bile duct cancer

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream. 

Chemotherapy is a common treatment for people with advanced bile duct cancer. This means that the cancer has spread outside the bile ducts or has come back sometime after you were first treated. 

When you have it

Chemotherapy won’t cure bile duct cancer on its own. You usually have it to shrink the cancer or slow down its growth. This can help to relieve pain and other symptoms. Some people also have chemotherapy:

  • after surgery to lower the risk of your cancer coming back 
  • as part of a clinical trial

Chemotherapy to shrink the cancer

Your doctor might suggest that you have chemotherapy if you can’t have surgery. You are most likely to have a combination of gemcitabine and cisplatin.  

Some people feel better after chemotherapy. Some may live longer after treatment. But others unfortunately won't benefit from having chemotherapy.

Your doctor will talk to you about the benefits of chemotherapy and the possible side effects. It is a good opportunity to ask them any questions you might have. 

Chemotherapy after surgery

Your doctor might suggest you have the chemotherapy drug capecitabine after surgery to remove bile duct cancer. You usually have capecitabine for 6 months. 

Chemotherapy as part of a clinical trial

Your doctor may ask you to take part in a clinical trial looking at chemotherapy or other treatments. Trials are an important way to find out which treatments work best.

Types of chemotherapy

You may have one drug or a combination of drugs to treat bile duct cancer. The most common types of chemotherapy drugs are:

  • gemcitabine and cisplatin
  • capecitabine (Xeloda)
  • fluorouracil (5FU)
  • oxaliplatin (Eloxatin)
  • a combination of chemotherapy drugs called FOLFOX

Check the name of the chemotherapy treatment with your doctor or nurse, then find out about it on our A to Z list of cancer drugs.

How you have chemotherapy

You have most chemotherapy drugs for bile duct cancer into your bloodstream (intravenously). Capecitabine is a tablet.

Into your bloodstream

You have treatment through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have treatment through a long line: a central line, a PICC line or a portacath. These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

Diagram showing a central line

Taking tablets

You must take tablets and capsules according to the instructions your doctor or pharmacist gives you.

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Talk to your specialist or advice line before you stop taking a cancer drug.

Where you have chemotherapy

You usually have treatment into your bloodstream at the cancer day clinic. You might sit in a chair for a few hours so it’s a good idea to take things in to do. For example, newspapers, books or electronic devices can all help to pass the time. You can usually bring a friend or family member with you.

You have some types of chemotherapy over several days. You might be able to have some drugs through a small portable pump that you take home.

For some types of chemotherapy you have to stay in a hospital ward. This could be overnight or for a couple of days.

Some hospitals may give certain chemotherapy treatments to you at home. Your doctor or nurse can tell you more about this.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You have these either a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Your doctors and pharmacists work out your chemotherapy dose based on your blood cell levels, and your weight, height and general health.

Before your first chemotherapy, your doctor will explain what drugs you need, how you have them, and what the side effects are. You’ll sign a consent form. This is a good time to ask any questions you might have.

DPD deficiency

Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called dihydropyrimidine dehydrogenase (DPD) in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.

Before starting treatment with capecitabine or fluorouracil you have a blood test to check levels of DPD. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor or nurse will talk to you about this.

Side effects

Common chemotherapy side effects include:

  • feeling sick
  • loss of appetite
  • losing weight
  • feeling very tired
  • a lower resistance to infections
  • bleeding and bruising easily
  • diarrhoea or constipation
  • hair loss
Contact your doctor or nurse immediately if you have signs of infection. These include a temperature above 37.5C or below 36C, or generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drugs you have
  • how much of each drug you have
  • how you react

Tell your treatment team about any side effects that you have.

Most side effects only last for a few days or so. Your treatment team can help to manage any side effects that you have.

When you go home

Chemotherapy for bile duct cancer can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. The nurse will give you telephone numbers to call if you have any problems at home.

Last reviewed: 
03 Nov 2021
Next review due: 
03 Nov 2024
  • Cancer: Principles and Practice of Oncology (10th edition)
    VT De Vita, TS Lawrence and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    JW Valle and others
    Annals of Oncology, 2016. Volume 27, Pages 28-37

  • Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update
    SA Khan and others 
    Gut, 2012. Volume 61, Pages 1657-1669

  • Electronic Medicines Compendium (eMC)
    Accessed November 2021

  • Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study
    JN Primrose and others
    Lancet Oncology, 2019. Vol 20, Issue 5. Pages 663-673

  • Cholangiocarcinoma 2020: the next horizon in mechanisms and managements
    JM Banales and others
    Nature reviews gastroenterology & hepatology, 2020. Vol 17, Pages 557-588

Related links