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Bile Duct Cancer - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Bile Duct Cancer. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.

Bile duct cancer begins when normal cells in the bile duct change and grow uncontrollably, forming a mass called a tumor. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body).

About the bile duct

The bile duct is a 4-inch to 5-inch long tube that connects the liver and gallbladder to the small intestine. The bile duct allows bile, which is made in the liver and stored in the gallbladder, to flow into the small intestine. Bile is a liquid that helps to break down fats found in foods and helps the body get rid of the waste material that is filtered out of the bloodstream by the liver.

The bile duct starts in the liver. Within the liver, smaller tubes (similar to small blood vessels) drain bile from the cells in the liver into larger and larger branches, ending in a tube called the common bile duct. The end of the bile duct empties into the small intestine.

The gallbladder is a reservoir that holds bile until food reaches the intestines. It is attached by a small duct, called the cystic duct, to the common bile duct about one-third of the way down the bile duct from the liver.

See illustrations of the bile duct.

Types of bile duct cancer

Cancer can occur in any part of the bile duct. For bile duct cancer, doctors look at the exact location of the tumor:

Extrahepatic. The part of the bile duct that is located outside of the liver is called extrahepatic. It is in this part of the bile duct where cancer usually begins. A common site for bile duct cancer is at the point where the right and left hepatic ducts join. A tumor that starts in this area is also sometimes called a Klatskin’s tumor. The rest of the bile duct cancers that begin outside the liver occur between where the right and left hepatic ducts meet and where the bile duct empties into the small intestine.

Intrahepatic. About 5% to 10% of bile duct cancers are intrahepatic, or located inside the liver.

This section is about primary bile duct cancer, which is cancer that starts in the bile duct. For information about cancer that began in another part of the body and then spread to the bile duct, please see Cancer.Net’s guide for that type of cancer.

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Bile Duct Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find information about how many people learn they have this type of cancer each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Primary bile duct cancer is uncommon. Each year, an estimated 2,000 to 3,000 people in the United States are diagnosed with bile duct cancer. The number of new cases of bile duct cancer is increasing, mostly due to rising rates of intrahepatic bile duct cancer. The reason for this increase is not known. It may be due to the use of more accurate tests to diagnose this type of cancer. Previously, intrahepatic bile duct cancer may have been thought to be a different type of cancer.

In some parts of the world, a parasite called a liver fluke can infect the bile duct and cause cancer. Liver flukes are very common in Asia and the Middle East, and therefore bile duct cancer is more common in these regions. Also, gallstones and inflammatory conditions of the digestive tract, such as ulcerative colitis or an associated condition called sclerosing cholangitis (PSC), an autoimmune disease in which the body's immune system attacks the bile ducts and causes scarring, increase the risk of bile duct cancer. See the Risk Factors section for more information.

The five-year survival rate is the percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases. The five-year survival rate for a person with an early stage, extrahepatic cancer is 30%; for a person with an early stage, intrahepatic cancer, it is 15%. The survival rate decreases if the cancer has spread outside the bile duct or into the nearby blood vessels before it is diagnosed.

Cancer survival statistics should be interpreted with caution. Estimates are based on data from many people with this type of cancer in the United States, but the actual risk for a particular person may differ. It is not possible to tell a person how long he or she will live with bile duct cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Learn more about understanding statistics.

Source: American Cancer Society.

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Bile Duct Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find a basic drawing of the bile duct, which is the part of the body affected by this disease. To see other pages, use the menu on the side of your screen.

Bile Duct Anatomy

Larger image

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Bile Duct Cancer - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find out more about what factors increase the chance of developing this type of cancer. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing bile duct cancer:

Previous disease or irritation of the bile duct. Inflammation of the bile duct can be caused by ulcerative colitis or stones similar to gallstones. Diseases and conditions that increase the risk of bile duct cancer include:

  • Primary Sclerosing Cholangitis (PSC), which is a rare inflammatory condition of the bile ducts with no known cause (see the Statistics section for more information).
  • Choledochal cyst, which is an abnormality a person is born with that causes a swollen area on the part of the bile duct outside the liver.
  • Caroli’s syndrome, which is an abnormality of the small bile ducts within the liver that a person is born with that increases the risk of infection and stones, like gallstones, forming in the liver.
  • Cirrhosis, which is liver disease that can cause scarring or long-lasting irritation.
  • Infection with liver flukes that invade the bile duct.

