Bile Duct Cancer: Introduction

What is cancer?

Cancer is when cells in the body change and grow out of control. To help understand what happens when you have cancer, look at how your body works normally. Your body is made up of tiny building blocks called cells. Normal cells grow when your body needs them, and die when your body does not 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 (metastasis).

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 that breaks down fats during digestion. When the liver secretes bile, it is then stored by the gallbladder. During meals, the gallbladder releases bile into the common bile duct to help with the digestion of food in the intestines. Two areas of the bile duct system are involved in this process:

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

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

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 different types depending on where it starts. Each type can cause different symptoms. The types are:

  • Perihilar (hilar) bile duct cancers. 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.

  • 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 typically grow in the common bile duct near the first part of 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 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 a buildup of bilirubin in the blood. Bilirubin is a yellow-brown substance in bile. The liver makes bile. Bile travels from the liver through the bile ducts to the intestine. If the bile ducts are blocked by a tumor or scarring, bilirubin builds up in the bloodstream. Jaundice is the most common symptom of bile duct cancer.

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

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

  • Pain. Pain may occur in the upper right side of the stomach under the ribs. Early bile duct cancers don’t often cause pain. But constant pain can develop as the bile duct cancer grows and spreads.

Other symptoms can include: 

  • Fever or chills

  • Pale-colored or greasy stools 

  • Bloating

  • Loss of appetite

  • Weight loss

When to see your healthcare provider

Many of these symptoms may be caused by other health problems. But it is important to see your 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 the answers down in a notebook. Make sure you ask how the treatment will change your daily life, including your diet, and how you will look and feel after treatment. Ask how successful the treatment is expected to be, and what the risks and possible side effects are.

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

Below are some questions to ask during your appointments.

Deciding on a treatment

  • What is the stage of my cancer?

  • Has the cancer spread anywhere else in my body?

  • What are the treatment choices?

  • 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 for me and why?

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

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

  • Are there any clinical trials I should apply for?

  • Will my insurance cover these treatments?

  • How much will treatment cost?

 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 take my other medicines during treatment?

 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 reach you after hours and on weekends?

  • What can I do about these 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 that I can join?

After treatment

  • How will I feel after the treatment?

  • 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 the cancer comes back?

Making a decision

When you have 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 a decision about treatment.


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Timothy J Pluard, MD

Oncology / Hematology

Shahzad Raza, MD

Oncology / Hematology

Jamie P Rigden, MD

Oncology / Hematology

Ali Shwaiki, 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.