Bile Duct Cancer: Introduction

What is cancer?

Cancer starts when cells in the body change (mutate) and grow out of control. To help understand what happens when you have cancer, it helps to look at how your body normally works. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body doesn't need them any longer.

Cancer is made up of abnormal cells that grow even though your body doesn’t need them. In most cancers, the abnormal cells grow to form a lump or mass called a tumor. If cancer cells are in the body long enough, they can grow into (invade) nearby areas. They can even spread to other parts of the body (metastasize).

What are bile ducts?

The bile ducts are thin tubes that go from the liver and gallbladder to the small intestine. The ducts carry bile. Bile is a fluid made in the liver. It breaks down fats during digestion. The liver makes bile. Its stored in the gallbladder. During meals, the gallbladder sends bile through the common bile duct into the intestines to help with the digestion of food. There are two parts of the bile duct system that make this happen:

  • Intrahepatic bile ducts. This part of the bile duct system is inside the liver. It’s a network of many small tubes inside the liver that collect bile from liver cells. These ducts join into two (right and left) large hepatic ducts that exit the liver and join to become the common hepatic duct.

  • Extrahepatic bile ducts. These are the parts of the bile duct system that are outside the liver. After coming out of the liver, the right and left hepatic ducts join together in an area called the hilum to form the common hepatic duct. The cystic duct draining the gallbladder merges with the common hepatic duct to form the common bile duct. The common bile duct connects to the first part of the small intestine. 

    Front view of upturned liver showing biliary tree, pancreas, stomach, and gallbladder.

What is bile duct cancer?

Bile duct cancer can grow in any part of the bile ducts. Another term for bile duct cancer is cholangiocarcinoma. This cancer is grouped by type, depending on where it starts. Each type can cause different symptoms. The types are:

  • Perihilar (hilar) bile duct cancers (PHC). These grow in the hilum, where the main right and left bile ducts join as they are leaving the liver. Most bile duct cancers start here. You may hear PHC also called a Klatskin tumor.

  • Intrahepatic bile duct cancers. These grow in the tiny bile ducts inside the liver. Only a small number of bile duct cancers are this type.

  • Distal bile duct cancers. These tend to grow in the common bile duct near where it connects to the small intestine.

Talk with your healthcare provider

If you have questions about bile duct cancer, talk with your healthcare provider. Your healthcare provider can help you understand more about this cancer.


Bile Duct Cancer: Symptoms 

What are the symptoms of bile duct cancer?

People with bile duct cancer (cholangiocarcinoma) may have any or all of these symptoms. It depends on where the cancer is growing. Symptoms may include:

  • Jaundice. This is the yellowing of the whites of the eyes and skin. It’s caused by high levels of bilirubin in the blood. Bilirubin is a yellow-brown substance in bile. The liver makes bile from the breakdown of red blood cells. Bile travels from the liver through the bile ducts to the intestine. If the bile ducts are blocked by a tumor, bilirubin builds up in the bloodstream. Jaundice is the most common sign of bile duct cancer.

  • Itchy skin. This is caused by high levels of bilirubin in the skin.

  • Dark brown urine. This is caused by rising levels of bilirubin in the blood that comes out in the urine.

  • Pain. Pain may start in the upper right side of the stomach under the ribs. At first, bile duct cancers don’t often cause pain. But constant right upper abdominal pain can develop as the cancer grows.

Other symptoms can include: 

  • Fever or chills

  • Pale-colored or greasy stools 

  • Bloating

  • Loss of appetite

  • Weight loss

When to see your healthcare provider

Bile duct cancer is rare. Most times these symptoms are caused by other health problems. But it's important to see a healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.

Treatment Questions

Bile Duct Cancer: Treatment Questions

Talking with healthcare providers about cancer can be overwhelming. It can be hard to take in all of the information. It helps to be prepared. Make a list of questions and bring them to your appointments. Write down the answers.

Make sure you ask how the treatment will change your daily life, including your diet, activity, and how you will look and feel after treatment. Ask how well treatment is expected to work, and what the risks and possible side effects are.

You may also want to ask a friend or family member to go with you. They can take notes and write down the answers. They can also ask questions you may not think of. You can ask your healthcare provider if you can record the conversation.

Here are some questions you may want to ask:

Deciding on a treatment

  • What is the stage of my cancer?

  • Has the cancer spread outside of my bile ducts or anywhere else in my body?

  • What are my treatment choices?

  • How much experience do you have treating this kind of cancer?
  • Do I need to be treated right away?

  • What treatments do you think are best for me and why?

  • What treatments do you think are not right for me and why?

  • What are the goals of the treatment you are recommending?

  • What's the success rate of this treatment for my stage of bile duct cancer?

  • Will treatment affect my sex life or ability to have children?
  • How quickly do I need to decide on a treatment plan?
  • Are there any clinical trials I should look into?

  • Will my insurance cover these treatments?

  • How much will I have to pay for treatment?

  • Should I get a second opinion?

 Getting ready for treatment

  • What is the length of the treatment period?

  • How long will each treatment take?

  • Where do I have to go for the treatment?

  • Who will give me the treatment?

  • Does someone need to go with me during treatments?

  • Can I drive myself or take public transportation to treatment?
  • Can I take my other medicines during treatment?

  • Will I be able to work during treatment?

  • What can I do to get ready for treatment?

  • Do you have someone on staff who can help me with transportation, finances, and other resources?

 Coping during treatment

  • What side effects should I expect?

  • How long will side effects last?

  • Are there side effects that I need to call you about?

  • How do I get help after hours and on holidays or weekends?

  • What can I do about side effects?

  • Should I change my diet? What foods can't I eat?

  • Will I be able to go to work and be around my family?

  • Are there support groups nearby or online that I can join?

After treatment

  • How will I feel after the treatment?

  • What long-term side effects do I need to watch for?
  • What type of follow-up will I need after treatment?

  • How will we know if treatment worked?

  • What are my options if the treatment doesn't work, or if the cancer comes back?

Making a decision

When you have the answers from your healthcare providers, it's time to think about your preferences. Think about what side effects you can and can't tolerate. Talk about all of your concerns with your healthcare provider before making your treatment decision.


Timothy J Pluard, MD

Oncology / Hematology

Jacob P Smeltzer, MD

Oncology / Hematology

Addison R Tolentino, MD

Oncology / Hematology

Saint Luke’s Cancer Institute

Saint Luke's provides comprehensive cancer care, from expert diagnosis and personalized treatment plans to survivorship support.


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