Diagnosis & staging
- Jaundice (when your skin and whites of your eyes turn yellow)
- Itchy skin
- Light or clay-coloured stools (poop)
- Weight loss you cannot explain
- Loss of appetite
- Fever
- Fatigue
- Abdominal (belly) pain
- Nausea (feeling queasy) or vomiting
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
How is bile duct cancer diagnosed?
Tests that may help diagnose bile duct cancer include:
- Physical examination: your doctor may look for signs of jaundice. They may feel your abdomen for lumps, tenderness, fluid build-up or an enlarged liver.
- Imaging to check for bile duct cancer and to see if it has spread
- Ultrasound
- CT (computerized tomography) scan
- MRI (magnetic resonance imaging)
- MRCP (magnetic resonance cholangiopancreatography): if your doctor thinks you have extrahepatic bile duct cancer.
- EUS (endoscopic ultrasound): a combination of an ultrasound and an endoscopy (when a long thin tube is put down your throat to look at your organs). This test can be used to do a biopsy of bile duct cells, check for bile duct stones or a tumour, and to check if cancer has spread to nearby lymph nodes.
- Cholangiography: dye is injected into your bile duct with a needle and x-ray pictures are taken. This can show where the cancer is.
- Endoscopic Retrograde Cholangiopancreatography (ERCP): used to check for extrahepatic bile duct cancer. A tube is put down your throat and into your bile duct. A dye is injected into the tube. The dye will show a narrowing or blockage of your bile duct. A brush can also be put into the tube to collect cells or tissue for a biopsy.
- Laparoscopy: surgery using a very small camera put into your body through your abdominal wall. The doctor will use the camera to look at your bile duct, liver and areas around them. This test can show how advanced the cancer is.
- Surgery or biopsy: may be needed to confirm cancer diagnosis.
- Tumour marker tests: A tumour marker is usually something made by a cancer cell or another cell when cancer is in your body. If you are diagnosed with bile duct cancer, your doctor may check for these tumour markers: CEA (carcinoembryonic antigen) and CA 19-9 (carbohydrate antigen 19-9).
Over 90% (90 out of 100) of bile duct cancers are adenocarcinomas. These cancers begin in the mucus glands lining the inside of the bile duct.
Bile duct adenocarcinoma is also called cholangiocarcinoma. Other bile duct cancers include squamous cell carcinoma, lymphoma and sarcoma. The different types of cancer start in different cells.
Bile duct cancers either start in the liver or outside of the liver:
- Extrahepatic - Cancer starts in the bile duct outside the liver. Extrahepatic bile duct cancers can be:
- Perihilar - Cancer starts in the hepatic duct where the bile ducts join just outside the liver. This is the most common place for bile duct cancer. It can also be called a hilar or Klatskin tumour.
- Distal - Starts in the area closest to the small intestine.
- Intrahepatic - Cancer starts in the bile duct inside the liver. Only about 10% (10 out of 100) bile duct cancers are intrahepatic.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
Bile duct cancer staging
Stage 0: The tumour (cancer growth) is only in the innermost layer of the bile duct.
Stage 1: The tumour is in the deeper layers of the bile duct.
Stage 2: The tumour has spread into the surrounding fat or the liver.
Stage 3A: The tumour has spread into the portal vein or the hepatic artery on one side of the liver.
Stage 3B: The tumour has spread into the portal vein on both sides of the liver, the common hepatic artery, or other bile ducts on one side of the liver and a main blood vessel on the other side of the liver.
Stage 4A: The cancer has spread to 4 or more lymph nodes.
Stage 4B: The cancer has spread to other parts of the body (distant metastasis).
Stage 0: The tumour (cancer growth) is only in the inner layer of the bile duct.
Stage 1: The tumour has spread less than 5 mm into the bile duct wall.
Stage 2A: The tumour has spread less than 5 mm into the bile duct wall and has spread to 1-3 nearby lymph nodes, or it has spread more than 12 mm into the bile duct wall.
Stage 2B: The tumour has spread 5-12 mm into the bile duct wall and has spread to 1-3 nearby lymph nodes, or it has spread more than 12 mm into the bile duct wall.
Stage 3A: The tumour has spread into the bile duct wall and has spread to 4 or more nearby lymph nodes.
Stage 3B: The tumour has spread into the blood vessels in the abdomen.
Stage 4: The cancer has spread to other parts of the body (distant metastasis).
Stage 1A: The tumour (cancer growth) is only in the bile duct and is 5 cm or smaller.
Stage 1B: The tumour is only in the bile duct and is larger than 5 cm.
Stage 2: One or more tumours have spread into blood vessels in the liver.
Stage 3A: The tumour has spread through the membrane that covers and supports the liver (visceral peritoneum).
Stage 3B: The tumour has spread into surrounding tissues outside the liver or the cancer has spread to nearby lymph nodes.
Stage 4: The cancer has spread to other parts of the body (distant metastasis).
For more information on staging, see our
About Cancer page.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Bile duct cancer can be grade 1, 2, 3 or 4. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
The grade of the cancer helps your health care team plan your treatment.
