Overview

Cancer of the bile duct (cholangiocarcinoma) is a rare type of cancer that mainly affects adults aged over 65.

Bile ducts are small tubes that connect the liver and small intestine. They allow fluid called bile to flow from the liver, through the pancreas, to the gut, where it helps with digestion. Cancer can affect any part of these ducts.

Bile duct cancer can sometimes be cured if it is found very early, but it's not usually found until a late stage, when a cure isn't possible.

Symptoms of bile duct cancer

There aren't usually any symptoms of bile duct cancer until it grows large enough to block the bile ducts.

This can cause:

  • yellowing of the skin and whites of the eyes (jaundice)
  • itchy skin
  • your poo to turn pale
  • darkening of your pee
  • loss of appetite and weight loss
  • persistent tiredness and feeling unwell
  • tummy (abdominal) pain and swelling – some people feel a dull ache in the upper right hand side of their tummy
  • high temperature
  • chills and shivering

See your GP if you have persistent symptoms that you're worried about – particularly if you have jaundice. These symptoms can have several causes, so it's important to get a proper diagnosis.

Causes of bile duct cancer

The cause of bile duct cancer is unknown. Most happen without a known cause, although some things can increase your risk of getting it.

These include:

  • primary sclerosing cholangitis – a rare type of liver disease that causes long-term inflammation of the liver
  • bile duct abnormalities – such as cysts (fluid-filled sacs) in the bile ducts that are present from birth
  • biliary stones within the liver – hard stones, similar to gallstones, that form in the bile duct
  • infection with a liver fluke parasite (a parasite worm; usually only a problem in Asian countries)
  • exposure to certain chemicals and toxins, including thorotrast (a type of dye that used to be used in medical scans)

There may also be a link with long-term hepatitis B and hepatitis C infections, liver scarring (cirrhosis), diabetes, obesity, smoking and excessive alcohol consumption.

Tests for bile duct cancer

Several tests may be needed to help diagnose bile duct cancer. These will usually be carried out in hospital.

Tests you may have include:

Read more about how bile duct cancer is diagnosed.

Treatments for bile duct cancer

It's not usually possible to cure bile duct cancer because it's often diagnosed after it has grown and spread.

But even if bile duct cancer is found at a late stage, treatment can help control the symptoms for months or possibly years.

The main treatments for bile duct cancer are:

  • surgery to remove the affected area – this is only suitable for a small number of people, but could get rid of the cancer completely
  • inserting a hollow tube (stent) into the bile duct to stop it becoming blocked – this can help relieve symptoms such as jaundice
  • chemotherapy – a medicine that stops cancer cells from growing and may relieve your symptoms
  • radiotherapy – where a beam of radiation is aimed at cancer cells to stop them from growing and to relieve your symptoms

Read more about how bile duct cancer is treated.

Outlook for bile duct cancer

The outlook for bile duct cancer depends on which part of the bile duct is affected and how far the cancer has spread.

Even if it's possible to remove the cancer, there's a chance it could come back later.

There are no UK-wide statistics for bile duct cancer, but it's estimated that:

  • around 30 out of 100 men will survive for 1 year or more after being diagnosed
  • 25 out of 100 women will survive for 1 year or more after being diagnosed
  • around 5 out of 100 men and women will survive for 5 years or more after being diagnosed

Cancer Research UK has more information about survival statistics for bile duct cancer.

Bile duct cancer support group

The Alan Morement Memorial Fund (AMMF) is the main UK charity that provides support for people affected by bile duct cancer.

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Diagnosis

It can be difficult to diagnose bile duct cancer. You may need to have several different tests.

Some of these tests that are described below.

Blood tests

In bile duct cancer, the cancerous cells may release certain chemicals that can be detected using blood tests. These are known as tumour markers.

But tumour markers can also be caused by other conditions, so this test can't be used to tell for certain whether or not you have bile duct cancer.

Scans

Several types of scan can be used to examine your bile ducts in detail and to check for lumps or other abnormalities that could be the result of cancer.

These include:

  • an ultrasound scan – high-frequency sound waves are used to build a picture of the inside of your body
  • a computerised tomography (CT) scan – a series of X-rays of your liver and bile ducts are taken and a computer is used to assemble them into a more detailed 3-dimensional image
  • a magnetic resonance imaging (MRI) scan – a strong magnetic field and radio waves are used to produce an image of the inside of your liver and bile duct

ERCP test

Endoscopic retrograde cholangiopancreatography (ERCP) allows your bile ducts to be seen clearly on an X-ray.

During the test:

  • an endoscope (a small, flexible tube with a camera at the end) is passed down your throat to the opening of your bile duct – an X-ray scanner is used to guide it to the right place
  • a special dye is injected into the bile duct so it shows clearly on the scanner and any abnormal areas are easier to see
  • a small sample of tissue may be removed (a biopsy) so it can be checked for signs of cancer
  • a stent (small hollow tube) may be inserted to hold a bile duct open and stop it becoming blocked

You'll be awake while the test is done. However, you'll usually be given an injection of a sedative medicine to make you very sleepy, and your throat will be numbed with local anaesthetic spray.

