Bile duct cancer - Diagnosing bile duct cancer

Bile duct cancer can be a challenging condition to diagnose. You usually need several different tests before an accurate diagnosis can be made.

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.

However, tumour markers can also be caused by other conditions. A positive blood test does not necessarily mean you have bile duct cancer, and a negative blood test does not always mean you don't.

Scans

A number of scans can be used to examine your bile ducts in more detail and check for lumps or other abnormalities that could be the result of cancer. These scans include:

ultrasound scan – high-frequency sound waves are used to build up a picture of the inside of your body
computer tomography (CT) scan – a series of X-rays of your liver are taken and a computer is used to assemble them into a more detailed three-dimensional image
magnetic resonance imaging (MRI) scan – this uses a strong magnetic field and radio waves to produce a picture of the inside of your liver

Endoscopic retrograde cholangio-pancreatography (ERCP)

Endoscopic retrograde cholangio-pancreatography (ERCP) allows your bile ducts show up more clearly on an X-ray scanner.

A special dye is injected and the X-ray scanner is used to guide an endoscope (a small, flexible tube with a camera at the end) down your throat and into your bile duct. The endoscope can detect blockages in your bile duct that could be the result of bile duct cancer.

A short wire-mesh tube, called a stent, may also be inserted into the artery during the procedure. The stent is left in place permanently to allow blood to flow more freely.

Spyglass

An advanced form of ERCP is a special test called a spyglass. This involves passing a specialised endoscope into the bile duct to detect abnormalities. It also enables a biopsy to be taken.

While this test can help confirm bile duct cancer in uncertain cases, it is very expensive and requires specialist training. Therefore, it is only available at a limited number of centres.

Percutaneous transhepatic cholangiography (PTC)

Percutaneous transhepatic cholangiography is carried out to obtain a detailed X-ray image of your bile duct.

The side of your abdomen (tummy) is numbed using local anaesthetic, and a special dye that shows up on X-rays is injected through your skin and into your liver duct.

As with ECRP, a stent may be inserted during the procedure. PTC and ECRP are both useful ways of detecting any blockages in your bile duct that could be caused by bile duct cancer.

Biopsy

If scans indicate that you may have bile duct cancer, a biopsy may be carried out to confirm a diagnosis.

During a biopsy, a small sample of tissue is taken from the body and checked under a microscope for cancerous cells.

A biopsy is usually performed while ERCP or PTC is being carried out. As well as taking bile and tissue samples from your bile duct, samples may be taken from nearby lymph nodes. This is to check whether the cancer has spread from your bile duct into your lymphatic system.

Staging

A widely used method of staging bile duct cancer is a number staging system. The stages are:

stage 1A – the cancer is contained inside the bile duct
stage 1B – the cancer is beginning to spread beyond the walls of the bile duct, but has not spread into the surrounding tissue or lymph nodes
stage 2 – the cancer has spread into nearby tissue, such as the liver, but has not spread into the lymph nodes
stage 3 – the cancer has spread into the lymph nodes and major blood vessels that supply the liver
stage 4 – the cancer has spread into distant organs, such as the lungs

Cancer support

If you are diagnosed with cancer, the Alan Morement Memorial Fund (AMMF) is currently the only dedicated UK charity that provides support for people affected by bile duct cancer.