If you have symptoms that suggest you may have bile duct cancer, it’s vital that your doctor has a clear and complete understanding of what’s causing them. When making a diagnosis, our experts take the time to learn about your medical history and understand your overall health. We conduct a thorough physical examination. You may have some of the following tests.
Diagnosing bile duct cancer may begin with a test to measure the amount of bilirubin in the blood. Bilirubin is a chemical that comes from the breakdown of red blood cells and gives bile its yellow color. A high bilirubin level can lead to jaundice (a yellowing of the skin and the whites of the eyes) and mean that the liver or bile ducts are not functioning properly. Other blood tests measure levels of liver enzymes (such as alkaline phosphatase, AST, ALT, and GGT) and can identify abnormal amounts of other substances (such as CEA and CA 19-9). Finding any of these substances in the blood can indicate the presence of bile duct cancer.
At MSK, we use the latest imaging techniques to pinpoint the exact size and location of newly diagnosed bile duct tumors. These details help us determine whether a tumor can be removed by surgery. They also help predict a tumor’s response to other treatments. Imaging helps guide our surgeons and interventional radiologists during many kinds of procedures.
The imaging techniques we use at MSK include:
CT scans take cross-sectional pictures of the body, helping doctors determine if the cancer cells are only in the bile duct or if they have spread to other areas. At MSK, we use triphasic CT scans. These take images of the bile ducts, liver, and nearby lymph nodes during three phases of blood flow through the liver.
Ultrasound is useful for detecting the location and number of tumors and whether the tumor involves the main blood vessels. Ultrasound can distinguish whether a mass is cancer or a benign (noncancerous) gallstone disease. Unlike CT, ultrasound does not use radiation.
Magnetic Resonance Cholangiopancreatography
This technique uses MRI to show how much a tumor has grown within the bile duct. It helps doctors determine if the tumor can be removed by surgery. More detailed MRI may be needed to see if the tumor has spread to the liver or other organs.
Positron Emission Tomography
PET scans can detect whether cancer has spread from the bile duct to other tissues or organs. PET and CT scans are sometimes used together (PET-CT) to pinpoint the exact location of tumors.
Other Diagnostic Techniques
We may do other tests to learn more about the extent of the tumor and the types of cells involved. These are often performed in an outpatient setting.
During a biopsy, a doctor removes a small amount of tissue from the area where the cancer is suspected. At MSK, we use an image-guided technique called fine needle aspiration to get the sample of bile duct cancer. This procedure is usually performed by an interventional radiologist (a doctor who specializes in minimally invasive techniques).
This technique involves inserting an endoscope (a long, narrow tube attached to a camera and light) through the mouth and down the throat to examine the interior lining of the bile ducts.
In this procedure, a doctor inserts a laparoscope (a thin lighted tube with a camera on its tip) through a small incision (cut) in the abdominal wall to look at the organs in the belly or pelvis. The doctor can then see the size of the cancer and if it has spread to other organs and lymph nodes. This evaluation is also called staging. Tissue samples may be removed for a biopsy during a laparoscopy as well.
Sometimes a bile duct tumor is too small to do a biopsy. If cancer is suspected, surgery to remove the tumor may be necessary to confirm the diagnosis.