When to seek medical advice
Check with your doctor if you develop any of the signs or symptoms of
biliary tract problems, such as:
Although these signs and symptoms are usually not related to cancer,
they may indicate other conditions that require medical care.
Screening and diagnosis
Many gallbladder cancers are discovered when a pathologist examines a
gallbladder that has been removed for symptoms of gallstones. But many
gallbladder and most bile duct cancers are found only after related
signs and symptoms appear.
If you develop any of the symptoms of biliary tract cancer, your doctor
will talk with you about your medical history and conduct a thorough
physical exam. You'll also likely have one or more of the following
Your doctor may order tests to check for elevated levels of
bilirubin or the enzyme alkaline phosphatase. You might also have
tests to measure certain substances (markers) in your blood that
sometimes indicate the presence of a tumor. People with bile duct
cancer tend to have high levels of the marker CA 19-9. But CA 19-9
levels can be elevated in people with other types of cancer as well
as in people who are cancer-free. For that reason, this isn't
considered a definitive test.
This test uses high-energy sound waves to produce images of your
internal organs, including your gallbladder. It has no side effects,
is not invasive and generally takes less than 30 minutes. While you
lie on a bed or table, a wand-shaped device (transducer) is placed
on your body. It emits high-frequency (nonaudible) sound waves that
are reflected from your gallbladder back to the transducer and then
translated into a moving image. Ultrasound is usually one of the
first tests done in the evaluation of patients with jaundice and is
especially good at diagnosing the presence of gallstones and
obstructed bile ducts. It can also show the presence and extent of
tumors. Endoscopic ultrasound is a technique that can sometimes
provide even better images. In this test, an ultrasound transducer
is attached to the end of a flexible, lighted viewing tube known as
an endoscope. The endoscope is gently passed down your throat into
your stomach and duodenum, and from there into the common bile duct.
tomography (CT) scan.
This is essentially a highly detailed X-ray that allows your doctor
to see your gallbladder in two-dimensional "slices." Split-second
computer processing creates these images while a series of thin
X-ray beams pass through your body. In most cases, you will have a
dye (contrast medium) injected into a vein before the test. By
helping to produce clearer images, the dye makes it easier to
distinguish a tumor from normal tissue. A CT scan can also help
determine if cancerous cells have spread to the common bile duct,
lymph nodes or liver.
resonance imaging (MRI).
Instead of X-rays, this test uses a powerful magnetic field and
radio waves to create images. Used in combination with
cholangiography — a test in which a small amount of dye is used to
highlight the biliary tract — it can help determine whether the flow
of bile is blocked or a tumor has invaded the liver. During the
test, you're encased in a cylindrical tube that can seem quite
confining to some people. The machine also makes a loud thumping
noise you might find disturbing. In most cases you'll be given
headphones for the noise. If you're claustrophobic, ask your doctor
whether another scanner or some mild sedation may be an option for
retrograde cholangiopancreatiography (ERCP).
In this procedure, an endoscope is gently passed down your throat,
through your stomach and into the upper part of your small
intestine. Air is used to inflate your intestinal tract so that your
doctor can more easily see the openings of the bile and pancreatic
ducts. A dye is then injected into these ducts via a catheter that's
passed through the endoscope. Finally, X-rays are taken of the
ducts. Your throat may be sore for a time after the procedure, and
you may feel bloated from the air introduced into your intestine.
Major complications are rare and include infection and bleeding.
This test is most sensitive for detecting an obstruction of the bile
ducts and its cause, and can also be used in preparation for
surgery. ERCP can also allow a biopsy to be performed, confirming a
A somewhat more invasive procedure than ERCP, laparoscopy also uses
a small, lighted instrument (laparoscope) to view your gallbladder,
liver and surrounding tissue. But in this case, the instrument is
attached to a television camera and inserted through a small
incision in your abdomen. During this procedure, your surgeon can
also take tissue samples to help confirm the diagnosis of cancer.
Laparoscopy is often used to confirm how far the cancer has spread.
In this test, a small tube (catheter) is inserted into a blood
vessel — usually in your groin — and gently threaded to the area to
be studied. A dye is then inserted into the catheter and X-rays
track the dye as it flows through your blood vessels. This test is
sometimes performed to show surgeons the exact location of blood
vessels near a bile duct cancer.
In this procedure, a small sample of tissue is removed and examined
for malignant cells under a microscope. It's the only way to make a
definitive diagnosis of cancer. Biopsies of the gallbladder and bile
ducts can be obtained in several ways. Your doctor may take tissue
samples during laparoscopy. Or he or she may choose to perform a
fine-needle aspiration (FNA) — a procedure in which a very thin
needle is inserted through your skin and into your gallbladder. An
ultrasound or CT scan is often used to guide the needle's placement.
When the needle has reached the tumor, cells are withdrawn and sent
to a lab for further study. Tissue samples can also be removed
during or after gallbladder surgery. Bile duct cells and tiny
fragments of duct tissue can be obtained through a procedure known
as biliary brushing. As in ERCP, an endoscope is inserted into the
bile duct where it empties into your small intestine. But instead of
injecting dye and taking X-rays, your surgeon uses a small brush
placed in the endoscope to scrape cells and bits of tissue from the
lining of the bile duct.
Staging biliary tract cancers
Staging tests help determine the size and location of cancer and whether
it has spread. This helps your doctor determine the best treatment for
Doctors stage biliary tract cancers in several ways. One method of
classifying stages is as follows:
This is cancer found only in the tissues that make up the walls of
the gallbladder or bile ducts. The cancer can be entirely removed
during an operation. The term resectable refers to a cancer
that can be removed.
At this stage, the cancer has spread to nearby lymph nodes or organs
such as the liver, pancreas, stomach or intestines. All the cancer
cannot be removed during an operation.
This refers to cancer that returns after it has been treated. It may
recur in the gallbladder or bile duct or in some other part of the
tumor that blocks the bile duct can cause pain, jaundice, nausea and
vomiting. Tumors located where the pancreatic duct enters the small
intestine may block the small intestine, preventing normal passage of
food. Or tumors may make it difficult to digest and absorb nutrients
from the food you eat by blocking the flow of pancreatic enzymes.
The most serious complication of biliary tract cancer is metastasis.
Your gallbladder and bile ducts are surrounded by a number of vital
organs, including your liver, stomach, pancreas and intestines. Because
biliary tract cancers are rarely discovered in the early stages, they
often have time to spread to these organs or to nearby lymph nodes.
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