DiagnosisBile duct cancer (cholangiocarcinoma)
It can be difficult to diagnose bile duct cancer. You may need to have a number of different tests.
Some of the tests that may be carried out 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 say for certain whether or not you have bile duct cancer.
Scans
Several scans 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 up a picture of the inside of your body
- a computerised tomography (CT) scan – a series of X-rays of your liver and bile duct are taken and a computer is used to assemble them into a more detailed three-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 cholangio-pancreatography (ERCP) allows your bile ducts to be seen clearly on an X-rayscanner.
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 – the X-ray scanner helps guide it to the right place
- a special dye is injected into the bile duct, so it shows up clearly on the scanner and any abnormal areas are easier to spot
- a small sample of tissue may be removed (a biopsy) so it can be checked under a microscope for signs of cancer
- a stent (hollow tube) may be inserted to hold the bile duct open and stop it becoming blocked
You'll be awake while the test is carried out, but you'll normally be given an injection of sedative medication to make you very drowsy 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 studied under a microscope
- a stent may be inserted to hold the bile duct open
You'll be awake while this is carried out, but you'll usually have sedative medication to make you drowsy 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 a system called the TNM system to stage bile duct cancer. This consists of three numbers:
- 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
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.