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Bile Duct

This information should not be used for self-diagnosis or in place of a qualified physician’s care.

Reviewed Jan 2016

The basics
  • Guidelines for treating this cancer have been developed by the Gastrointestinal (GI) Tumour Group.
  • For health professional information on treating this cancer, please see our Cancer Management Guidelines (Bile duct).
  • Other names/types of bile duct cancer: cancer of the bile duct, cholangiocarcinoma, intrahepatic bile duct cancer, distal bile duct cancer, extrahepatic bile duct cancer, perihilar bile duct cancer, Klatskin tumour.
  • The bile duct is a 4-5 inch long tube that carries bile from the liver to the gallbladder and then to the small intestine.
  • Bile is a fluid made in the liver to help digest fats in the small intestine. Bile is sent to the gallbladder where it is stored until it is needed in the small intestine to help digest food.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

  • Bile duct cancer is relatively rare.
  • People older than 65 years are more likely to develop bile duct cancer.
  • Women and men get this type of cancer in roughly equal numbers.
  • People with chronic inflammation of the bile duct, called sclerosing cholangitis, have an increased risk of bile duct cancer.
  • Some diseases, such as polycystic liver disease, ulcerative colitis, stones in the bile duct, choledochal cysts, cirrhosis (damage to the liver) and Caroli syndrome, may increase the risk of bile duct cancer.
  • Being overweight is a risk factor.
  • There is a much higher rate of bile duct cancer in South East Asia. This is probably because of the high rate of infection by liver flukes, which are parasites that live in the bile duct.
  • Infection with hepatitis B or hepatitis C may increase the risk of bile duct cancer.
  • Exposure to hazardous materials, such as dioxins, asbestos, nitrosamines and Thorotrast, is a risk factor.
  • Bile duct cancer is more common in some families with a history of the disease.
  • Statistics:

Can I help to prevent it?

  • Avoid excessive use of alcohol because it may lead to cirrhosis (damage to the liver). Not drinking at all will reduce your cancer risk the most. If you choose to drink alcohol, the key is to keep your drinking at the safest possible levels, called low-risk drinking. The American Institute for Cancer Research advises that if you do drink alcohol, limit your consumption to no more than two drinks a day for men and one drink a day for women. 
  • Hepatitis B may lead to cirrhosis, so vaccinations are encouraged to protect against hepatitis B. Learn more about Hepatitis B vaccination on the Immunize BC website.
  • If travelling in parts of the world where liver flukes are common, drink only purified water and choose foods that have been thoroughly cooked.
  • Avoid exposure to hazardous chemicals.

Screening for this cancer 

  • No effective screening program exists for this cancer yet.

Signs and Symptoms

  • Jaundice (yellowing of the skin and whites of the eyes)
  • Itching of the skin
  • Light or clay-coloured stools
  • Unexplained weight loss
  • Loss of appetite
  • Fever
  • Abdominal pain
  • Bleeding
Diagnosis & staging


These are tests that may be used to diagnose this type of cancer. 

  • Physical examination
  • Ultrasound
  • 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.
  • MRI
  • 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


  • Adenocarcinoma
    • 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
  • Sarcoma
  • 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)
  • Stage 0
    The cancer is limited to the innermost layer of the bile duct 
  • Stage IA 
    The cancer is limited to the bile duct. Stage IB The cancer has spread through the wall of the bile duct 
  • Stage IIA
    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
  • Stage IIB
    The cancer has spread to lymph nodes, but not to organs far from the bile duct 
  • Stage III 
    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.
  • Stage IV 
    The cancer has spread to organs far from the bile duct


Cancer therapies can be highly individualized – your treatment may differ from what is described below.


  • The preferred treatment is surgery to remove the tumour. 
  • If the tumour cannot be removed, surgery may be performed to bypass a blockage or a stent (plastic or metal tube) may be inserted into the bile duct to keep it open.

Radiation Therapy

  • Radiation therapy may be used if the tumour is fairly small and cannot be removed by surgery.
  • It can also be used sometimes to help with symptoms such as pain.


  • The role of chemotherapy is still being studied.
  • Chemotherapy is sometimes helpful, although it will not cure bile duct cancer.

Advanced Bile Duct Cancer

  • Many patients with apparently advanced disease can enjoy a prolonged period of palliation by using a combination of surgery and radiation therapy. Please see also the resources available for patients with advanced cancer.

Follow-up after Treatment

  • Guidelines for follow-up after treatment are covered on our website.
  • You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer oncologist or nurse.
  • Follow-up testing is based on your type of cancer and your individual circumstances.
  • Life after Cancer focuses on the issues that cancer survivors can face.
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