Bile duct cancer (cholangiocarcinoma) is an uncommon form of primary liver cancer, making up 10–15% of all primary liver cancers worldwide. It starts in the cells lining the ducts that carry bile between the liver, gall bladder and bowel. Symptoms are similar to those of hepatocellular carcinoma (HCC).
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Risk factors
The main risk factor for bile duct cancer is long-term inflammation of the bile ducts. This may be caused by the same liver problems that can lead to HCC, such as hepatitis and fatty liver disease. Other risk factors include exposure to certain chemicals in the printing industry, or having inflammatory bowel disease or liver conditions such as primary sclerosing cholangitis which can cause scar tissue in the bile ducts.
Diagnosis
The main tests are ultrasound and MRI. In some cases, you may have a special MRI called a magnetic resonance cholangiopancreatography (MRCP), which shows bile ducts in more detail. Another option is an endoscopic retrograde cholangiopancreatography (ERCP). This uses a thin tube with a light and camera (endoscope) to examine the bile ducts or insert a stent.
Some blood tests look for proteins produced by cancer cells. These proteins are called tumour markers. Some people with bile duct cancer have higher levels of the tumour marker called CA 19-9.
Staging
Bile duct cancer is staged using the TNM system. This gives a number to the size of the tumour (T), how many lymph nodes are affected (N), and how far the cancer has spread, or metastasised, to distant parts of the body (M).
Treatment
Some people may have surgery to remove part of the liver or to insert a stent. Chemotherapy is a common treatment. This uses drugs to kill or damage cancer cells so they cannot grow or spread, and is usually given through a drip into a vein. External beam radiation therapy may be used for advanced bile duct cancer. This uses radiation to kill or damage cancer cells. SIRT, an internal radiation therapy, may be an option. Rarely, some people may be able to have a liver transplant.
More resources
Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital, WA.
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