Diagnosis & staging
These are tests that may be used to diagnose this type of cancer.
- Physical examination
- CT scan
- ERCP - Endoscopic Retrograde Cholangiopancreatography - A tube is passed down the throat and into the bile duct. A dye is injected into the tube, which can show a narrowing or blockage of the bile duct. A brush can also be inserted into the tube to collect cells or tissue for a biopsy.
- Cholangiography – A dye is injected into the bile duct with a thin needle and x-ray pictures are taken. This test can show where the tumour is located.
- Angiography – A small tube is inserted into a blood vessel, dye is injected and a series of x-ray images is then taken. Angiography is used to show the location of blood vessels near the tumour.
- Surgery or biopsy may be needed to confirm diagnosis.
For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.
Types and Stages
- Over 90% of bile duct cancers are adenocarcinomas
- Adenocarcinoma begins in the mucus glands lining the inside of the bile duct
- Bile duct adenocarcinoma is also called cholangiocarcinoma
- Squamous cell carcinoma
- Bile duct cancers are generally divided into 3 groups based on their location:
- Intrahepatic – in the bile duct branches inside the liver
- Extrahepatic or distal – in the common bile duct outside the liver near the small intestine
- Perihilar or Klatskin tumour – in the hepatic duct where the bile ducts join just outside the liver
Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.
T describes the site and size of the main tumour (primary)
N describes involvement of lymph nodes
M relates to whether the cancer has spread (presence or absence of distant metastases)
The cancer is limited to the innermost layer of the bile duct
The cancer is limited to the bile duct. Stage IB The cancer has spread through the wall of the bile duct
The cancer has spread to the liver, gallbladder, pancreas, or the right of left branches of the hepatic artery or to the right or left branches of the portal vein
The cancer has spread to lymph nodes, but not to organs far from the bile duct
The cancer has spread to the portal vein, or the hepatic artery, or duodenum (part of the small intestine), gallbladder, colon, or stomach and may have spread to lymph nodes, but has not spread to organs far from the bile duct.
The cancer has spread to organs far from the bile duct