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This PDQ cancer information summary has current information about the treatment of bile duct cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Date Last Modified") is the date of the most recent change. The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Adult Treatment Editorial Board.
CONTENTS
- What Is Bile Duct Cancer (Cholangiocarcinoma)?
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Bile duct cancer is a rare disease in which malignant (cancer) cells form in the bile ducts. Bile duct cancer is also called cholangiocarcinoma.
A network of tubes, called ducts, connects the liver, gallbladder, and small intestine. This network begins in the liver where many small ducts collect bile (a fluid made by the liver to break down fats during digestion). The small ducts come together to form the right and left hepatic ducts, which lead out of the liver. The two ducts join outside the liver and form the common hepatic duct. The cystic duct connects the gallbladder to the common hepatic duct. Bile from the liver passes through the hepatic ducts, common hepatic duct, and cystic duct and is stored in the gallbladder.
When food is being digested, bile stored in the gallbladder is released and passes through the cystic duct to the common bile duct and into the small intestine.
Types of bile duct cancer
There are two types of bile duct cancer:
Signs and symptoms of bile duct cancer
These and other signs and symptoms may be caused by bile duct cancer or by other conditions. Check with your doctor if you have any of the following:
There are no routine screening tests to check for bile duct cancer before signs and symptoms occur. To learn about tests that are used to diagnose bile duct cancer, see Bile Duct Cancer Diagnosis.
- Bile Duct Cancer Causes and Risk Factors
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Anything that increases your chance of getting a disease is called a risk factor. There are several risk factors associated with bile duct cancer. Not everyone with one or more of these risk factors will develop the disease, and the disease will develop in some people who don’t have any known risk factors. People who think they may be at risk should discuss this with their doctor.
Risk factors for bile duct cancer include the following conditions:
There are actions you can take that can help to decrease your risk of getting cancer. To learn more about ways to prevent cancer, see Cancer Prevention Overview.
- How is bile duct cancer diagnosed?
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Procedures that make pictures of the bile ducts and the nearby area help diagnose bile duct cancer (cholangiocarcinoma) and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the bile ducts or to distant parts of the body is called staging.
In order to plan treatment, it is important to know if the bile duct cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage bile duct cancer are usually done at the same time. Every person will not receive all the tests described below.
The following tests and procedures may be used:
Different procedures may be used to obtain a sample of tissue and diagnose bile duct cancer. Cells and tissues are removed during a biopsy so they can be viewed under a microscope by a pathologist to check for signs of cancer. The type of procedure used depends on whether the patient is well enough to have surgery.
Types of biopsy procedures include the following:
What affects bile duct cancer prognosis?
Once bile duct cancer has been diagnosed, the prognosis (chance of recovery) and treatment options depend on the following:
Treatment options may also depend on the symptoms caused by the cancer. Bile duct cancer is usually found after it has spread and can rarely be completely removed by surgery. Palliative therapy may relieve symptoms and improve the patient's quality of life.
- Bile Duct Cancer Stages
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This page describes the stages of bile duct cancer (cholangiocarcinoma) for adults. The stage describes the extent of cancer in the body. Knowing the stage helps the doctor plan the best treatment. Bile duct cancer stages are described using the TNM staging system. To learn more about TNM and how cancer stages are described, see Cancer Staging.
To learn about the tests and procedures used to diagnose and stage bile duct cancer, see Bile Duct Cancer Diagnosis.
Intrahepatic bile duct cancer
Perihilar bile duct cancer
Distal bile duct cancer
For bile duct cancer, the following groups are used to plan treatment:
Resectable (localized) bile duct cancer
The cancer is in an area, such as the lower part of the common bile duct or perihilar area, where it can be removed completely by surgery.
Unresectable (including metastatic and recurrent) bile duct cancer
Unresectable cancer cannot be removed completely by surgery. Most patients with bile duct cancer cannot have their cancer completely removed by surgery.
Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic bile duct cancer may have spread to the liver, other parts of the abdominal cavity, or to distant parts of the body. To learn more about metastatic cancer, see Metastatic Cancer: When Cancer Spreads.
Recurrent bile duct cancer is cancer that has come back after treatment. The cancer may come back in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body. To learn more about recurrent cancer, see Recurrent Cancer: When Cancer Comes Back.
To learn about treatment options, see Bile Duct Cancer Treatment.
- Bile Duct Cancer Treatment
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This page describes the different types of treatment for bile duct cancer (cholangiocarcinoma). Which of these treatments a patient receives will depend on whether the cancer can be completely removed with surgery (resectable) or not (unresectable). To learn more, see treatment of resectable and treatment of unresectable bile duct cancer.
Types of treatment
Surgery
The following types of surgery are used to treat bile duct cancer:
After the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. It is not yet known whether chemotherapy or radiation therapy given after surgery helps keep the cancer from coming back.
The following types of palliative surgery may be done to relieve symptoms caused by a blocked bile duct and improve quality of life:
Radiation therapy
Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. These are the main ways radiation might be given to treat bile duct cancer:
External and internal radiation therapy are used to treat bile duct cancer and may also be used as palliative therapy to relieve symptoms and improve quality of life.
To learn more about radiation therapy and its side effects, see Radiation Therapy to Treat Cancer and Radiation Therapy Side Effects.
Chemotherapy
Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. There are two main types of chemotherapy used to treat bile duct cancer.
It is not known whether systemic chemotherapy helps in the treatment of resectable bile duct cancer.
To learn about the different ways chemotherapy works against cancer, what to expect when receiving chemotherapy, and how to manage chemotherapy side effects, see Chemotherapy to Treat Cancer.
Liver transplant
In a liver transplant, the entire liver is removed and replaced with a healthy donated liver. A liver transplant may be done in patients with perihilar bile duct cancer. If the patient has to wait for a donated liver, other treatment is given as needed.
Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do. The following targeted therapies are being studied in patients with bile duct cancer that is locally advanced and cannot be removed by surgery or has spread to other parts of the body:
To learn more about how targeted therapy works against cancer, what to expect when having targeted therapy, and targeted therapy side effects, see Targeted Therapy to Treat Cancer.
Immunotherapy
Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.
Immune checkpoint inhibitor therapy is a type of immunotherapy. The following immune checkpoint inhibitor may be used to treat bile duct cancer:
To learn more about how immunotherapy works against cancer and immunotherapy side effects, see Immunotherapy to Treat Cancer and Immunotherapy Side Effects.
Clinical trials
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. For some patients, taking part in a clinical trial may be the best treatment choice.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
To learn more about clinical trials, see Clinical Trials Information for Patients and Caregivers.
Treatment of resectable (localized) bile duct cancer
If the cancer has not spread and is in a place where surgery can be safely done, the tumor and some of the tissue around it will be removed. This lowers the chance of the cancer coming back. Chemotherapy with or without radiation therapy may be given after surgery.
Treatment of resectable intrahepatic bile duct cancer may include the following:
Treatment of resectable perihilar bile duct cancer may include the following:
Treatment of resectable distal bile duct cancer may include the following:
Adjuvant therapy for resectable bile duct cancer may include the following:
Treatment of unresectable bile duct cancer (including metastatic or recurrent disease)
Most people with bile duct cancer cannot have their cancer completely removed with surgery. This may be the case if the cancer has spread too far, the cancer is in a place that is too difficult to completely remove with surgery, or the patient is not healthy enough for surgery.
Treatment of unresectable bile duct cancer (including metastatic or recurrent disease) may include the following: