Bile Duct Cancer Detection and Diagnosis

Signs of Bile Duct Cancer 

Typically, bile duct cancer does not cause symptoms during the early stages of the disease. When symptoms do occur, it's usually because of a bile duct that’s blocked by cancer cells. The signs and symptoms listed below could mean bile duct cancer, but they are also associated with other medical conditions. Check with your doctor if you experience any of the following:

  • Jaundice (yellowing of the skin or whites of the eyes)
  • Dark urine, even if you’re hydrated
  • Pale-colored and/or greasy-looking stool
  • Abdominal pain
  • Fever
  • Itchy skin
  • Nausea and vomiting
  • Unexplained weight loss

Tests to Determine a Bile Duct Cancer Diagnosis

No standard screening tests are currently available to detect bile duct cancer before symptoms appear. However, several tests can help make a diagnosis.

In addition to a physical examination, the following lab tests may be used to diagnose bile duct cancer:

Liver function tests

A blood sample is checked to measure the levels of bilirubin and alkaline phosphatase released into the blood by the liver. Increased levels of these substances can indicate liver disease caused by bile duct cancer.

Tumor marker tests

These tests look for tumor markers released into the blood by organs, tissues, or tumor cells. Elevated levels of carcinoembryonic antigen (CEA) and CA19-9 may indicate bile duct cancer.

Imaging Tests

  • Ultrasound: Sound waves create images of the bile duct and surrounding organs. Endoscopic ultrasound involves inserting a thin, flexible tube through the mouth to visualize the bile duct.
  • CT scan: An X-ray machine linked to a computer takes a series of detailed pictures of the organs near the bile duct (especially the liver), as well as lymph nodes and distant organs where cancer might have spread.
  • MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside your body, including the liver, bile ducts, gallbladder, pancreas, and pancreatic duct. The latest MRI technology is magnetic resonance cholangiopancreatography (MRCP), which is specifically used to diagnose bile duct cancer. 
  • Percutaneous transhepatic cholangiography (PTC): During this test, a thin needle is inserted into the bile duct in the liver. A contrast medium is injected into the bile ducts to make them visible on X-rays, helping to identify blockages.

Other Tests

  • Endoscopy: This procedure involves the insertion of an endoscope (a long, narrow tube with a camera and light) through the mouth and into the throat to examine the interior lining of the bile ducts.
  • Laparoscopy: This surgical procedure examines the organs inside the abdomen, such as the bile ducts and liver, for signs of cancer. Small incisions (cuts) are made in the wall of the abdomen, and a laparoscope (a thin, lighted tube) is inserted into one of the incisions.

Biopsy

A tissue sample is removed during a biopsy and examined under a microscope by a pathologist to check for signs of cancer. While other diagnostic tests can suggest cancer, a biopsy is the only guaranteed way to confirm it. 

Biopsies may be taken in different ways, including: 

  • Fine needle aspiration (FNA): A very small needle is placed into the tumor, and suction is used to extract cells. CT scans may help guide the needle. A specialist reviews the cells to determine the nature of the tumor.
  • Endoscopic retrograde cholangiopancreatography (ERCP): ECRP involves using a thin tube with a camera to examine the bile ducts. The tube is passed through the mouth and guided through the digestive tract to reach the bile ducts. A dye may be injected into the bile ducts to enhance visibility on X-rays. Sometimes, this procedure is also used to collect tissue samples for biopsy.

At the time of your biopsy, your oncologist may recommend testing the tissue sample for certain genetic changes (biomarkers) in the cells. Also called molecular testing of the tumor, these laboratory tests help identify specific genes, proteins, and other factors unique to the tumor. 

Once the diagnostic tests are complete, your doctor will discuss the results with you. If the diagnosis is bile duct cancer, these results will also help the oncologist determine the extent of the cancer, known as staging.

More About the Stages of Bile Duct Cancer