Diagnosing Bile Duct Cancer

About Bile Duct Cancer

At Penn Medicine's Abramson Cancer Center, patients with bile duct cancer receive their care from a multidisciplinary team of nationally recognized experts in the diagnosis, treatment and research of gastrointestinal cancer.

Cholangiocarcinoma is a rare cancer involving the bile ducts. Bile ducts are the structures within the gastrointestinal tract that carry bile. Bile is the digestive fluid excreted by the liver, which flows via the bile ducts into the intestine.

There are two types of cholangiocarcinomas:

  • Intrahepatic: cancer that arises from within the liver
  • Extrahepatic: cancer that arises from outside of the liver and distal bile ducts

Cholangiocarcinomas can be further classified based on the tissue from which they arise. Most cholangiocarcinomas are adenocarcinomas, meaning they arise from glandular tissue.

Bile duct cancer is rare, accounting for about 3 percent of all gastrointestinal cancers.

Penn Medicine's multidisciplinary approach to cancer diagnosis and treatment provides better outcomes and gives patients access to the most advanced treatment, surgical techniques and clinical trials.

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Read more About Bile Duct Cancer

Diagnosing Bile Duct Cancer

An accurate cancer diagnosis from trusted cancer specialists is the first step in getting personalized treatment options for treating bile duct cancer.

Patients who choose Penn’s Abramson Cancer Center benefit from a multidisciplinary team of cancer specialists including gastroenterologists, radiologists, pathologists and surgeons who work together to provide a diagnosis and treatment plan custom designed for every patient with bile duct cancer.

Cancer specialists at Penn Medicine are highly experienced in using the most advanced techniques for diagnosing cancer and are actively researching better and more precise ways to detect bile duct cancer.

An accurate diagnosis is an important step in planning cancer treatment, so it’s important patients know that when they come to the Abramson Cancer Center, they are taking an important step in getting the best cancer treatment available.

Navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse to help them make an appointment with the right physician. Penn Medicine’s contact center has experienced cancer nurses available and ready to guide patients in finding the cancer specialist right for them.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN (7366).

Screening for Bile Duct Cancer

Currently, there are no standard bile duct cancer screening recommendations for the general public like mammograms for breast or colonoscopies for colon cancer. However, patients at increased risk may benefit from specific diagnostic testing, and this should be discussed with a gastroenterologist.

Diagnostic Tools for Bile Duct Cancer

When physicians suspect cancer, they may order several tests to make a diagnosis and stage the disease.

Bile duct cancer is most often diagnosed when patients show symptoms of a blockage or narrowing of the bile ducts.

  • Medical history and physical exam. Physicians examine patients for jaundice, or yellowing of the skin, which may be a sign bile is not draining properly from the bile ducts.
  • Lab tests. Lab tests can help a physician diagnose cancer, determine current organ function, learn how other organs may be affected and look for signs of reoccurrence. Lab tests can also look for elevated tumor markers such as carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and liver function.
  • Imaging tests. Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
    • Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is the diagnostic test most performed to diagnose bile duct cancer. Performed while the patient is under sedation, the procedure combines endoscopy and fluoroscopy to diagnose cancer. If cancer is suspected, the physician may biopsy the area or collect suspicious cells for further review.  
    • Endoscopic ultrasound (EUS).  Also performed under sedation, this procedure combines endoscopy and ultrasound to provide images of the bile ducts and surrounding structures, and may also be used for tissue acquisition.
    • Computed tomography (CT). Three-dimensional X-rays of the inside of the body are combined by a computer into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (dye) is used to provide better detail.
    • Magnetic resonance imaging (MRI). Magnetic fields are used to create detailed images of the body. A contrast medium may be injected into a vein to create a clearer picture.
    • Percutaneous transhepatic cholangiography (PTC). A thin needle is inserted via the liver into the biliary tree and dye is injected before an X-ray is taken. A stent may be left to drain bile if a blockage is found.
  • Biopsy. If other tests find a change that is possibly cancer, a sample of the suspicious area is removed and viewed under a microscope. A biopsy is the only way to tell if cancer is really present. 
    • Brush cytology. Brush cytology is a type of procedure that collects suspicious cancer cells. During an ERCP, a physician may use a small brush passed through the endoscope to collect cells for the lab.
    • Cholangioscopy. During an ERCP, a smaller endoscope is threaded through the larger one. The scope is inserted into the bile duct and, using a tiny camera, the physician can take a directed biopsy of the suspicious area. This procedure removes a larger piece of tissue, and may provide a more accurate diagnosis.
  • Laparoscopy. A minimally invasive surgical procedure allows the physician to view the lymph nodes and other organs to see if cancer has spread. Biopsies may be taken of the organ tissue.

Staging Bile Duct Cancer

Staging systems provide doctors with a common language for describing tumors. After cancer is first diagnosed, a series of tests are used to investigate the extent of the cancer and to see whether it has spread to other parts of the body from where it started. Staging is a way of recording the size and growth of a cancer, and determining the plan for treatment. By understanding the stage of their cancer, patients can make informed decisions about their treatment.

  • Stage 0. Cholangiocarcinomas only involve the lining of the bile duct and have not spread to lymph nodes or other organs. Also called carcinoma in situ.
  • Stage I. One of the following:
    • IA. Cancer is found in the bile duct only.
    • IB. Cancer has spread through the wall of the bile duct
  • Stage II. One of the following:
    • IIA. Cancer has spread to the liver, gallbladder, pancreas and/or the right or left branch of the hepatic artery or the right or left branch of the portal vein.
    • IIB- Cancer has spread to nearby lymph nodes and is found in the bile duct, has spread through the wall of the bile duct, or has spread to the liver, gallbladder, pancreas, and/or right or left branches of the hepatic artery or portal vein.
  • Stage III. Cancer that has spread and one of the following:
    • To the main portal vein or to both the right and left branches of the portal vein.
    • To the hepatic artery.
    • To other nearby organs and tissues.
  • Stage IV. Tumor that has spread to other distant organs.

A physician may also classify the disease as one of the following:

  • Local. The bile duct cancer lies within the bile duct and can be completely removed surgically. There is no evidence of any spread to areas outside of the bile duct.
  • Locally advanced. The cancer is still confined to the area around the bile duct, but does affect nearby organs, arteries, and/or veins. There is no evidence of spread to any distant areas of the body.
  • Metastatic. The tumor has spread beyond the area of the bile duct to reach distant areas of the body. It is unlikely that surgery can remove the cancer.

Bile Duct Cancer Treatment

Following the diagnosis and staging of bile duct cancer, cancer specialists at Penn Medicine’s Abramson Cancer Center develop a personalized treatment plan. Penn’s treatment options for bile duct cancer include:

  • Surgery
    • Bile duct resection
    • Partial hepatectomy
    • Whipple procedure
    • Surgical biliary bypass
    • Endoscopic stent placement
  • Radiation therapy
    • 3-D conformal radiation
    • Intensity-modulated radiation therapy (IMRT)
    • Volumetric-modulated arc therapy (VMAT)
    • Proton therapy
    • Brachytherapy
  • Chemotherapy and biologic therapies
  • Clinical trials
  • Other treatments
    • Integrative medicine and wellness
    • Palliative care
    • Penn Home Care and Hospice

Because navigating a cancer diagnosis and treatment options can be difficult, patients who wish to connect with a cancer specialist at Penn Medicine can speak with a cancer nurse, who can help them make an appointment with the right physician.

To connect with a cancer nurse at Penn Medicine, patients should call 800-789-PENN.

Read more Bile Duct Cancer Treatment

Bile Duct Cancer Survivorship

Survivorship programs at Penn Medicine are a distinct phase of bile duct cancer care and are designed to help patients' transition from their cancer treatment routine to a post-cancer care lifestyle.

Cancer treatments can result in physical, emotional and financial complications long after the therapy is complete.

Read more Bile Duct Cancer Survivorship

Stand Up to Cancer

Peter O'Dwyer, MD, professor of Hematology-Oncology and program director of Development Therapeutics in the Abramson Cancer Center, was interviewed on NBC10's 10! Show about Penn's work as part of the Stand Up to Cancer Dream Team... Read more

Clinical Trials

Clinical Trials

Clinical trials are studies to find new ways to prevent, detect and treat cancer. The purpose of each clinical trial is to answer a specific question. Our physicians carefully design these studies to find new ways to improve care and quality of life ... more about clinical trials