Radiotherapy for bile duct cancer

Radiotherapy uses high energy x-rays to treat cancer cells. For bile duct cancer, you usually have external radiotherapy. This means using a radiotherapy machine to aim radiation beams at the cancer. 

You have this treatment in the hospital radiotherapy department. It doesn't hurt, although laying on the radiotherapy couch can be uncomfortable.

When you might have radiotherapy for bile duct cancer

Radiotherapy isn't a common treatment for bile duct cancer. You might have it if you can't have surgery. Or to help control symptoms caused by bile duct cancer spread. This is called palliative treatment.

Radiotherapy to help control symptoms

Your doctor might suggest that you have radiotherapy to help control symptoms such as pain. Radiotherapy can help to shrink the cancer and make you feel better. 

You might have 1 treatment or a few treatments given over a few days. These treatments are sometimes known as fractions.

Types of radiotherapy for bile duct cancer

You usually have external radiotherapy. This means that a radiotherapy machine aims the radiation beams at the cancer. 

There are different types of external radiotherapy. Your doctor decides which is best for you.

You are most likely to have conformal radiotherapy or intensity modulated radiotherapy (IMRT). These shape the radiation beams to closely fit the area of the cancer.

Stereotactic body radiation therapy (SBRT)

Researchers are looking into a type of radiotherapy called stereotactic body radiation therapy (SBRT). This gives radiotherapy from many different positions around the body. The cancer receives high doses of radiation but the surrounding tissues only get a low dose. This lowers the risk of side effects.

Your doctor might ask you to enter a clinical trial looking at SBRT for bile duct cancer. 

Selective Internal Radiation Therapy (SIRT)

Selective internal radiation therapy is a type of internal radiotherapy. It is sometimes called radioembolisation or trans arterial radioembolisation (TARE).

SIRT is a way of giving radiotherapy treatment to the liver. Your doctor puts tiny radioactive beads into a blood vessel that takes blood into your liver. The beads get stuck in the small blood vessels in and around the cancer, and the radiation destroys the cancer cells.

SIRT isn't routinely used for people with bile duct cancer in the UK. Your doctor may be able to make a special application if they think this can help you or ask you to join a clinical trial. 

Planning your radiotherapy treatment

You have a planning session with your radiotherapy team a few days before you start treatment. This means working out the dose of radiotherapy you need and exactly where you need it.

Your planning appointment takes from 15 minutes to 2 hours.

You usually have a planning CT scan in the radiotherapy department.

The scan shows the cancer and the area around it. You might have other types of scans or x-rays to help your treatment team plan your radiotherapy. The plan they create is just for you.

Photo of a CT scanner

Your radiographers tell you what is going to happen. They help you into position on the scan couch. You might have a type of firm cushion called a vacbag to help you keep still.

The CT scanner couch is the same type of bed that you lie on for your treatment sessions. You need to lie very still. Tell your radiographers if you aren't comfortable.

Injection of dye

You might need an injection of contrast into a vein in your hand. This is a dye that helps body tissues show up more clearly on the scan.

Before you have the contrast, your radiographer asks you about any medical conditions or allergies. Some people are allergic to the contrast.

Having the scan

Once you are in position your radiographers put some markers on your skin. They move the couch up and through the scanner. They then leave the room and the scan starts.

The scan takes about 5 minutes. You won't feel anything. Your radiographers can see and hear you from the CT control area where they operate the scanner. 

Ink and tattoo marks

The radiographers make pin point sized tattoo marks on your skin. They use these marks to line you up into the same position every day. The tattoos make sure they treat exactly the same area for all of your treatments. They may also draw marks around the tattoos with a permanent ink pen, so that they are clear to see when the lights are low.

Photograph of radiotherapy tattoo marks

The radiotherapy staff tell you how to look after the markings. The pen marks might start to rub off in time, but the tattoos won’t. Tell your radiographer if that happens. Don't try to redraw them yourself. 

After your planning session

You might have to wait a few days before you start treatment. During this time the physicists and your radiographer doctor (clinical oncologist) decide the final details of your radiotherapy plan. They make sure that the area of the cancer will receive a high dose and nearby areas receive a low dose. This reduces the side effects you might get during and after treatment. 

The radiotherapy room

Radiotherapy machines are very big and could make you feel nervous when you see them for the first time. The machine might be fixed in one position or able to rotate around your body to give treatment from different directions. The machine doesn't touch you at any point.

Before your first treatment, your therapy radiographers Open a glossary item will explain what you will see and hear. In some departments the treatment rooms have docks for you to plug in music players. So you can listen to your own music while you have treatment.

Photo of a linear accelerator

Before each treatment session

The radiographers help you to get onto the treatment couch. You might need to raise your arms over your head.

The radiographers line up the radiotherapy machine using the marks on your body. Once you are in the right position, they leave the room.

During the treatment

You need to lie very still. Your radiographers might take images (x-rays or scans) before your treatment to make sure that you're in the right position. The machine makes whirring and beeping sounds. You won’t feel anything when you have the treatment.

Your radiographers can see and hear you on a CCTV screen in the next room. They can talk to you over an intercom and might ask you to hold your breath or take shallow breaths at times. You can also talk to them through the intercom or raise your hand if you need to stop or if you're uncomfortable.

The short video below shows how you have radiotherapy:

You won't be radioactive

External radiotherapy won't make you radioactive. It's safe to be around other people, including pregnant women and children.

Side effects of radiotherapy

For bile duct cancer, you usually have a short course of radiotherapy treatment of only a few days, so you might have very few side effects. You are likely to have more side effects if you have treatment for a couple of weeks. 

Side effects tend to start a week after the radiotherapy begins. They gradually get worse during the treatment and for a couple of weeks after the treatment ends. But they usually begin to improve after around 2 weeks or so.

Tiredness and weakness

You might feel tired during your treatment. It tends to get worse as the treatment goes on. 

Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.

Feeling or being sick

You might feel sick at times. Let your treatment team know if you feel sick, as they can give you anti sickness medicines.

Reddening or darkening of your skin

Your skin might go red or darker in the treatment area. You might also get slight redness or darkening on the other side of your body. This is where the radiotherapy beams leave the body. 


Radiotherapy to the tummy (abdomen) can cause diarrhoea. Drink plenty of fluids and let your doctor know if you have frequent diarrhoea.

Last reviewed: 
03 Nov 2021
Next review due: 
03 Nov 2024
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