How is Bile Duct Cancer Diagnosed?

Diagnosing bile duct cancer often requires several tests because tumors can develop in different areas of the biliary system. Doctors usually need to determine both whether cancer is present and whether the tumor can be completely removed with surgery.

Medical history and physical exam

Your doctor will ask about symptoms and risk factors such as:

• Jaundice

• Itching

• Abdominal pain

• Weight loss

• Primary sclerosing cholangitis

• Chronic liver disease

• Previous bile duct problems

During the physical exam, your doctor may check for jaundice, abdominal tenderness, liver enlargement, or other signs of disease.

Liver function tests

Blood tests can measure substances such as:

• Bilirubin

• Alkaline phosphatase

• AST

• ALT

Abnormal results can suggest that bile is not draining properly or that the liver is affected. These tests cannot diagnose cancer by themselves.

CA 19-9

CA 19-9 is a tumor marker that can sometimes be elevated in bile duct cancer. However, CA 19-9 can also increase because of:

• Bile duct blockage

• Infection

• Pancreatitis

• Other cancers

It is therefore not accurate enough to diagnose bile duct cancer on its own.

CEA

CEA is another tumor marker that may sometimes be measured. Like CA 19-9, it is not specific enough to diagnose bile duct cancer by itself.

Ultrasound

An abdominal ultrasound can show enlarged bile ducts, liver abnormalities, or a possible obstruction. It is often one of the first imaging tests performed when someone has jaundice.

CT scan

CT imaging can help doctors evaluate:

• Tumor size

• Tumor location

• Nearby blood vessels

• Lymph nodes

• Liver involvement

• Distant spread

MRI and MRCP

MRI creates detailed images using magnets and radio waves. Magnetic resonance cholangiopancreatography, or MRCP, is a specialized MRI technique that creates detailed images of the bile ducts, gallbladder, liver, pancreas, and pancreatic duct. MRCP can help doctors see where a bile duct is narrowed or blocked.

ERCP

Endoscopic retrograde cholangiopancreatography, or ERCP, combines endoscopy and X-ray imaging. During the procedure, a doctor passes an endoscope through the mouth and into the small intestine. Contrast dye is injected into the bile ducts so they can be seen on X-rays. ERCP can be used to:

• Identify a blockage

• Collect cells or tissue for testing

• Place a stent to improve bile drainage

Endoscopic ultrasound

Endoscopic ultrasound, or EUS, uses an ultrasound probe attached to an endoscope. It can help evaluate tumors, nearby lymph nodes, and other structures. A biopsy may sometimes be obtained during the procedure.

Percutaneous transhepatic cholangiography

During PTC, a needle is inserted through the skin and into a bile duct within the liver. Contrast material helps show the bile ducts on imaging. Doctors may also collect tissue or place a drainage tube if the bile duct is blocked.

Biopsy

A biopsy removes cells or tissue so a pathologist can look for cancer under a microscope. However, the way a biopsy is performed can matter, particularly if surgery or liver transplantation is being considered. Ask whether tissue should be obtained before any biopsy procedure and which method is most appropriate for your tumor location.

Biomarker and molecular testing

Biomarker testing is particularly important for advanced cholangiocarcinoma because some tumors contain molecular changes that can be targeted with treatment. Testing may look for:

• FGFR2 fusions or rearrangements

• IDH1 mutations

• HER2 alterations

• BRAF V600E

• NTRK gene fusions

• RET alterations

• Mismatch repair deficiency

• Microsatellite instability

• Other actionable genomic changes

Broad next-generation sequencing can test many cancer-related genes at once. This testing may identify an FDA-approved treatment or a clinical trial.