Bile duct cancer (cholangiocarcinoma)

Cancer of the bile duct (cholangiocarcinoma) is a rare type of cancer that mainly affects adults aged over 65.

Bile ducts are small tubes that connect the liver and small intestine. They allow fluid called bile to flow from the liver, through the pancreas, to the gut, where it helps with digestion. Cancer can affect any part of these ducts.

Bile duct cancer can sometimes be cured if caught very early on, but it's not usually picked up until a later stage, when a cure isn't possible.

Symptoms of bile duct cancer

There aren't usually any symptoms of bile duct cancer until it grows large enough to block the bile ducts.

This can cause:

• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin
• pale stools and dark urine
• loss of appetite and weight loss 
• persistent tiredness and feeling unwell
• tummy (abdominal) pain and swelling – some people feel a dull ache in the upper right hand side of their tummy
• high temperature (fever) of 38C (100.4F) or above
• chills and shivering

See your GP if you have persistent symptoms that you're worried about – particularly if you have jaundice. These symptoms can have a number of causes, so it's important to get a proper diagnosis.

Causes of bile duct cancer

The exact cause of bile duct cancer is unknown. Most occur without a clear cause, although some things can increase your risk of getting it.

These include:

• primary sclerosing cholangitis – a rare type of liver disease that causes long-term inflammation of the liver
• bile duct abnormalities – such as cysts (fluid-filled sacs) in the bile ducts that are present from birth
• biliary stones within the liver – hard stones, similar to gallstones, that form in the bile duct
• infection with a liver fluke parasite (mostly a problem in Asia)
• exposure to certain chemicals and toxins, including thorotrast (a special dye that used to be used in medical scans)

There may also be a link with long-term hepatitis B and hepatitis C infections, liver scarring (cirrhosis), diabetes, obesity, smoking and excessive alcohol consumption.

Tests for bile duct cancer

Several tests may be needed to help diagnose bile duct cancer. These will usually be carried out in hospital.

Tests you may have include: 

• blood tests to check for signs of cancer or a problem with your liver
• scans, such as an ultrasound scan, computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan
• detailed X-rays taken after a special dye has been injected into your bile ducts to make them show up more clearly
• a biopsy – where a small sample of tissue is removed so it can be looked at under a microscope for signs of cancer

Read more about how bile duct cancer is diagnosed.

Treatments for bile duct cancer

It's not usually possible to cure bile duct cancer because it's often only diagnosed after it has grown and spread.

But even in these cases, treatment can help control the symptoms for months or possibly years.

The main treatments for bile duct cancer are:

• surgery to remove the affected area – this is only suitable for a small number of people, but could get rid of the cancer completely
• inserting a hollow tube (stent) into the bile duct to stop it becoming blocked – this can help relieve symptoms such as jaundice
• chemotherapy – where medication is given to stop the cancer cells growing and to relieve your symptoms
• radiotherapy – where a beam of radiation is carefully aimed at the cancer cells to stop them growing and to relieve your symptoms

Read more about how bile duct cancer is treated.

Outlook for bile duct cancer

The outlook for bile duct cancer depends on which part of the bile duct is affected and how far the cancer has grown.

Even if it's possible to remove the cancer, there's a chance it could come back later. 

Overall:

• one in every two to five people (20-50%) will live at least five years if bile duct cancer is caught early on and surgery is carried out to try to remove it
• one in every 50 people (2%) will live at least five years if it's caught at a later stage and surgery to remove it isn't possible

Cancer Research UK has more information about survival statistics for bile duct cancer.

Bile duct cancer support group

The Alan Morement Memorial Fund (AMMF) is the main UK charity that provides support for people affected by bile duct cancer.