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Cholangiocarcinoma (Bile Duct Cancer)

A specific type of cancer known as cholangiocarcinoma develops in the thin tubes (bile ducts) that transport the digesting fluid bile. The small intestine and the gallbladder are linked by bile ducts in the liver. Although it can happen at any age, cholangiocarcinoma, also known as bile duct cancer, mostly affects adults over the age of 50.


Depending on where cancer develops in the bile ducts, doctors categories cholangiocarcinoma into many types:


  1. Intrahepatic cholangiocarcinoma: A kind of liver cancer that develops in the bile ducts that are located inside the liver.
  2. Biliary cholangiocarcinoma: Bile ducts nearby the liver is where they develop. Additionally, known as perihilar cholangiocarcinoma.
  3. Distal cholangiocarcinoma: develops in the bile duct section closest to the small intestine. Additionally, known as extrahepatic cholangiocarcinoma.



Signs and symptoms of cholangiocarcinoma can include:


  1. Your skin and the whites of your eyes turn yellow (jaundice)
  2. Severely itchy skin;
  3. White-coloured stools
  4. Fatigue
  5. Abdominal pain on the right side, just below the ribs
  6. Losing weight without trying
  7. Fever
  8. Night sweats
  9. Dark urine

Stages of cancer:


Bile duct tumours are staged using a numerical staging approach into 4 primary stages, ranging from 1 to 4. Depending on the type of bile duct cancer you have, the staging will vary. An overview of bile duct cancer staging is provided below for all kinds of diseases.

Stage 1, small cancer. Cancer have not yet begun to disseminate to the nearby tissue.

Stage 2, A bigger cancer. Tumors could exist in one or more places. There might be cancer cells in the neighboring lymph nodes, and they might have spread into the tissues around them.

Stage 3 indicates localized cancer spread:

a) Tissues
b) Blood vessels
c) Organs such as the pancreas and gallbladder, and lymph nodes

Stage 4 denotes the progression of the malignancy to other body regions. Bile duct carcinoma frequently metastasizes to the liver and lungs.

This condition may also be referred to as metastatic bile duct cancer.


One or more of the following tests may be ordered if your doctor suspects you have cholangiocarcinoma:


  1. Liver Function Test: Your doctor may be able to learn more about the cause of your symptoms and signs by ordering blood tests to assess your liver function.
  2. Tumor Markers Test: Blood tests for carbohydrate antigen (CA) 19-9 may provide your doctor with further information about your diagnosis. Bile duct cancer cells overproduce the protein CA 19-9. However, a high blood level of CA 19-9 does not necessarily indicate bile duct cancer. Other bile duct illnesses, like bile duct inflammation and blockage, can also have this outcome.
  3. Endoscopic Retrograde Cholangiopancreatography (ERCP): An extremely small camera is attached to a thin, flexible tube that is sent down your mouth, through your digestive system, and into your small intestine during endoscopic retrograde cholangiopancreatography (ERCP). The camera is used to look at the region where your small intestine and bile ducts converge. To make the bile ducts more visible on imaging examinations, your doctor may also use this treatment to inject dye into them.
  4. Imaging Test: Your doctor can use imaging tests to inspect your inside organs and check for cholangiocarcinoma symptoms. Ultrasound, computerised tomography (CT) scans, and magnetic resonance imaging (MRI) combined with magnetic resonance cholangiopancreatography are methods used to detect bile duct cancer (MRCP). An increasingly popular non-invasive ERCP substitute is MRCP. It provides 3D images without the use of a dye to make them more vivid.
  5. A Biopsy: is a process to take a little sample of tissue for microscopic analysis. Your doctor might take a biopsy sample during ERCP if the suspicious area is very close to where the bile duct connects to the small intestine. Your doctor may take a tissue sample if the suspected region is inside or close to the liver by passing a long needle through your skin to the affected area (fine-needle aspiration). To direct the needle to the correct location, he or she may employ an imaging test, such as endoscopic ultrasound or CT scan. Which treatment options you later have may depend on how your doctor takes a biopsy sample. For instance, you will lose your eligibility for a liver transplant if a fine-needle aspiration biopsy is used to diagnose your bile duct cancer.

Risk factors:


The risk of bile duct cancer may increase as a result of the following circumstances. It is crucial to remember that the majority of Americans who develop this illness do not have any clear risk factors.


Previous bile duct illness or inflammation. Inflammation of the bile duct can be brought on by ulcerative colitis or stones that resemble gallstones. The following illnesses and diseases raise the risk of bile duct cancer:


  1. Primary Sclerosing Cholangitis (PSC): A rare inflammatory condition of the bile ducts which is caused by unknown reasons.
  2. Choledochal Cyst: This is an abnormality that a person has from birth. It causes swelling on the part of the bile duct outside the liver.
  3. Caroli Syndrome: An individual is usually born with this deformity in which the portion of the bile duct outside the liver becomes swollen as a result.
  4. Cirrhosis: Cirrhosis is a liver condition that can result in chronic inflammation or scarring. Hepatitis viruses and alcohol use are the two most common causes of cirrhosis, while there are other factors as well.
  5. Liver Flukes: Liver flukes are parasites that can infect the bile duct.
  6. Age: Older adults are more at risk of developing bile duct cancer.
  7. Certain Chemicals: Bile duct cancer may be brought on by dioxins, nitrosamines, and polychlorinated biphenyls (PCBs). People who work in the automotive and rubber industries in particular may be exposed to these chemicals more frequently.



The location of the tumour and whether it has spread determine the course of your cholangiocarcinoma treatment. Early bile duct tumours that haven't spread can be treated surgically. However, most bile duct tumours are already advanced when they are discovered. Your healthcare professional might suggest a mix of several medicines in certain circumstances.



A cancer that develops in the slender tubes that transport bile, the digestive fluid, through the liver. It's a rare but deadly type of cancer. Yellow skin and eyes (jaundice), intensely itchy skin, and white stool are all symptoms. Surgery, chemotherapy, and radiation therapy are all options for treatment.

Dr. Azhar Perwaiz
Meet The Doctor
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