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:
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.
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 physical examination allows the doctor to look for any signs of extrahepatic bile duct cancer. During a physical examination, the doctor may:
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.
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:
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:
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:
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:
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.
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:
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:
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:
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:
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.
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.