PTC test

Percutaneous transhepatic cholangiography (PTC) may also be used to get a detailed image of your bile duct.

During the test:

  • a needle is passed through your skin and used to inject a special dye into your bile duct
  • detailed X-rays are taken of your bile duct
  • a small sample of tissue from your bile duct may be removed so it can be examined
  • a small hollow tube (stent) may be inserted to hold a bile duct open and stop it becoming blocked

You'll be awake while this is done. However, you'll usually be given a sedative medicine to make you aleepy, and local anaesthetic to numb the area where the needle is inserted.

Stages of bile duct cancer

If you're diagnosed with bile duct cancer, it will be possible to give your cancer a "stage". This is a number that indicates how far the cancer has spread.

Doctors use the TNM system to stage bile duct cancer, which consists of 3 factors:

  • T (tumour) – describes the size of the tumour
  • N (node) – describes whether the cancer has spread to nearby lymph glands
  • M (metastases) – describes whether the cancer has spread to another part of the body

The doctor will give each factor a number based on how much the cancer has grown or spread. For example, "T3 N1 M1" would describe a large cancer that has spread into lymph nodes and into another part of the body.

Knowing the stage of your cancer will help your doctors decide on the best treatment for you.

Cancer Research UK has more detailed information about the stages of bile duct cancer.

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Treatment

Treatment for bile duct cancer usually aims to control the symptoms for as long as possible. But if it's caught early enough, there's sometimes a chance it could be cured.

The main treatments are:

  • surgery to remove the affected area
  • stent insertion – an operation to widen and unblock a bile duct
  • chemotherapy– medicine to slow down the spread of cancer cells and relieve symptoms
  • radiotherapy– a beam of radiation is used to slow down the spread of cancer cells and relieve symptoms

In early-stage bile duct cancer, a cure may be possible by removing the affected part of the bile duct and gallbladder, and usually some of the liver or pancreas.

A cure is unlikely to be possible in more advanced cancer, but inserting a stent, or treating with chemotherapy or radiotherapy can help relieve the symptoms.

Surgery

If it's possible to cure your cancer, surgery to remove the cancerous tissue will be recommended.

Depending on exactly where the cancer is, it may be necessary to remove:

  • the part of your bile duct that contains cancerous cells
  • your gallbladder
  • nearby lymph glands
  • part of your liver
  • part of your pancreas

Surgery may be done through a single large incision (cut) in your tummy, or occasionally by using surgical instruments that are inserted through smaller incisions (called "keyhole" or laparoscopic surgery).

It's possible to live a normal life after surgery. You can live without a gallbladder, and surgeons can often reconstruct bile ducts. Your liver should still work even if part of it was removed.

Unblocking the bile duct

If your bile duct becomes blocked as a result of cancer, treatment to unblock it may be recommended.

This will help reduce symptoms such as:

  • yellowing of the skin and the whites of the eyes (jaundice)
  • itchy skin
  • abdominal (tummy) pain

The bile duct can be unblocked using a small hollow tube called a stent, which widens the bile duct and keeps it open.

The stent can be inserted using either a long, flexible tube (endoscope) passed down your throat, or by making a small cut (incision) in your skin.

Occasionally, a stent can become blocked. If this happens, it will need to be removed and replaced.

Chemotherapy

Chemotherapy is used to relieve the symptoms of bile duct cancer, slow down the rate it spreads and prolong life.

It's used when the cancer is unsuitable for surgery but you're in good enough general health to have chemotherapy.

It's usually given through a drip into a vein in your arm.

Side effects of chemotherapy can include:

  • tiredness
  • feeling and being sick
  • hair loss
  • a higher chance of getting infections

The side effects should pass once the course of treatment has finished.

Read more about chemotherapy.

Radiotherapy

Like chemotherapy, radiotherapy is occasionally used with the aim of relieving symptoms, slowing the spread of the cancer and prolonging life, although it's not clear how effective it is in bile duct cancer.

It's usually given using a machine that carefully aims a beam of radiation at the cancerous area.

Side effects of radiotherapy can include:

  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin and loss of hair in the treatment area

The side effects should pass once the course of treatment has finished.

Read more about radiotherapy.

Clinical trials and research

Research is being done to look for better treatments for bile duct cancer.

For example, recent trials have looked at new combinations of chemotherapy medication and whether treatment with medicines called targeted therapies is effective.

There is also some research being done on injecting tiny radioactive "beads" into the blood vessels that supply the liver. The beads become trapped and release radiation directly into the cancer cells.

You may be asked if you want to take part in a clinical trial as part of your treatment. You can also ask your care team about any trials you may be able to participate in.

Read more about clinical trials.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 10/11/2020 10:47:17