Age. Older adults are more likely to develop bile duct cancer.

Certain chemicals. Dioxins, nitrosamines, and polychlorinated biphenyls (PCBs) may cause bile duct cancer. In particular, people who work in rubber plants and automotive industries may be exposed to these chemicals.

Reducing Your Risk

Research continues to look into what factors cause this type of cancer and what people can do to lower their personal risk. There is no proven way to completely prevent this disease, but there may be steps you can take to lower your individual risk of bile duct cancer.

  • Avoid coming in contact with hazardous chemicals. Even though thorium dioxide (a chemical, previously used in x-ray examinations, associated with a high risk of developing bile duct cancer) has been banned from use, other hazardous chemicals are still available or found in the environment.
  • If traveling in parts of the world where liver flukes are common, drink only purified water and foods that have been thoroughly cooked.

Talk with your doctor if you have concerns about your personal risk of developing this type of cancer.

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Bile Duct Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

People with bile duct cancer may experience the following symptoms or signs, usually because the tumor is blocking the bile duct. Sometimes, people with bile duct cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom or sign on this list, please talk with your doctor.

One common symptom is jaundice, which is a yellowing of the skin and the whites of the eyes. When the bile duct is blocked, the liver cannot excrete bile, and the bile backs up into the bloodstream. (The blockage may not be cancer; it can also be caused by a gallstone or scar tissue.) Bile contains bilirubin, which is dark yellow and can cause the skin and whites of the eyes to turn yellow if there are higher levels of it in the bloodstream. A person’s urine may also become a dark color, and bowel movements may become pale.

However, it is important to note that jaundice is a common symptom for many conditions so there can be many causes. Your doctor may need to do several diagnostic tests (see the Diagnosis section for a complete list) to find the exact cause. Many diseases associated with jaundice are not serious or life threatening, and bile duct cancer is one of the less common causes.

In addition to jaundice, other symptoms of bile duct cancer include:

  • Itching, caused by a buildup of bile salts and bilirubin in the body that is then deposited in the skin
  • Weight loss
  • Loss of appetite
  • Fever
  • Abdominal pain. Early bile duct cancer usually does not cause pain, but a person may experience pain if the cancer has spread.

Your doctor will ask you questions about the symptoms you are experiencing to help find out the cause of the problem, called a diagnosis. This may include how long you’ve been experiencing the symptom(s) and how often.

If cancer is diagnosed, relieving symptoms and side effects remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose cancer and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has spread. This list describes options for diagnosing this type of cancer, and not all tests listed will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of cancer suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose bile duct cancer or distinguish it from other possible causes of jaundice (see Symptoms):

Blood chemistry tests. Blood chemistry tests measure the levels of bilirubin and alkaline phosphatase, as well as test for other liver functions. High levels of these substances could indicate that the bile duct is not working well.

Tumor marker tests (CEA and CA19-9). Tumor markers are substances found in higher than normal amounts in the blood, urine, or tissues of people with certain types of cancer. Bile duct cancer may cause high levels of carcinoembryonic antigen (CEA) and CA19-9 in the blood. However, a person can have bile duct cancer even if there are normal levels of these markers. Also, high levels of these substances can sometimes occur from diseases other than cancer.

Other tests may be performed to provide more information about the bile duct cancer. These include:

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).

The type of biopsy performed depends on the location of the tumor. The doctor can obtain tissue samples during a procedure called a percutaneous transhepatic cholangiography (PTC) or another procedure called an endoscopic retrograde cholangiopancreatography (ERCP). PTC and ERCP are described below. Or, a sample will be taken by using a computed tomography scan (CT or CAT scan; see below) to guide a thin needle through the skin into the possible tumor to collect a sample of cells. 

Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. Occasionally, a biopsy is not possible. In this uncommon situation, people will be treated for bile duct cancer based on other test results and symptoms.

Ultrasound. An ultrasound uses sound waves to create a picture of the internal organs. During an ultrasound, the doctor may be able to see the actual tumor; more often when one of the larger bile ducts is blocked, the small bile ducts behind the blockage get larger. It is this “dilation of ducts” that can be seen on an ultrasound.

