Bile duct cancer usually starts in any part of the bile duct system.³  There are three types and each type is based on where the cancers first develop:¹

• Intrahepatic bile duct cancer develops in the bile ducts inside the liver
• Perihilar (or hilar) bile duct cancer develops in the bile ducts just outside the liver, where the right and left hepatic ducts join
• Distal bile duct cancer develops in the bile ducts in the portion closest to the small intestine

During the early stages of bile duct cancer there may not be any symptoms. Diagnosis usually occurs in the advanced stage of the cancer.⁴  Symptoms of bile duct cancer may include:^1,4

• Jaundice
• General weakness
• Nausea and vomiting
• Unexplained weight loss and loss of appetite
• Fever
• Itchy skin
• Pain in the abdomen
• Darkened urine
• Pale bowel movements

Having one of more of these symptoms does not mean you have bile duct cancer. It is a good idea to speak with your GP or specialist about any questions or concerns that you may have.

Factors that may increase your risk of developing bile duct cancer can include:^1,3,4

• Bile duct stones
  
• Infection with the Hepatitis B or Hepatitis C virus
• Infection with a liver fluke parasite
• Pre-existing medical conditions, such as bowel disease, including for example, chronic ulcerative colitis or liver disease, that may include primary sclerosing cholangitis - a chronic liver disease where the bile ducts (both inside and outside the liver) become inflamed and scarred, leading to narrowing and blockage
• Biliary cysts

If you have one or more of these risk factors, it doesn't mean that you have bile duct cancer. It is recommended to make an appointment with your GP or specialist to chat through any questions or concerns that you may have.

A range of tests may be performed to analyse symptoms, to diagnose bile duct cancer type and the disease stage. Following a physical examination, further tests may include:^1,3

• Biopsy – where a tiny sample of tissue is taken for analysis
• Blood tests - to test gallbladder and liver function, plus check for tumour markers
• Imaging scans - may include X-ray, ultrasound,
  magnetic resonance imaging (MRI) scan, computed tomography (CT) scan, and magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP) - this test is a type of X-ray, that is used to create an image of the bile duct, which can help show if a tumour causes any blockages or abnormalities and if necessary, take a sample of bile duct tissue or insert a small tube (called a stent) to open up the ducts.
• Percutaneous transhepatic cholangiography (PTC) - this is a type of X-ray, and like an ERCP the test is used to help create an image of the bile duct to test for abnormalities or blockages. A stent can be inserted to open up the bile ducts, which allows bile to drain into the small intestine or an external bag. This may be used when surgery is not an option.

Surgery may be combined with other treatments. It may involve complete or partial removal of the cancer.⁴

Radiation therapy uses high-energy X-rays or other particles to treat cancer and can be used at all stages⁴

Chemotherapy is an approach to cancer therapy which involves the administration of medicine, usually orally or by injection, which is intended to kill cancer cells or minimise their growth and spread. Chemotherapy can be used in conjunction with other cancer treatments.^4,5

Immunotherapy is a type of treatment that is intended to help your immune system fight cancer. There are different types of immunotherapy for cancer that work in different ways.¹

This type of treatment is designed and aims to attack specific cancer cells. Targeted therapy medicines mimic antibodies that our bodies naturally produce that target and attach to proteins on cancer cells, making it easier for our immune system to find and destroy the cancer.¹

All cancer treatments may have side effects. The type and severity of side effects will vary between individuals.^4,6,7 You can ask your doctor for detailed information about the side effects which you may experience with any treatment recommended for you.

• Rest when needed – it is important to acknowledge when you are fatigued and rest when you need to^6,7
• Aim to maintain a healthy diet,⁶ and we also encourage you to think about eating foods that interest you rather than what you think you should eat
• Appetite changes are common, and you may experience taste changes or nausea. Help manage this by eating small, frequent snacks and avoiding smells that make you nauseous⁶
• Drink adequate water⁶
• Reach out to support groups and others who have had cancer treatment⁷
• Record your side effects in a diary or journal⁸
• Speak to your doctor about incorporating some gentle exercise into your weekly routine^6,7
• Ask for and accept help from family, friends and neighbours⁷
• Be open with employers about your treatment and discuss flexible working options if you need them