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Bile duct cancer

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Diagnosing extrahepatic bile duct cancer

Diagnosis is the process of finding the cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other reasons for a health problem before making a cancer diagnosis. Diagnostic tests for extrahepatic bile duct cancer are usually done when:

  • the signs and symptoms of extrahepatic bile duct cancer are present, such as jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow.
  • the doctor suspects extrahepatic bile duct cancer after talking with a person about their health and completing a physical examination
  • routine tests suggest a problem with the bile ducts

Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • primary sclerosing cholangitis (PSC)
    • choledochal cyst
    • abnormal pancreaticobiliary duct junction
    • ulcerative colitis
    • parasitic infections (liver fluke)
  • signs and symptoms that may suggest extrahepatic bile duct cancer

A physical examination allows the doctor to look for any signs of extrahepatic bile duct cancer. During a physical examination, the doctor may:

  • look at the whites of the eyes and skin for yellowing (a sign of jaundice)
  • feel the abdomen for any lumps, tenderness or buildup of fluid
    • The abdomen is checked for enlarged organs, such as an enlarged liver (hepatomegaly) or enlarged gallbladder (called Courvoisier's sign).

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They may be used to diagnose bile duct problems or extrahepatic bile duct cancer.

  • Increased bilirubin (a pigment in bile) may indicate a blockage of the bile ducts or a problem with the liver because of an extrahepatic bile duct tumour.
  • Increased alkaline phosphatase, alanine aminotransferase (ALT) and aspartate transaminase (AST) may indicate that extrahepatic bile duct cancer has spread to the liver.
  • Increased alkaline phosphatase may also indicate blocked bile ducts.

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Ultrasound

Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • view the bile ducts to check for problems or cancer in people with jaundice or abdominal pain
    • An abdominal ultrasound is often the first imaging test done when there are symptoms and extrahepatic bile duct cancer is suspected.
  • see if the cancer has spread to the liver or gallbladder

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Tumour marker tests

Tumour markers are substances – usually proteins – in the blood that may indicate the presence of extrahepatic bile duct cancer. Tumour marker tests are used to check a person's response to cancer treatment, but they can sometimes be used to help diagnose extrahepatic bile duct cancer in people with jaundice.

The tumour markers that may be measured are:

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • check for cancer in the bile duct
    • Some extrahepatic bile duct tumours may be too small to be detected by CT scan.
  • assess the extent of cancer in the bile duct
  • see if cancer has spread outside the bile duct, to nearby lymph nodes, the liver or other organs or structures in the abdomen

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It may be used to:

  • check the extent and stage of extrahepatic bile duct cancer
  • see if the cancer has spread to nearby organs or structures

A special type of MRI called magnetic resonance cholangiopancreatography (MRCP) may be done if the doctor suspects extrahepatic bile duct cancer. MRCP can give detailed information about the bile ducts.

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Endoscopic retrograde cholangiopancreatography (ERCP)

An endoscopic retrograde cholangiopancreatography (ERCP) is done when extrahepatic bile duct cancer is suspected. It helps determine if and where any of the bile ducts are blocked because of a tumour. It allows the doctor to look inside the bile ducts using a flexible tube with a light and lens on the end (an endoscope).

An ERCP may be used to:

  • determine if there is a bile duct tumour and take a biopsy to look for cancer cells
  • see if cancer has spread from the bile ducts
  • help plan surgery
  • place a small tube (stent) into the bile duct to relieve a blockage caused by a tumour

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Percutaneous transhepatic cholangiography (PTC)

A percutaneous transhepatic cholangiography (PTC) is an x-ray of the bile ducts and liver using a contrast dye to enhance the pictures. A thin needle is inserted through the skin into the bile duct area. A special dye is injected into the bile ducts. The dye outlines the structure of the bile ducts and liver on the x-ray.

PTC may be used to:

  • take a biopsy of the bile duct to check for cancer cells
  • determine if a tumour is blocking the bile ducts
  • see if a bile duct tumour has spread to the liver
  • place a small tube (stent) into the bile duct to relieve a blockage caused by a tumour
  • place a tube (catheter) into the bile duct to drain bile into a collection bag outside the body

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Endoscopic ultrasound

Endoscopic ultrasound (EUS) combines endoscopy and ultrasound. Similar to ERCP, EUS uses a flexible tube with a light and lens on the end (an endoscope). A small ultrasound transducer (probe) is placed on the tip of the endoscope. The endoscope allows the doctor to look at the bile ducts and gallbladder from inside the body (internally) rather than externally.

EUS may be used to:

  • detect stones in the bile ducts
  • take a biopsy of the bile duct to look for cancer cells
  • determine if there is a bile duct tumour
  • examine suspicious nearby lymph nodes and take a biopsy if it looks like the cancer has spread

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Biopsy

During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. Sometimes imaging tests may give doctors enough information to confirm the presence of a bile duct tumour and a biopsy may not be needed.

Biopsies of extrahepatic bile duct cancer can be done by:

  • endoscopic retrograde cholangiopancreatography (ERCP)
  • percutaneous transhepatic cholangiography (PTC)
  • fine needle aspiration
    • The procedure is done using endoscopic ultrasound or computed tomography (CT) to guide the needle.

If surgery is planned and the bile duct will be removed, then the surgeon will send the bile duct tissue for examination at the time of surgery, and a biopsy isn't necessary.

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Laparotomy

Extrahepatic bile duct cancer may be staged by doing a laparotomy. A surgical cut (incision) is made in the abdomen to check the abdominal cavity for signs of cancer. The surgeon will also remove tissue, bile and fluid for examination under a microscope.

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See a list of questions to ask your doctor about diagnostic tests.

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