To view the bile duct, the doctor may use an endoscopic (a thin, flexible tube inserted through the mouth) or laparoscopic (see below) ultrasound. Both of these procedures allow for a clearer view of the bile duct and can help the doctor perform a biopsy.

CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a contrast medium (a special dye) is injected into a vein or given orally (by mouth) to provide better detail. CT scans can also be used to guide a needle biopsy.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. An MRI specific for the bile duct is called MRI cholangiopancreatography. A contrast medium may be injected into a patient’s vein or given orally to create a clearer picture.

PTC. During this test, a thin needle is inserted into the bile duct in the liver. The doctor injects a contrast medium through the needle, so the bile ducts show up on x-rays. By looking at the x-rays, the doctor can tell whether there is a blockage of the bile ducts and, if so, locate the site of the blockage. This is important in planning treatment.

ERCP. During this procedure, the doctor inserts a flexible tube down a person’s throat, through the stomach, and into the bile duct while the patient is lightly sedated. Dye is injected into the tube, which helps outline the bile duct on an x-ray. A tiny brush can also be inserted through the tube to collect cells and tissue fragments for a biopsy. This technique can help to find and take a sample of the tumor and provide information that is important in planning treatment.

Laparoscopy. The doctor views the bile duct, gallbladder, and liver through a lighted tube inserted into a surgical opening in the person’s abdomen. Some laparoscopes can help the doctor to work with small instruments through the tube to take a tissue sample.

After these diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer; this is called staging.

The next section helps explain the different stages for this type of cancer. Use the menu on the side of your screen to select Stages, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.

The method used to stage other types of cancers, called the TNM classification (Stage I through IV), is medically complex for bile duct cancer. A simpler way to describe the stages of bile duct cancer is under the headings listed below. By classifying each cancer into one of these categories, the health care team can then plan the best treatment strategy.

Local. This type of bile duct cancer is located only within the bile duct and can be removed surgically. There is no evidence of any spread to areas outside of the bile duct.

Locally advanced. This type is still located only in the area around the bile duct, but it does affect nearby organs, arteries, and/or veins. There is no evidence of spread to any distant parts of the body.

Metastatic. The tumor has spread beyond the area of the bile duct to reach distant parts of the body. It is unlikely that surgery can remove all of the cancer.

Recurrent. Recurrent cancer is cancer that has come back after treatment. If there is a recurrence, the cancer may need to be staged again (called re-staging) using the system above.

Information about the cancer’s stage will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for this type of cancer. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu on the side of your screen.

This section outlines treatments that are the standard of care (the best proven treatments available) for this specific type of cancer. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study to test a new treatment to evaluate whether it is safe, effective, and possibly better than the standard treatment. Your doctor can help you review all treatment options. For more information, see the Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team.

Descriptions of the most common treatment options for bile duct cancer are listed below. Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving the treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer using surgery. Learn more about cancer surgery.

Due to the location and sensitivity of the bile duct area, surgery for bile duct cancer can be difficult. And, it has limitations based on how large the tumor is and where it has spread (see the Stages section). For instance, metastatic cancer cannot be completely removed surgically, and additional treatment will be necessary.

Common surgical treatment options for bile duct include:

Surgical removal of the bile duct. If the tumor has not spread beyond the bile duct, removing the organ surgically may be the recommended treatment. Lymph nodes (tiny, bean-shaped organs that help fight infection) may also be removed during the surgery and checked for cancer.

Partial hepatectomy. If the cancer is near the liver, the surgeon will remove part of the liver. The remaining section of liver takes over the functions of the entire liver and can, in some cases, regrow to its normal size within a few weeks.

Whipple procedure. If the cancer is near the pancreas, this surgery may be recommended. This is an extensive operation where the surgeon removes part or all of the pancreas and part of the small intestine, bile duct, and stomach, and then reconnects the digestive tract and biliary system. An experienced surgeon should perform this procedure. To maintain the flow of bile, the remaining part of the bile duct is connected to the small intestine. About 5% to 10% of people do not survive this complicated operation; others (25% to 45%) have serious complications, such as bleeding, infection, or leaking of bile or pancreatic juices. 

