Bile Duct Cancer Symptoms

Bile duct cancer usually surfaces with many vague symptoms. Maybe stomach pain or weight loss brought you to the hospital. Maybe you went in for routine gallbladder surgery, but your doctor found something much more complex and unexpected.

Jennifer Wo, MD, is a radiation oncologist and program director for the Gastrointestinal Radiation Oncology Program at Mass General Brigham Cancer Institute. Here, she explains common symptoms of bile cancer to watch out for, what to expect after diagnosis, and new treatments for bile duct cancer.

What is bile duct cancer?

Bile duct cancers develop when cells grow out of control in the bile duct, or biliary system. This system of thin tubes drains bile (a fluid that helps your body digest fat) from the liver to the gallbladder and small intestine.

The biliary system is like a tree, where all the little branches are up in the liver. As bile flows from the liver, it goes into bigger branches until it arrives at the right and left bile ducts. Then the branches join up with a tube from the gallbladder, forming a common bile duct that empties into the intestine.

The gallbladder stores bile and releases it into the common bile duct every time you eat. Cancer can form anywhere in this network of bile ducts or in the gallbladder.

Types of bile duct cancer

Bile duct cancers, also called cholangiocarcinoma, are named for where they occur. The types of bile duct cancers include:

• Intrahepatic cholangiocarcinoma, where cancer forms in the smaller bile duct branches that are inside the liver.
• Extrahepatic cholangiocarcinoma, where cancer forms in the bile duct system outside of the liver. This includes two types: common bile duct cancer and perihilar bile duct cancer (also called Klatskin tumors).

Signs and symptoms of bile duct cancer

Recognizing bile duct cancer symptoms can be hard. You likely won’t have obvious signs of cancer, but rather vague symptoms such as:

• Abdominal (belly) discomfort
• Dark urine
• Feeling full early
• Food intolerances, especially to fatty foods
• Itching
• Jaundice (a yellow tint to your skin or eyes)
• Light-colored, floating stool
• Unexplained weight loss

“Bile duct cancer is rare, and these symptoms are more likely to result from something else going on,” Dr. Wo explains. “But it’s still important to get checked out. See your primary care provider if you have any of these symptoms. If it’s something more serious, we’ll want to look at treatment quickly.”

How fast does bile duct cancer spread?

Cancer can spread, or metastasize, from the bile ducts to other parts of the body. Most often, it spreads to the liver, abdominal lymph nodes, abdominal cavity (the space surrounding organs in the belly), lungs, or bones.

“How fast bile duct cancer spreads varies from person to person,” Dr. Wo says. “Unfortunately, it’s often a silent disease. Symptoms are vague and usually present at later stages, Stage 3 and Stage 4, when the cancer has already spread beyond the bile duct.”

Compared to other metastatic cancers, bile duct cancers are generally on the more aggressive end, even when they’re removed. However, researchers continue to study the disease and are finding new ways to treat it through clinical trials.

Receiving a bile duct cancer diagnosis

Bile duct cancers are usually discovered when you see a doctor for an entirely different health concern. Since it happens so rarely, no screening tests exist to catch bile duct cancer early.

If your doctor suspects cancer, you may get a:

• Computed tomography (CT) scan, imaging using a series of x-rays
• Magnetic resonance imaging (MRI) scan, imaging using a strong magnetic field and radio waves
• Positron emission tomography (PET) scan, imaging using a safe radioactive sugar
• Biopsy, procedure to get a tissue sample

These tests help spot cancer in the biliary system and throughout your body to confirm a diagnosis. If imaging shows a blockage in your biliary system, you may get an endoscopic retrograde cholangiopancreatography (ERCP). This procedure allows your doctor to take tissue samples and open a blocked bile duct with stents (tubes that widen and support the duct).

Bile duct cancer treatment: What to expect

Your treatment plan depends on whether the cancer can be removed with surgery. Surgery may not be possible if cancer has spread, involves the bile ducts too extensively, or involves critical blood vessels. Sometimes surgery would take too much of a toll on your body—most bile duct cancer surgeries are major operations.

You may need additional treatment before or after surgery. Chemotherapy, immunotherapy, and radiation therapy help make the tumor smaller or treat remaining cancer cells.

For patients with bile duct cancer, Dr. Wo recommends going to a high-volume center with a lot of expertise, not just for surgery but in managing the complications and complexities of the condition. These tumors are in difficult locations that require individualized care based on your anatomy and your cancer journey.

Your care team should include specialists from:

• Surgery
• Medical oncology
• Radiation oncology
• Interventional radiology
• Gastroenterology

New treatments for bile duct cancer

Even when tumors can’t be removed or when cancer has spread, you still have treatment options. Cancer medications, including chemotherapy, immunotherapy, and targeted therapy, attack cancer cells in your body.

Mass General played a pivotal role in identifying and developing targeted therapies for IDH1 and FGFR mutations that tend to occur in intrahepatic bile duct cancer. Those breakthroughs provided different types of therapies where none existed before.

In addition to cancer medications, you have access to radiation therapies. Mass General also pioneered an advanced procedure called high-dose ablative radiation. This therapy, which treats intrahepatic bile duct cancer, shrinks tumors while limiting radiation exposure to surrounding tissue. Proton radiation therapy similarly targets cancer cells with potential to minimize damage to healthy tissue.

Is bile duct cancer curable?

Bile duct cancers are very challenging, high-risk cancers. Treatment can potentially cure some forms of this disease. Researchers continue to search for better therapies to bring hope.

“Since bile duct cancer is often very advanced when it’s found, a health care system that does a lot of research is more likely to have novel clinical trials that may be beneficial to your treatment,” says Dr. Wo.

Mass General Brigham Cancer Institute is a national leader in bile duct cancer treatment and research. You can find clinical trials that offer the latest therapies, working to optimize cancer medications, radiation, and surgery.