Bile Duct Cancer

Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in your bile ducts. It often grows quickly — and quietly. So by the time you have symptoms, there’s a chance it’s already spread to other parts of your body. You may have:

• Intrahepatic cholangiocarcinoma affects the bile ducts inside your liver.
• Hilar cholangiocarcinoma affects where the main bile duct divides into right and left bile ducts.
• Extrahepatic cholangiocarcinoma affects the part of the bile duct outside your liver. This is the most common type of bile duct cancer.
• Gallbladder cancer is cholangiocarcinoma that starts in your gallbladder.

What to expect at your first visit

No one’s cancer story is the same. You may have different symptoms from someone else with the same condition. Sharing what’s been going on and how you’re feeling — in your own words — is an important part of your diagnosis.

That’s why your provider will ask you a few questions at your first appointment. They’ll want to know:

• What are your symptoms?
• How long have you had them?
• Are they getting worse?
• Have you ever had cancer before?
• Have you ever been diagnosed with a liver or gallbladder condition?
• Has anyone in your family ever had liver problems or cancer?

After we spend some time talking, your provider will do a physical exam to check your overall health and any noticeable symptoms. They’ll also order some tests to help confirm a diagnosis.

Testing for bile duct cancer

Many different tests can help us pinpoint what’s happening, so we can build your custom treatment plan. You may have:

• Blood tests for cancer: These tests look for proteins and other substances that can be signs of cancer.
• Liver function tests: We check your blood for levels of substances that could be signs of a blocked bile duct or show that your liver isn’t working right.
• Tumor marker tests: These tests check your blood or urine (pee) for CA-19-9, a protein specific to cholangiocarcinoma.
• Abdominal ultrasound: This lets us take pictures of your liver, pancreas and gallbladder to look for signs of cancer.
• CT scan: With these scans, we can get detailed pictures of your liver, lymph nodes and other organs where the cancer might have spread.
• Magnetic resonance cholangiopancreatography (MRCP): This imaging test takes detailed pictures of your liver, bile ducts, gallbladder, pancreas and pancreatic duct.
• Endoscopic retrograde cholangiopancreatography (ERCP):This test uses an advanced, minimally invasive tool with a camera (endoscope) and a thin tube (catheter) to add dye for contrast in the pictures.
• Percutaneous transhepatic cholangiography (PTC): With this test, we takes X-rays of your bile ducts like an ERCP, but the dye is sent directly to your liver and bile ducts with a needle through your skin.
• Biopsy: For this test, we take a small sample of tissue that’s examined for cancer cells under a microscope.

Your test results help us confirm whether you have cancer. They also help us learn about the cancer’s stage, if it’s spread and what treatments could offer the best results.

Second Opinions for Bile Duct Cancer

When you learn you may have bile duct cancer, it’s important to feel confident that you have a team of healthcare providers you trust on your side. That’s why we encourage second opinions.

Our expert cancer specialists will take the time to help you better understand your diagnosis and treatment options. We also know that cancer doesn’t wait, so we always try to meet with you as soon as possible. Getting a second opinion can help you feel more in control of your care. And it can give you peace of mind knowing you’ll have the most capable, compassionate providers in your corner.

Meet Our Bile Duct Cancer Team

Cancer treatment relies on the experience and input of providers from many different specialties. At Cleveland Clinic, your team of experts will work together to make sure you get the most personalized treatment and always keep you at the center of your care. Your team could include:

• Medical and surgical oncologists.
• Gastroenterologists.
• Hepatologists (liver specialists).
• Radiologists.
• Interventional radiologists.
• Liver and transplant surgeons.
• Pathologists.
• Nurse practitioners.
• Palliative care
• Social workers.
• Nurse coordinators.

No two cancers are the same. That’s why we tailor your treatment to match your needs. Your care plan is based on where the cancer is, if it’s spread (stage) and your overall health. This plan will aim to:

• Shrink the tumor.
• Remove as much of it as possible with surgery.
• Extend your lifespan.
• Manage symptoms and their effects on your life.

Depending on your test results, we may recommend a variety of treatment options.

Surgery

For early-stage bile duct cancer (cholangiocarcinoma), we can often remove part of your bile duct or we may take part of your bile duct and a section of your liver (partial hepatectomy).

If cancer started in your extrahepatic bile ducts, we may recommend the Whipple procedure. This surgery also removes your gallbladder and parts of your stomach, pancreas and small intestine. If your liver no longer works as it should, your provider may talk to you about the possibility of getting a liver transplant. 

When bile duct cancer is very advanced, we may suggest palliative surgery. We’ll place small, hollow tubes called stents into your bile duct to open it, drain the blocked bile and ease your symptoms.

Radiation therapy

Radiation therapy sends high-energy rays to the cancerous tissues. Radiation can destroy cancer cells before surgery to shrink the tumor. Or we may recommend it after surgery to kill any remaining cancer cells. Radiation therapy can also reduce cancer pain.

We can sometimes deliver radiation directly to your bile duct with something called radioembolization (or Y-90 treatment). In this minimally invasive procedure, an interventional radiologist places tiny beads of radiation in the tumor’s blood vessels through a small catheter to stop blood flow to the tumor and shrink it. Radioembolization delivers high doses of radiation to the tumor without harming healthy tissue.

Chemotherapy

You may have chemotherapy before surgery to shrink a tumor. Or you may have it after surgery to destroy any remaining cancer cells. If the cancer has spread to several different places in your body, systemic (throughout your system) therapies like chemotherapy may be the only option. We can sometimes deliver chemo directly to your bile duct:

• Transarterial chemoembolization (TACE): Similar to radioembolization, our expert interventional radiologists use a catheter (thin, flexible tube) to place tiny chemo beads in the tumor’s blood vessels to stop blood flow to the tumor and shrink it.
• Hepatic artery chemo-infusion (HAI): We surgically place a pump to inject chemo medications directly into the main artery that supplies your liver with blood.

Immunotherapy

Immunotherapy activates your body’s immune system to find and attack cancer cells. This is an innovative new way to treat bile duct cancer.

Targeted therapy

Targeted therapy targets certain characteristics of bile duct cancer cells to destroy them. Unlike chemotherapy, it doesn’t damage your healthy cells. This is another new and developing approach to treating bile duct cancer.

Taking the Next Step

Being diagnosed with a rare cancer like bile duct cancer (cholangiocarcinoma) can bring about all kinds of emotions — and questions about your future. But you don’t have to make decisions about what comes next alone. Cleveland Clinic has a team of experts with experience in treating advanced bile duct cancer. We’ll help you get the best treatment options. And you’ll have support, guidance and the compassionate care — every step of the way.