Liver transplantation. Complete removal of the liver (total hepatectomy) and bile ducts followed by transplantation of a donor liver has been used to treat this type of cancer. However, bile duct cancer tends to recur very quickly after transplantation, and this means that this procedure is very rarely used.

Stent placement and surgical bypass

In some situations, surgery cannot completely remove the tumor. However, surgery can still help relieve symptoms of the cancer and improve the patient’s quality of life.

In this situation, a surgeon may be able to bypass the blocked area by connecting part of the bile duct before the blockage with a part of the small intestine beyond the blockage. During this procedure, the surgeon may insert a stent (a plastic or metal tube) into the bile duct to keep it open.

In addition to surgery, a plastic or metal stent can be passed through the blockage either during the ERCP procedure or during a procedure similar to PTC (see the Diagnosis section for more detail). Although these procedures do not remove the tumor, they can relieve the side effects and people often experience long periods of time when all of their symptoms disappear and quality of life is much better. For both of these procedures, the doctor may insert the stent internally so the person is not aware of it. Sometimes, this is not possible, and a tube will be passed through the liver to redirect the bile externally (outside the body) into a bag that will need regular changing. Some doctors suggest that in these situations people receive long-term antibiotics to protect against infection. 

Radiation therapy

Radiation therapy uses high-energy x-rays or other particles to kill cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation therapy is given using implants, it is called internal radiation therapy or brachytherapy. Occasionally, internal radiation therapy may be used for bile duct cancer.

Radiation therapy can be used for treatment or to control the symptoms and pain of advanced disease. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Systemic chemotherapy is delivered through the bloodstream to reach cancer cells throughout the body. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication. A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Efforts to improve chemotherapy by investigating new drugs or new combinations of drugs are being made through clinical trials. This is often how patients with bile duct cancer receive chemotherapy.

Chemotherapy may be used before surgery to shrink the tumor or when surgery is not an option. Recent evidence suggests that the combination of cisplatin (Platinol) and gemcitabine (Gemzar) can lengthen the lives of patients who have bile duct cancer that cannot be removed by surgery. Other drugs that have been used to treat bile duct cancer include fluorouracil (5-FU, Adrucil) and doxorubicin (Adriamycin). Chemotherapy may also be given after surgery to help prevent a recurrence, although how well this approach works is being researched in clinical trials.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care can help a person with any stage of illness. People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, and radiation therapy. Talk with your doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Recurrent bile duct cancer

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED.

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the cancer’s stage has changed. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the therapies described above (such as surgery, radiation therapy, and chemotherapy), but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

Metastatic bile duct cancer

If cancer has spread to another location in the body, it is called metastatic cancer. Patients with this diagnosis are encouraged to talk with doctors who are experienced in treating this stage of cancer, because there can be different opinions about the best treatment plan. Learn more about seeking a second opinion before starting treatment, so you are comfortable with the treatment plan chosen. This discussion may include clinical trials.

Your health care team may recommend a treatment plan that includes a combination of surgery, radiation therapy, and chemotherapy. Supportive care will also be important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

If treatment fails

Recovery from cancer is not always possible. If treatment is not successful, the disease may be called advanced or terminal cancer.

This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than six months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in a hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and bereavement.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat patients with bile duct cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and manage the late effects that may occur after treatment. Talk with your doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease and possible recurrence after treatment.

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating bile duct cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with bile duct cancer.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for bile duct cancer, learn more in the Latest Research section.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends. 

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

The next section helps explain the areas of research going on today about this type of cancer. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about bile duct cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

A major focus of bile duct cancer research is to find out if new drugs that work differently than chemotherapy (such as anti-angiogenesis therapy; see below) might make the current standard chemotherapy work better for advanced biliary tract cancer.

Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. Anti-angiogenic agents being studied for bile duct cancer treatment include bevacizumab (Avastin) and sorafenib (Nexavar).

Epidermal growth factor receptor (EGFR) inhibitors. Researchers have found that drugs that block EGFR may be effective at stopping or slowing the growth of bile duct cancer. Drugs being studied in this category include cetuximab (Erbitux), erlotinib (Tarceva), and panitumumab (Vectibix).

