Bile Duct Cancer

The bile ducts are thin tubes that transport fluid called bile from the liver to the gallbladder to the small intestine to help digest fats. Bile duct cancer is a rare type of tumor that develops anywhere in the bile ducts. More common in people older than 60 with a history of medical conditions including inflammatory bowel disease (IBD), bile duct cancer can cause yellowing of the skin and eyes (jaundice), itchy skin and light-colored stools.

Most bile duct cancers fit into a category of cancers called adenocarcinomas. Bile duct adenocarcinoma forms in mucous glands lining the bile ducts. Bile duct cancer is also referred to as biliary adenocarcinoma or cholangiocarcinoma. Bile duct cancers are classified according to their location:

Intrahepatic bile duct cancer develops in tiny bile ducts inside the liver and is rare.
Extrahepatic bile duct cancer starts outside the liver, is common and includes:
- Perihilar bile duct cancer (Klatskin tumors)affects the upper part of the bile duct.
- Distal bile duct cancer affects the bottom half of the bile duct.

Surgeons at Brigham and Women’s Hospital (BWH) specialize in hepatobiliary diseases, including bile duct cancer. As the surgical team for the Pancreas and Biliary Tumor Center at Dana-Farber Brigham Cancer Center, we offer world-class patient care with leading-edge research in the fight against pancreatic cancer and bile duct cancer. Our board certified surgeons pioneered the use of laparoscopic techniques in treating hepatobiliary cancers and today use robotics and other minimally invasive surgery technologies for liver resection and Whipple procedure operations.

Learn more about bile duct cancer.

Bile Duct Cancer Surgeons

Risks Factors for Bile Duct Cancer

Factors that contribute to an increased risk for bile duct cancer include:

Older than age 60
Obesity
East Asian or Middle Eastern descent or residence
History of bile duct or liver diseases
X-rays with contrast injection in 1940s
Exposure to certain chemicals

Learn if you are at risk for bile duct cancer.

Symptoms of Bile Duct Cancer

Bile duct cancer may cause the following symptoms:

Jaundice
Pain in upper right side of stomach
Itchy skin
Dark brown urine
Light, clay-colored stools
Fever or chills
Bloating
Loss of appetite
Weight loss

Learn more about symptoms of bile duct cancer.

Diagnosis of Bile Duct Cancer

If you are having symptoms of bile duct cancer, your surgeon will ask about your health history, your family’s history of cancer and risk factors. Diagnostic tests may include:

Computed tomography scan (CT or CAT scan)
Magnetic resonance imaging (MRI)
Ultrasound
Tumor markers
Endoscopic retrograde cholangiopancreatography (ERCP)
Magnetic resonance cholangiopancreatography (MRCP)
Percutaneous transhepatic cholangiography (PTC)

Learn more about diagnostic tests for bile duct cancer.

Stages of Bile Duct Cancer

The process used to find out if cancer has spread within the bile ducts or to other parts of the body is called staging. The stage is determined from the results of physical exams, imaging tests and biopsies. The TNM system, developed by the American Joint Committee on Cancer and the International Union Against Cancer, is a standard system used to stage bile duct cancer. TNM represents:

T (tumor) refers to the size of the tumor in the bile ducts and whether or not it has invaded nearby organs.
N (node) refers to whether the lymph nodes in the area of the bile ducts have become cancerous.
M (metastasis) refers to whether the cancer has spread to other, distant organs in the body, such as your bones, liver, or lungs.

Learn more about the stages of bile duct cancer.

Treatment for Bile Duct Cancer

Surgical Treatment

Treatment for bile duct cancer involves different surgical approaches, depending on the location of the tumor. Our surgeons are internationally recognized specialists who are faculty members at Harvard Medical School and have years of experience in bile duct cancer surgery. They have perfected many of the most progressive surgical procedures including:

Removal of the bile duct If you have a small perihilar bile duct tumor confined to the bile duct outside, but near the liver, your surgeon may remove the entire bile duct and make a connection to your small intestine, allowing the bile to flow again. If the cancer has spread to nearby tissues, the surgeon may need to remove that tissue and nearby lymph nodes for testing.
Partial hepatectomy (liver resection) removes the part of your liver where the intrahepatic bile duct cancer is found. A large or small part of your liver may be removed. Surrounding normal tissue will be removed and tested to be sure the cancer is gone.
Whipple procedure (pancreaticoduodenectomy) If the bile duct cancer is close to your pancreas, your surgeon removes your bile duct and gallbladder, along with part of your pancreas, stomach and the first part of your small intestine.
Surgical biliary bypass If your surgeon cannot completely remove the bile duct cancer, a bypass helps lessen symptoms. Connecting your bile duct to a piece of your small intestine creates a new pathway around the tumor to allow the bile to flow to your intestine for normal digestion of fats. This surgery does not cure the cancer, but can relieve jaundice and other symptoms. It may precede other treatment.
Stent placement If the cancer is blocking your bile duct, your doctor may place a thin tube called a stent into the bile duct. It helps keep the duct open and drains bile that builds up in the area. This prevents symptoms such as pain or jaundice.

Non-Surgical Treatment

Learn more about chemotherapy and radiation therapy for bile duct cancer.

What You Should Expect

You will receive a thorough diagnostic examination to evaluate if you have bile duct cancer and determine what course of treatment is needed. Careful monitoring and the involvement of an experienced surgeon are important to the successful outcome for patients with bile duct cancer.

If you are having surgery or a procedure, you will likely be scheduled for a visit to the Weiner Center for Preoperative Evaluation for pre-operative information and tests.

The day of surgery, you will be cared for in the operating room by surgeons, anesthesiologists and nurses who specialize in surgery for patients with bile duct cancer. After surgery, you recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff.

Learn more about your hospital stay and returning home.

Multidisciplinary Care

The Pancreas and Biliary Tumor Center at Dana-Farber Brigham Cancer Center provides advanced multidisciplinary care for patients with gastrointestinal diseases, such as bile duct cancer. Our treatment team includes surgeons, medical and radiation oncologists, radiologists, pathologists, endoscopists, anesthesiologists and gastroenterologists. In addition, patients have full access to BWH’s world-renowned academic medical community with its diverse specialists and state-of-the-art facilities.

Cancer Surgery Appointments and Locations

Contact one of our cancer surgeons in the list at the top of the page to make an appointment.

Cancer Surgery Locations