Tests for bile duct cancer
Bile duct cancer is also called cholangiocarcinoma. It is a rare type of cancer that develops in the 
.
You usually have a number of tests to check for bile duct cancer. These include:
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blood tests
-
scans such as ultrasound scans and CT scans
Most people are diagnosed with bile duct cancer after they become unwell and go to A&E. Others start by seeing their GP if they have symptoms that could be due to cancer. Some people are also diagnosed after having tests for something else.
Tests you might have to find out the cause of your symptoms
The tests you have first depend on the symptoms you have. Tests might include:
- physical examination
- blood tests
- ultrasound scan
- CT scan
- MRI scan
- checking for
tumour markers - taking a sample of tissue - this is called a biopsy
Physical examination
Your doctor feels your tummy (abdomen) for any areas that might be swollen or might not feel normal, including a lump. Tell your doctor if you have pain anywhere, and they can feel those areas too. They can also listen to your abdomen and chest to find out if they sound normal.
Blood tests
Blood tests can check your general health. This includes checking:
- how well your liver and kidneys are working
- the number of
blood cells such as red blood cells
Ultrasound scan
Ultrasound scans use high frequency sound waves to create a picture of a part of the body. You usually have an ultrasound scan of your abdomen. This helps doctors look at your:
- bile ducts
pancreas - liver
CT scan
A CT scan uses x-rays and a computer to create detailed pictures of the inside of your body. The computer puts them together to make a 3 dimensional (3D) image.
You usually have a CT scan of your chest and abdomen to look for:
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any abnormal areas in your bile ducts and liver
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any abnormal areas elsewhere in your abdomen and chest
MRI scan
You might have a regular MRI scan. You might also have a special type of MRI scan called an MRCP.
MRI stands for magnetic resonance imaging. It is a type of scan that creates pictures using magnetism and radio waves. MRI scans produce pictures from angles around the body and show up organs very clearly.
MRCP stands for magnetic resonance cholangio pancreatography. This type of MRI shows your pancreas, gallbladder and bile ducts in detail. You usually have an MRI scan of your abdomen at the same time as the MRCP.
Tumour markers
Tumour markers are substances that might be raised if there is a cancer. They’re usually proteins. They can be found in the blood, urine or body tissues.
Some tumour markers are only produced by one type of cancer. Others can be made by several types. Some markers are found in non cancerous conditions as well as cancer.
Doctors might use tumour markers to monitor how well your cancer treatment is working or check if the cancer has come back.
Doctors usually check the CA19-9 tumour marker for bile duct cancer.
Some people with bile duct cancer don't have a raised CA19-9 level. So your doctor will use this result alongside your other tests to see if you are likely to have bile duct cancer.
Biopsy
A biopsy means taking a sample of tissue and sending it to the laboratory so it can be looked at under a microscope. This is the only way to be certain whether a lump or growth in the bile duct is a cancer or not.
There are different ways to have a biopsy of the bile ducts. This includes having a biopsy:
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during an endoscopic retrograde cholangio pancreatography (ERCP)
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during a cholangioscopy
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using an ultrasound or CT to guide the needle
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during a percutaneous transhepatic cholangiography (PTC)
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during an endoscopic ultrasound scan (EUS)
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during an operation on your abdomen called a laparoscopy
ERCP
ERCP stands for endoscopic retrograde cholangio pancreatography. It is a test to help diagnose conditions of the liver, bile ducts, pancreas or gallbladder.
Your doctor puts a long, flexible tube called an endoscope down your throat to look at your pancreas and bile ducts.
The endoscope has a small camera and light at the end. Your doctor can look down the endoscope or at pictures on a TV screen. They can take x-rays and biopsies of any abnormal looking areas.
You usually have an injection of sedation first to make you drowsy.
Cholangioscopy
You might also have a cholangioscopy when you have an ERCP. During the ERCP your doctor puts a smaller tube called a cholangioscope down through the endoscope. This smaller tube has a probe and camera attached.
The cholangioscope can go directly into the bile ducts. Your doctor can see if there are any abnormal areas and take biospies.
A cholangioscopy may also be called a SpyGlass procedure.
Biopsy using an ultrasound or CT to guide the needle
Your doctor can use an ultrasound or CT scan to look at the bile ducts and take a biopsy.
They use the scan to guide a fine needle through the skin and into the bile ducts. Then attach a syringe to the needle and draw up a sample of cells. This is called a fine needle aspiration (FNA).
You have an injection of into your abdomen before the biopsy.
Percutaneous transhepatic cholangiography (PTC)
A PTC is a way of looking at your bile ducts using x-rays.
Your doctor injects some local anaesthetic into the right side of your abdomen. This makes the area numb. They then use x-rays to help them put a long thin needle into your liver and bile ducts.
Your doctor then injects some dye down the needle. This shows up any blockages on the x-ray. They can also take biopsies of any abnormal looking areas.
You usually have a PTC if you can't have an ERCP for any reason.
Endoscopic ultrasound scan (EUS)
This test combines an ultrasound scan and an endoscopy to look at your food pipe (oesophagus), stomach, pancreas and bile ducts.
Your doctor uses a long flexible tube called an endoscope. It has a tiny camera and light on the end and an ultrasound probe attached. This uses high frequency sound waves to create a picture of the inside of your body.
Your doctor can take biopsies of any abnormal areas during the test.
You're usually awake when you have the test, but you can ask to have a medicine to help you relax (sedation).
Laparoscopy
A laparoscopy is a small operation to look inside your abdomen. It is also called keyhole surgery. You have it under a .
During a laparoscopy your surgeon can:
- look for signs of cancer and see if it has spread
- take a biopsy
Your doctor might do a laparoscopy to see if surgery to remove the cancer is possible.
If a biopsy shows bile duct cancer
If a biopsy shows you have bile duct cancer, then you usually have tests to find out more about the cancer.
The tests you might have include:
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PET scan
-
PET-CT scan
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genetic tests on the cancer cells
Scans help your doctor see how big the cancer is and if it has spread. This is called the stage of the cancer.
The results of all these tests help your doctor decide what treatment is best for you.
PET scan
PET stands for positron emission tomography. PET scans show a 3 dimensional (3D) picture of the inside of your body. It uses a mildly radioactive drug to show up areas of your body where cells are more active than others.
You might have a PET scan to:
- help diagnose bile duct cancer
- look for cancer in the
lymph nodes and other parts of the body
PET-CT scan
A PET-CT scan combines a CT scan and a PET scan. You might have a PET-CT scan to look for cancer in the lymph nodes and other parts of your body. This helps your doctor find out the stage of your cancer.
Genetic tests on the cancer
If a biopsy shows you have bile duct cancer, your doctor will usually look to see if the cancer cells have any changes (mutations). This can include mutations to the:
- IDH1 gene
- FGFR2 gene
Knowing this helps your doctors decide which treatment is best for you.
Other tests
Occasionally your doctor may want you to have other tests. This will depend on your general health, symptoms and the cancer. Your doctor will explain what the tests are for and how to prepare for them.
Coping with bile duct cancer
Coping with a diagnosis of bile duct cancer can be difficult. There is help and support available to you and your family.
