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Bile duct cancer

Published by Bupa's health information team, May 2008.

This factsheet is for people who have bile duct cancer, or who would like information about it.

Bile duct cancer is rare. Around 600 people in the UK are diagnosed with bile duct cancer each year. It's more common in Chile, Japan and Northern India. Bile duct cancer is most common in people aged between 50 and 70. It's rare in people under 40.

Bile duct cancer is also called cholangiocarcinoma.

• Animation - How cancer develops
• About bile duct cancer
• Symptoms
• Causes
• Diagnosis
• Treatment
• Living with bile duct cancer
• Further information
• Questions and answers
• Related topics
• Sources

How cancer develops

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About bile duct cancer

The bile duct

Bile is a digestive fluid that helps to break down fatty food. It's made in your liver then passes to the gallbladder via the bile duct where it's stored. Bile then passes from the gallbladder into your small bowel through the common bile duct. Bile has a yellow/green colour as it contains bilirubin, which comes from the breakdown of used red blood cells. If bile isn't removed from your blood it builds up and you become jaundiced (yellow skin).

The location of the bile duct and surrounding structures

What is bile duct cancer?

A bile duct tumour is a lump created by an abnormal and uncontrolled growth of cells. It can be either malignant (cancerous) or benign.

Cancerous tumours can grow through your bile duct and spread to other parts of your body (through the bloodstream or the lymph system) where they may grow and form secondary tumours. This spread of cancer is called a metastasis.

Benign tumours don't spread to other areas of the body.

Types of bile duct cancer

Bile duct cancer usually starts in the gland cells of the bile duct and is called adenocarcinoma. Part of the bile duct is found in the liver and part of it is outside the liver. If the bile duct cancer is found inside the liver it's called intra-hepatic bile duct cancer. If it's outside the liver it's called extra-hepatic bile duct cancer. Intra-hepatic bile duct cancer is treated in the same way as liver cancer.

This factsheet will focus on extra-hepatic bile duct cancer.

Symptoms

If you have bile duct cancer, you may have some of the following symptoms:

• mild pain in the upper abdomen (tummy)
• loss of appetite or feeling sick
• your skin and the white of your eyes are yellowed (jaundice)
• dark urine
• pale coloured faeces
• unexplained weight loss
• itchy skin
• diarrhoea (loose stools)

Although not necessarily a result of bile duct cancer, if you have any of these symptoms you should visit your GP.

Causes

The causes of bile duct cancer aren't fully understood at present. However, there are certain factors that make bile duct cancer more likely and these are listed below.

• It's slightly more common if you were born with abnormal bile ducts.
• If you have ulcerative colitis your risk is increased.
• Your risk increases if you are a smoker or have been exposed to particular industrial chemicals used in the metal or rubber industry.
• If you have been infected with a parasite called the liver fluke, this increases the risk of bile duct cancer. Infection generally occurs in Eastern Europe, Asia and South America so it's more common in these areas.
• Hepatitis B or C infection may also increase your risk of bile duct cancer
.

Diagnosis

Your doctor will ask you about your symptoms and will examine you. Your GP may give you a blood test and may refer you to a different doctor, such as a specialist in conditions that affect the gallbladder, for further tests including the following.

• Further blood tests may be taken to check your general health and the levels of bilirubin in your blood.
• An ultrasound scan uses high frequency sound waves to produce an image of the abdomen.
• A CT (computerised tomography) scan uses X-rays to build up a three-dimensional picture of the abdomen.
• An MRI (magnetic resonance imaging) scan uses magnets and radiowaves to produce two- and three-dimensional pictures of the body.
• An endoscopic retrograde cholangio-pancreatography (ERCP) is a test using a narrow, flexible, tube-like telescopic camera called an endoscope which is used to check parts of your digestive system. You will have an anaesthetic spray to numb your throat and you may need a sedative.
• Percutaneous transhepatic cholangiography (PTC) is when a needle is passed through the skin to the liver and a dye is injected into the bile duct in the liver. An X-ray is then taken to detect any blockages or cancer. For this you will need a local anaesthetic.
• Some people may need an angiogram, which is when a fine tube is inserted into an artery in your groin and a dye is injected. This will highlight all the blood vessels when an X-ray is taken.
• A biopsy may be taken. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
• Other tests can include an endoscopic ultrasound scan (EUS) which uses an endoscope which has an ultrasound probe to check the pancreas and the surrounding tissues. An ultrasound is used to produce images to detect any cancer. Some people may need a laparotomy, which is a small incision made in your abdomen so your doctor can look directly at the bile duct and surrounding tissues. For this you will need a general anaesthetic.

For more information, see Related topics. The results of the tests will determine your course of treatment.

Treatment

The treatment for bile duct cancer depends on the type, stage and grade of cancer that you may have. Bile duct cancer is often at an advanced stage when it's diagnosed and it may not be possible to cure the cancer. The following treatments may be used even if a cure isn't possible.

Surgery

Surgery may be used to remove the bile ducts and possibly some of the surrounding tissue and organs if they are also affected by the cancer. This is the only way to cure the cancer. The bile duct is in an awkward position and it may not be possible to remove all of the cancer. Bypass surgery, which allows the bile to flow from the liver to the small bowel, may be suggested if it isn't possible to remove the tumour.

Stent insertion

A stent (a small hollow tube) may be inserted to help the bile drain properly into the digestive system and prevent jaundice. This can be added during an ERCP or PTC. A catheter (a longer tube which drains to the outside of the body) can also be inserted.

Radiotherapy

This uses radiation to destroy cancer cells but isn't generally suitable for bile duct cancer. It's sometimes given at the same time as chemotherapy. For more information, see Related topics.

Chemotherapy

Medicines to attack cancer cells are given to some people with certain types of cancer. Chemotherapy medicines may be given if the cancer can't be completely removed or has spread elsewhere in the body. In some patients it can shrink the tumour for a short time. You may be offered this type of treatment as part of a clinical trial. For more information, see Related topics.

Photodynamic therapy

A light sensitive medicine is injected into your body via a vein and is taken up by cancer cells. A laser is then passed over the cells to activate the medicine which then kills the cells. It's not yet clear how effective this treatment is.

Living with bile duct cancer

After treatment for cancer you will have regular check ups with your doctor to detect any evidence of the cancer returning. If the cancer has already spread you may be seen regularly by doctors or specialist nurses to arrange treatments that can deal with any symptoms you might develop.

Being diagnosed with cancer can be distressing for you and your family. Specialist cancer doctors and nurses are experts in providing the care and support you need. There may be support groups where you can meet people who may have similar experiences to you. Ask your doctor for advice.

Further information

• Cancerbackup
  0808 800 1234
  www.cancerbackup.org.uk

Related topics

• Chemotherapy
• CT scan
• General anaesthesia
• Local anaesthesia and sedation
• Radiotherapy
• Abdominal ultrasound
• Cancer staging and grading

Sources

• Bile Duct Cancer. Cancerbackup. www.cancerbackup.org.uk, accessed 10 October 2007
• Bile Duct Carcinoma. GP Notebook. www.gpnotebook.co.uk, accessed 10 October 2007
• Khan SA, TH, Davidson BR, Taylor-Robinson SD, Cholangiocarcinoma. The Lancet, 2005. 366: 1303-1314
• Photodynamic Therapy for Bile Duct Cancer. National Institute of Health and Clinical Evidence (NICE). www.nice.org.uk, accessed 11 October 2007
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press 2005:442-443
• Souhami R, TJ, Cancer and its Management. 5th ed. Oxford: Blackwell, 2005

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: May 2008. Expected review date: May 2010.