Most bile duct cancers are not found until patients go to a doctor because they have symptoms.
 

Signs and symptoms of bile duct cancer

Signs and symptoms may not be present until the later stages of bile duct cancer, but in some cases they may lead to an early diagnosis. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an early stage, when it is most treatable.
 

When bile duct cancer does cause symptoms, it is usually because the bile duct is blocked.
 

Jaundice: This is the most common symptom of bile duct cancer. Jaundice occurs when the liver cannot get rid of bile, and one of the chemicals in bile called bilirubin "backs up" into the bloodstream. Bilirubin is greenish yellow and colors all the body tissues, including the skin and the white part of the eyes, making people with this condition begin to look yellow.
 

It is important to realize that most cases of jaundice are not caused by cancer. It is more often due to hepatitis (inflammation of the liver) or a gallstone that has traveled to the bile duct. But whenever jaundice occurs, a doctor should be seen right away.
 

Itching: Excess bilirubin in the blood can also reach the skin, which can cause itching. Most people with bile duct cancer notice itching.
 

Abdominal pain: Early bile duct cancers usually do not cause pain, but more advanced cancers may lead to abdominal pain, especially below the ribs on the right side.
 

Loss of appetite/weight loss: People with bile duct cancer may not feel hungry and may unintentionally lose weight.
 

Fever: Some people with bile duct cancer develop fevers.
 

Light colored stools/dark urine: Bilirubin contributes to the brown color of bowel movements, so if its flow into the intestine is blocked the color of a person's stool might be lighter. When bilirubin levels in the blood get high, it can also come out in the urine and turn it dark.
 

Nausea/vomiting: This is not a common symptom of bile duct cancer, but it may be seen in people who develop an infection (cholangitis) as a result of bile duct blockage. It is often seen along with a fever.
 

These are symptoms and signs of bile duct cancer, but it is important to remember that they are more likely to be caused by non-cancerous diseases. For example, people with gallstones may have many of these same symptoms. There are many causes of abdominal pain that are far more common than bile duct cancer. And hepatitis (infection of the liver by a virus) is a much more common cause of jaundice. Still, if you have any of these problems, it's important to see your doctor right away so the cause can be found and treated, if needed.
 

History and physical exam

If there is reason to suspect that you have bile duct cancer, your doctor will want to take a complete medical history to check for symptoms and risk factors, including your family history.
 

A physical exam is done to look for signs of bile duct cancer and other health problems. If bile duct cancer is suspected, the exam will focus mostly on the abdomen to check for any masses, tenderness, or build up of fluid. The skin and the white part of the eyes will be checked for jaundice (a yellowish color).
 

If symptoms and/or the results of the physical exam suggest bile duct cancer might be present, more involved tests will likely be done. These may include lab tests, imaging tests, and other procedures.
 

Blood tests

Tests of liver and gallbladder function: The doctor may order lab tests to find out how much bilirubin is in the blood. Bilirubin is the chemical that gives the bile its yellow color. Problems in the bile duct, gallbladder, or liver may cause too much bilirubin to remain in the blood. A high bilirubin count tells the doctor that there may be problems with the bile duct, gallbladder, or liver.
 

The doctor may also order tests for other substances in your blood, such as albumin, alkaline phosphatase, AST, ALT, and GGT. These are sometimes called liver enzymes or liver function tests. They can also give an indication of bile duct, gallbladder, or liver disease. Although elevations of these substances may point to blockage of the bile duct, they cannot show if it is due to cancer or some other reason.
 

Tumor markers: Tumor markers are substances made by cancer cells that can sometimes be found in the blood. People with bile duct cancer may have high blood levels of the carcinoembryonic antigen (CEA) and CA 19-9 tumor markers. High amounts of these substances often mean that there is cancer, but the absence of these markers does not mean there is no cancer, since not all cancers make them.
 

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests may be done for a number of reasons, including to help find a suspicious area that might be cancerous, to learn how far cancer may have spread, and to help find out if treatment has been effective.
 

Imaging tests can often identify and locate a bile duct blockage. But they often do not reveal whether the blockage is due to a tumor or a benign problem such as scarring.
 

Ultrasonography (ultrasound)

Ultrasound is often the first imaging test done in people who have symptoms such as jaundice or pain in the right upper part of their abdomen. For this test, a small instrument called a transducer emits sound waves and picks up their echoes as they bounce off internal organs. The echoes are converted by a computer into a black-and-white image that is displayed on a video screen. The echoes produced by most tumors differ from those of normal tissue. The patterns of echoes can help distinguish between some types of benign and malignant tumors.
 

This is a very easy procedure to have done that does not use radiation. For an ultrasound exam of the liver, you simply lie on a table while the doctor or ultrasound technician places the transducer (which is shaped like a wand) on the skin over the right upper part of the abdomen. Usually, the skin is first lubricated with gel.
 

Endoscopic or laparoscopic ultrasound: These techniques allow the doctor to place the ultrasound transducer inside the body and closer to the bile duct to produce more detailed images than a standard ultrasound. The transducer is on the end of a thin, lighted tube that has an attached viewing device (an endoscope or laparoscope). The tube is either passed through the mouth and down through the stomach and near the bile duct (endoscopic ultrasound) or through a surgical incision (cut) in the side of the patient's body (laparoscopic ultrasound).
 

If there is a tumor, the doctor may be able to tell how far it has grown and spread, which can help in planning for surgery. Ultrasound may be able to show if nearby lymph nodes are enlarged, which may be a sign that cancer has reached them. It may also be used to guide a needle into a suspicious node so that cells can be removed (biopsied) and viewed under a microscope.
 

Computed tomography (CT) scan

The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one x-ray, a CT scanner takes many pictures as it rotates around you. A computer then combines these into images of slices of the part of your body that is being studied.
 

Before any pictures are taken, you may be asked to drink 1 to 2 pints of a liquid called oral contrast. This helps outline the intestine so that certain areas are not mistaken for tumors. You may also receive an IV (intravenous) line through which a different kind of contrast dye (IV contrast) is injected. This helps better outline structures in your body.
 

The injection can cause some flushing (redness and warm feeling). Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays.
 

You need to lie still on a table while the scan is being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. You might feel a bit confined by the ring you have to lie in while the pictures are being taken.
 

CT scans can have several uses:

• They are often used to help make the initial diagnosis of bile duct cancer by showing tumors in the area.

• They can be helpful in staging the cancer (determining the extent of its spread). CT scans can also show the organs near the bile duct (especially the liver), as well as lymph nodes and distant organs where cancer may have spread to. This can help to find out if surgery is a good treatment option.

• CT scans can also be used to guide a biopsy needle precisely into a suspected tumor or metastasis. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table, while a radiologist advances a biopsy needle through the skin and toward the location of the mass. CT scans are repeated until the needle is within the mass. A biopsy sample is then removed and looked at under a microscope.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans provide detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into very detailed images of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better see details.
 

MRI scans provide a great deal of detail and can be very helpful in looking at the bile ducts and nearby organs. Sometimes they can help tell a benign tumor from a malignant one. Special types of MRI scans may also be used in people who may have bile duct cancer. MR cholangiopancreatography (MRCP) can be used to look at the bile ducts and is described below in the section on cholangiography. MR angiography (MRA) looks at blood vessels and is mentioned below in the section on angiography.
 

MRI scans may be a little more uncomfortable than CT scans. They take longer -- often up to an hour. You may be placed inside a large cylindrical tube, which is confining and can upset people with a fear of enclosed spaces. Newer, "open" MRI machines can help with this if needed. The MRI machine makes buzzing and clicking noises that you may find disturbing. Some places will provide earplugs to help block this out.