Photodynamic therapy (PDT). After the doctor gives an inactive form of a drug, he or she uses a special light that is directed at the tumor in the bile duct through an endoscope in a procedure similar to ERCP (see the Diagnosis section for more information about this procedure). This causes a chemical change in the drug, activating it to kill the tumor cells in the area where the light is directed. PDT is currently used to relieve pain and symptoms, not to eliminate bile duct cancer. Doctors are also looking at whether PDT can reduce the risk of a stent becoming blocked by stopping the tumor from growing into it.

Immunotherapy. Immunotherapy (also called biologic therapy) is designed to boost the body’s natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Hyperthermia therapy. Hyperthermia therapy kills cancer cells by increasing body temperature; it also may make cancer cells more likely to be destroyed by radiation therapy and chemotherapy.

Radiosensitizers. Researchers are looking at radiosensitizers to treat bile duct cancer. Radiosensitizers are drugs that make tumor cells more likely to be killed by radiation therapy.

Genetics. Scientists are also researching the genetic progression of bile duct cancer, which is the process of how one genetic change turns into many genetic changes that cause a cell to become cancerous.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current bile duct cancer treatments in order to improve patients’ comfort and quality of life.

Looking for More about the Latest Research?

If you would like additional information about the latest areas of research regarding bile duct cancer, explore these related items that will take you outside of this guide:

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Coping With Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of cancer, but it may help to know that preventing and controlling side effects is a major focus of your health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for bile duct cancer are described in detail within the Treatment Options section. Learn more about the most common side effects of cancer and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the cancer’s stage, the length and dosage of treatment(s), and your overall health.

Before treatment begins, talk with your doctor about the possible side effects of each type of treatment you will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving you may need during treatment and recovery, as family members and friends often play an important role in the care of a person with bile duct cancer. Learn more about caregiving.

In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Patients and their families are encouraged to share their feelings with a member of their health care team who can help with coping strategies. Learn more about the importance of addressing such needs, including concerns about managing the cost of your cancer care.

During and after treatment, be sure to tell the health care team about the side effects your experience, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your doctor.

The next section helps explain medical tests and check-ups needed after finishing cancer treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will read about your medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for bile duct cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. ASCO offers cancer treatment summary forms to help keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

People treated for bile duct cancer may need to visit the doctor regularly for several years because there is always a risk that the tumor will recur after treatment or that the person will develop another tumor. Researchers are studying ways to prevent both recurrences and the development of secondary or “new” tumors, but currently there is no standard preventive treatment.

If the tumor was not removed by surgery and a stent or surgical bypass was used to relieve jaundice, the most important part of follow-up care is making sure the stent or bypass procedure still works to remove the blockage. If jaundice becomes worse (a deeper yellow), if a person becomes jaundiced again after the stent has originally cleared the blockage, or if a person develops a fever along with sweating, shaking, or abdominal pain, a doctor should be consulted immediately, as the stent may need to be changed or repositioned.

A possible long-term side effect of treatment for bile duct cancer is the development of strictures after any surgery to the biliary system (bile ducts and gallbladder). These are noncancerous scars that form slowly, but may narrow the bile ducts causing symptoms similar to those of the original bile duct cancer.

People treated for bile duct cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level. Learn more about the next steps to take in survivorship, including making positive lifestyle changes.

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

  • What type of bile duct cancer do I have? Where is it located?
  • Can you explain my pathology report (laboratory test results) to me?
  • What is the stage of my cancer? What does this mean?
  • What are my treatment options?
  • What clinical trials are open to me?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?
  • What is my prognosis?
  • Who will be part of my health care team, and what does each member do?
  • Who will be coordinating my overall treatment and follow-up care?
  • What are the possible side effects of this treatment, both in the short term and the long term?
  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?
  • Could this treatment affect my sex life? If so, how and for how long?
  • Could this treatment affect my ability to become pregnant or have children? If so, should I talk with a fertility specialist before cancer treatment begins?
  • How can I keep myself as healthy as possible during treatment?
  • If I’m worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What are the chances that the cancer will recur?
  • What are the signs that may indicate that the cancer has returned?
  • What are the signs that may indicate that my stent has become blocked?
  • What follow-up tests will I need, and how often will I need them?
  • What support services are available to me? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Bile Duct Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 07/2013

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Bile Duct Cancer. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

This is the end of Cancer.Net’s Guide to Bile Duct Cancer. Use the menu on the side of your screen to select another section, to continue reading this guide.