Diagnosis of bile duct cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing bile duct cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor may refer you to a specialist or order tests to check for bile duct cancer or other health problems.

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as bile duct cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of bile duct cancer.

The following tests are commonly used to rule out or diagnose bile duct cancer. Many of the same tests used to diagnose cancer are used to find out 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.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• risk factors for bile duct cancer
• symptoms that suggest bile duct cancer

A physical exam allows your doctor to look for any signs of bile duct cancer. During a physical exam, your doctor may:

• look at the whites of the eyes and skin for a change to a yellow colour (a sign of jaundice)
• feel the abdomen (belly) for any lumps, a larger than normal liver (hepatomegaly), tenderness or a buildup of fluid

Find out more about physical exams.

Blood chemistry tests measure certain chemicals in the blood. They show how well organs are functioning and can help find abnormalities. Blood chemistry tests used to diagnose bile duct cancer include the following.

Increased bilirubin (a chemical in bile) may indicate a blockage of the bile ducts or a problem with the liver or gallbladder. If the enzymes such as alkaline phosphatase, alanine aminotransferase (ALT) and aspartate transaminase (AST) are increased, it means that the liver is not working normally. Your doctor may order more tests to find out why.

Find out more about blood chemistry tests.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has bile duct cancer.

Tumour marker tests are generally used to check a person’s response to cancer treatment. They can also sometimes be used to help diagnose extrahepatic bile duct cancer in people with jaundice. The tumour markers that may be increased in bile duct cancer are carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA).

Find about more about tumour marker tests.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to view the bile ducts to check for cancer. An abdominal ultrasound is often the first imaging test done when there are symptoms of bile duct cancer, such as jaundice or pain in the abdomen. It may also be used to check if the cancer has spread to the liver or gallbladder.

The doctor may also do an ultrasound using an endoscope or a laparoscopy to get better and more detailed images.

Find out more about ultrasounds.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to check for cancer in the bile ducts. Some bile duct tumours may be too small to be seen by a CT scan. It may also be used to assess the amount of cancer in the bile duct and to see if cancer has spread outside the bile duct to nearby lymph nodes, the liver or other organs or structures in the abdomen.

Find out more about CT scans.

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI may be used to:

• check the amount and stage of 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 thinks it might be extrahepatic bile duct cancer. MRCP can give detailed information about the bile ducts.

Find out more about MRIs.

An ERCP is done when extrahepatic bile duct cancer is suspected. It helps to see if the bile duct is 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:

• find out 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.

A 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
• find out 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

An endoscopic ultrasound (EUS) combines an endoscopy and an ultrasound. Similar to an ERCP, EUS uses a flexible tube with a light and lens on the end (an endoscope). A small ultrasound probe (transducer) 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.

An EUS may be used to:

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

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will confirm whether or not cancer cells are found in the sample. Sometimes imaging tests may give doctors enough information to confirm that there is a bile duct tumour, and a biopsy may not be needed.

Biopsies of bile duct cancer can be done by:

• ERCP
• PTC
• fine needle aspiration using an endoscopic ultrasound or a CT scan 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 examining at the time of surgery, and a biopsy won’t be necessary.

Find out more about biopsies.

Bile duct cancer may be staged by doing a laparoscopy. A cut (incision) is made in the abdomen and a laparoscope (a tube with a light and camera at one end) is used to check the abdominal cavity for signs of cancer. The surgeon will look for spread of the cancer to the peritoneum and liver. During this procedure, tissue, bile and fluid may be removed and examined under a microscope.

In a laparotomy, the abdomen is opened by a wide cut. This surgery helps the doctor check the organs in the abdomen to find out if the cancer can be completely removed with surgery (is resectable). 

To make the decisions that are right for you, ask your healthcare team questions about a diagnosis.