Bile duct cancer usually starts in any part of the bile duct system.³  There are three types, based on where the cancer first develops: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 commonly occurs once the cancer is more advanced.⁴  Symptoms of bile duct cancer may include:^1,4

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

Having one or 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 include:^1,3,4

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

If you have one or more of these risk factors, it does not necessarily mean that you have bile duct cancer. It is recommended to make an appointment with your GP or specialist to discuss any questions or concerns that you may have.

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

• Biopsy – where a tiny sample of tissue is taken for analysis
• Blood tests – to assess gallbladder and liver function, and check for tumour markers
• Imaging scans – may include X-ray, ultrasound, magnetic resonance imaging (MRI), computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP) – a type of X-ray used to create images of the bile ducts, which can help show if a tumour is causing blockages or abnormalities. If necessary, a sample of bile duct tissue can be taken and a small tube (stent) inserted to open the ducts
• Percutaneous transhepatic cholangiography (PTC) – another type of X-ray used to create images of the bile ducts to check for abnormalities or blockages. A stent can be inserted to open the bile ducts, allowing 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