Comprehensive bile duct cancer care

Bile duct cancer is a rare yet aggressive cancer. It’s so rare that you may not have heard of it unless you or a loved one has been diagnosed with it. If this happens, you can count on our multidisciplinary team to provide the latest treatments with a compassionate approach.

Understanding bile duct cancer

Bile duct cancer grows in the bile ducts – a cluster of very small tubes shaped like a tree. The tiniest branches (ductules) start in the liver and feed into progressively larger ducts. This duct system carries bile (a fluid that helps digest fats) down to your gallbladder for storage and releases bile to your small intestine when needed.

Most bile duct tumors are cholangiocarcinomas, which grow in gland cells inside the bile ducts. There are a few other kinds of bile duct cancers that are very rare. You may see the terms bile duct cancer and cholangiocarcinoma used interchangeably.

Types of bile duct cancers

Cancerous bile duct tumors are divided into three types depending on where they start to grow. Those types of cancerous tumors are:

• Intrahepatic bile duct cancers: Start in bile ducts within the liver.
• Perihilar bile duct cancers: Start in the area around where the ducts leave the liver. Also called hilar bile duct cancers or Klatskin tumors.
• Distal bile duct cancers: Start toward the bottom of the bile ducts, close to the small intestine.

Perihilar and distal bile duct cancers are sometimes grouped together and called extrahepatic bile duct cancers. Extrahepatic means they aren’t inside the liver.

Bile duct cancer symptoms

Cancer of the bile ducts doesn’t usually produce symptoms until it’s advanced. When it does cause symptoms, it’s often because the tumor has grown so large that it’s blocking a bile duct or putting pressure on organs or nerves in the area.

The most common symptom of bile duct cancer is jaundice (yellowing of skin or eyes). Some other bile duct cancer symptoms are:

• Itching
• Light-colored or greasy stools
• Dark urine
• Abdominal pain
• Loss of appetite
• Weight loss
• Fever
• Nausea and vomiting

It’s important to remember that any of these potential bile duct cancer symptoms is more likely to be caused by some other condition – such as gallstones, hepatitis or other liver diseases – because cancer of the bile ducts is so rare.

Bile duct cancer diagnosis

When you see your doctor, they’ll perform a physical that may include probing the area around your liver (upper right side of your abdomen) to see if you have tender spots or unusual lumps. They’ll take a complete family medical history and discuss your potential symptoms of bile duct cancer.

They’ll order liver function tests to check levels of substances such as bilirubin, albumin, liver enzymes and tumor markers. The results will help them diagnose your condition.

Over the long run, knowing what your blood test results were like at the beginning of your treatment also lets your doctor and health care team track any changes that happen during your treatment.

Common imaging tests

Depending on your symptoms and test results, imaging tools such as X-rays, MRIs, CT scans or ultrasound will be used to create images of your bile ducts and surrounding structures to:

• Find suspicious areas that might be cancer
• Help your doctor guide a biopsy needle into a suspicious area to take a sample for testing
• Help make treatment decisions

Such images may be taken at intervals during your treatment to:

• See whether cancer has spread
• Learn if treatments are working
• Look for signs of cancer coming back after treatment

Advanced testing options

Advocate is one of few medical providers in the Chicago region that uses endoscopic ultrasound (also called EUS or endosonography) for identification of tumors. Learn more about how we use endoscopic ultrasound for cancer.

Endoscopic retrograde cholangiopancreatography (ERCP)

Another kind of endoscopic testing we use is called endoscopic retrograde cholangiopancreatography (ERCP). A thin tube with a tiny camera and light (endoscope) is inserted through your mouth, esophagus and stomach to the small intestine.

Then we insert an even thinner tube (catheter) through the endoscope and guide it into the bile duct. The catheter is used to insert contrast dye to help the duct system show up more clearly on images. The catheter may also be used to take a small sample of tissue (biopsy) or insert a stent (small tube) into a duct to help keep it open.

Percutaneous transhepatic cholangiography

Percutaneous transhepatic cholangiography (PTC) is similar to ERCP, but the endoscope is inserted through a small incision in the abdomen. This procedure is more invasive, so it’s usually done only if ERCP can’t be used.

Treatment options for bile duct tumors

Being diagnosed with bile duct cancer brings with it the need to make a lot of choices about how to proceed. Your multidisciplinary team may recommend surgery, radiation, chemotherapy, immunotherapy, targeted therapy, palliative therapy or a mixture of options. Learn more about treatment for bile duct cancer.

Support for every step

In addition to expert medical care, we provide access to the resources you and your loved ones need to manage a diagnosis of cancer of the bile ducts. You’ll find a full range of free or low-cost cancer support services – from education to rehabilitation, nutritional to spiritual counseling, and other empowering programs. These resources include:

• Access to cancer clinical trials
• Cancer patient navigators
• Cancer counseling program