Bile duct cancer (Cholangiocarcinoma) is a malignancy arising from the cells that line the bile ducts. This results in narrowing and obstruction of the liver’s drainage system.
The cancer can occur in the ducts within the liver (intrahepatic ducts) or in the ducts that connect the liver to the small intestine (common hepatic duct and common bile duct).
The obstruction rarely causes pain but frequently causes yellowing of the eyes and skin (jaundice), itching, and weight loss.
The diagnosis is suspected when blood tests reveal abnormally elevated liver enzymes and an imaging study such as ultrasound, CT scan, or MRI scan demonstrates swelling or dilatation of the bile ducts above the obstructing cancer.
The diagnosis can be confirmed by performing an MRI scan of the bile ducts (MRCP) that will demonstrate an area of obstruction and a possible mass lesion. Endoscopic Retrograde Cholangiopancreatography (ERCP) can also be performed to confirm the diagnosis, obtain biopsies and relieve the obstruction.
After the patient is deeply sedated, the physician passes a flexible tube (endoscope) through the mouth, esophagus, and stomach and into the beginning of the small intestine called the duodenum. At this location, the bile duct drains into the intestine through a small nipple-like opening called the papilla. A plastic tube called a catheter is then passed through the scope, into the papilla and up into the bile duct. Contrast material is then injected into the ducts and images are obtained using an x-ray machine. A brush can be passed into the narrowing of the bile duct to obtain a tissue specimen to confirm the diagnosis of cancer. A plastic or metal tube called a stent can also be placed across the narrowing to relieve the obstruction.
Definitive treatment options include surgery to remove and possibly cure the cancerous growth, or chemotherapy/radiation therapy to shrink it.