Cholangiocarcinoma (Bile Duct Cancer)

A healthcare provider will evaluate your symptoms, review your medical history and do a physical exam.

Tests for cholangiocarcinoma may include:

• Liver function tests: These liver tests check your blood for high levels of substances, such as elevated liver enzymes, that might indicate your liver isn’t working as it should. High levels may also mean you have a bile duct blockage.
• Tumor marker tests: These tests check your blood or urine for tumor markers — substances that might mean you have cancer. High levels of carbohydrate antigen (CA) 19-9 or carcinoembryonic antigen (CEA) may be signs of bile duct cancer.
• Imaging tests: An abdominal ultrasound is usually the first imaging test you’ll need if your provider suspects bile duct cancer. You may also need a CT scan or an MRI, including a specialized MRI called magnetic resonance cholangiopancreatography (MRCP).
• Endoscopic tests: These tests use an endoscope (a thin, flexible tube with a camera) to examine your bile ducts. While you’re sedated (in a light sleep), the endoscope goes into your mouth and down to your small intestine so your provider can see your bile ducts up close. Tests include endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP).
• Percutaneous transhepatic cholangiography (PTC): A PTC is a procedure that can be used to view bile duct blockages related to cholangiocarcinoma and drain the blockage. During the procedure, your provider will deliver a contrast dye directly into your bile ducts and liver. The dye causes blockages to show up more clearly on an X-ray. They’ll place a tube into the bile duct so it can drain. A PTC is usually only for people who can’t have an ERCP.

If test results indicate cancer, your healthcare provider will perform a biopsy to confirm the diagnosis. A biopsy removes a tissue sample so it can be tested for cancer. Your provider can take samples during an ERCP or PTC by inserting a small needle through your skin.

If you do have cholangiocarcinoma, your provider may perform tests on your tissue biopsy and blood (liquid biopsy) to check for genetic changes in cancer cells (biomarkers). Cholangiocarcinoma tumors can have important biomarkers. If they’re present, you may be eligible for special cancer treatments that target these cells for destruction (targeted therapy).

How is cholangiocarcinoma staged?

Cancer staging is an important part of a bile duct cancer diagnosis. It allows your healthcare provider to determine how much cancer is in your body. Staging helps your provider plan treatment and determine your prognosis.

Staging guidelines are different for each type of cholangiocarcinoma. But in general, bile duct cancer staging looks at the size of the tumor and whether cancer has spread from the bile ducts to your:

• Blood vessels.
• Lymph vessels and lymph nodes.
• Organs near your bile ducts, like your liver or gallbladder.
• Distant organs, such as your lungs, bones or abdominal cavity.

The staging scale ranges from stage 0 to stage 4. The least advanced and most treatable is Stage 0, or carcinoma in situ. This means you have abnormal cells that could become cholangiocarcinoma, but haven’t yet. Stage 4 is the final (or most advanced) stage of cholangiocarcinoma. At this stage, the cancer is metastatic. It’s spread beyond your bile ducts to distant parts of your body.