Diagnosis

It can be difficult to diagnose bile duct cancer. You may need to have several different tests.

Some of these tests are described below.

Blood tests

In bile duct cancer, the cancerous cells may release certain chemicals that can be detected using blood tests. These are known as tumour markers.

But tumour markers can also be caused by other conditions, so this test cannot be used to tell for certain whether or not you have bile duct cancer.

Scans

Several types of scan can be used to examine your bile ducts in detail and check for lumps or other abnormalities that could be the result of cancer.

These include:

• an ultrasound scan – high-frequency sound waves are used to build a picture of the inside of your body
• a CT scan – a series of X-rays of your liver and bile ducts are taken and a computer is used to assemble them into a more detailed 3-dimensional image
• a MRI scan – a strong magnetic field and radio waves are used to produce an image of the inside of your liver and bile ducts

ERCP test

Endoscopic retrograde cholangiopancreatography (ERCP) allows your bile ducts to be seen clearly on an X-ray.  

During the test:

• an endoscope (a small, flexible tube with a camera at the end) is passed down your throat to the opening of your bile ducts – an X-ray scanner is used to guide it to the right place
• a special dye is injected into a bile duct so it shows clearly on the scanner and any abnormal areas are easier to see
• a small sample of tissue may be removed (a biopsy) so it can be checked for signs of cancer
• a small hollow tube (stent) may be inserted to hold a bile duct open and stop it becoming blocked

You'll be awake while the test is done. However, you'll usually be given an injection of a sedative medicine to make you very sleepy, and your throat will be numbed with local anaesthetic spray.

PTC test

Percutaneous transhepatic cholangiography (PTC) may also be used to get a detailed image of your bile ducts.

During the test:

• a needle is passed through your skin and used to inject a special dye into your bile ducts
• detailed X-rays are taken of your bile ducts
• a small sample of tissue from a bile duct may be removed so it can be examined
• a small hollow tube (stent) may be inserted to hold a bile duct open and stop it becoming blocked

You'll be awake while this is done. However, you'll usually be given a sedative medicine to make you sleepy, and local anaesthetic to numb the area where the needle is inserted.

Stages of bile duct cancer

If you're diagnosed with bile duct cancer, it will be possible to give your cancer a "stage". This is a number that indicates how far the cancer has spread.

Doctors use the TNM system to stage bile duct cancer, which consists of 3 factors:

• T (tumour) – describes the size of the tumour
• N (node) – describes whether the cancer has spread to nearby lymph glands
• M (metastases) – describes whether the cancer has spread to another part of the body

The doctor will give each factor a number based on how much the cancer has grown or spread. For example, "T3 N1 M1" would describe a large cancer that has spread into lymph nodes and into another part of the body.

Knowing the stage of your cancer will help your doctors decide on the best treatment for you.

Cancer Research UK has more detailed information about the stages of bile duct cancer.

Page last reviewed: Tue Sep 2022 Next review due: Wed Feb 2020