Biliary / Bile Duct Cancer

About the Condition

Cancer of the bile ducts is also known as biliary cancer, and affects the biliary system, which is made up of a series of tubes that begin in the liver and end in the small intestine, and are used to carry bile through the body to break down fatty foods. Biliary cancer occurs when the genetic material of cells in the bile ducts become damaged or changed, producing mutations that affect normal cell growth and division. The abnormal cells then replicate, causing cancer. If undetected, the cancer can spread beyond the biliary system and move to other parts of the body.

The precise causes of biliary cancer are not known, but several recognized risk factors have been identified, which include:

  • Being over the age of 65*
  • Having primary sclerosing cholangitis (PSC), which is a rare type of liver disease that causes long-lasting (chronic) inflammation of the liver
  • Having bile duct abnormalities, such as the presence of fluid-filled sacs (cysts) in the bile duct. These cysts are usually present from birth, and itis estimated that 6-30% of people with these conditions will develop cancer of the bile duct*
  • Having biliary stones, which are are similar to gallstones, except they form inside the liver rather than inside the gallbladder. Biliary stones are rare in western Europe, but are relatively common in parts of Asia, such as Japan and Taiwan. It is estimated that approximately 10% of people with biliary stones will develop biliary cancer
  • Spending time in parts of the Far East, particularly Thailand, where biliary cancer is approximately 100 times more common than in the West*. This is thought to be due to chronic bile duct infection by liver worms, which are common in those areas but not a factor in the West
  • Having non-alcoholic fatty liver disease
  • Having diabetes
  • Having Hepatitis B or C, which are viral liver infections thought to cause a tenfold increase in the risk of developing biliary cancer
  • Having an inflammatory bowel disease, which is a general term that describes a number of conditions that cause inflammation inside the digestive system. The two most common types (although still rare in general terms) of inflammatory bowel disease are:
  • Ulcerative colitis, which affects around 100,000 people in England
  • Crohn’s disease, which affects around 90,000 people in England
  • Exposure to certain chemical toxins, such as
    • Thorotrast, which was widely used in radiography until it was banned during the 1960s after its dangerous properties were fully understood
    • Asbestos
    • Polychlorinated Biphenyls (PDBs), which used to be used in building and manufacture but has since been banned



Biliary cancer often doesn’t display any symptoms until it has progressed to a later stage, but the most common obvious symptoms include:

  • Abdominal pain
  • No appetite
  • Jaundice, which is yellowing of the skin and the whites of the eyes
  • High temperatures
  • Weight loss
  • Dark coloured urine
  • Clay coloured stools

Some people find it embarrassing to talk about these sorts of symptoms, but if any of the above apply to you, or if you have any concerns about similar symptoms, it is essential that you see your doctor at once, as your chances of recovery are much higher if your cancer is diagnosed early.



If you’re referred to CCL for diagnosis, your consultant or oncologist will advise you on which tests are relevant to your individual symptoms. Because biliary cancer patients do not usually show symptoms until the cancer has progressed, it is vital that the diagnosis is swift and accurate. The tests for this disease include:

  • An Ultrasound scan, which uses high frequency sound waves to look inside the body and produce live images on a computer display.
  • A Computerised Tomography (CT) scan, which shows a 3D image of the area being looked at
  • A Magnetic Resonance Imaging (MRI) scan, which is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body
  • Specialised X-rays, where special liquids or dyes are injected into the abdomen to create a clearer picture on the x-ray
  • A biopsy, where cell samples are taken for examination for signs of cancer
  • Blood tests



Once the diagnosis of biliary cancer has been confirmed, it should be possible to determine how far the cancer has progressed. The spread of the cancer is measured in stages, which are:

  • Stage 1A – the cancer is contained inside the bile duct
  • Stage 1B – the cancer is beginning to spread beyond the walls of the bile duct but has not spread into the surrounding tissue or lymph nodes
  • Stage 2A – the cancer has spread into nearby tissue, such as the liver or pancreas, but has not spread into the lymph nodes
  • Stage 2B – the cancer has spread into nearby tissue and lymph nodes
  • Stage 3 – the cancer has spread into the major blood vessels that supply the lungs, or into organs such as the stomach, gallbladder or bowel
  • Stage 4 – the cancer has spread into distant organs, such as the lungs



The treatment of biliary cancer depends on the stage of the cancer, and treatment is tailored to each individual patient. At CCL, patients with biliary cancer are treated by a team of different specialists, called a Multi-Disciplinary Team, or MDT. This team works together to create a treatment plan to suit the individual needs of the patient.

Treatment options involve:

  • Surgery to remove the affected area

Depending on the stage of the cancer, the surgery could remove:

  • The affected area of the bile duct
  • Part of the liver
  • Part of the gall bladder
  • Any affected lymph nodes
  • Surgery to relieve blockage of the bile ducts, which could be:
  • An endoscopic procedure, which involves inserting a long, flexible tube with a light and video camera on the end (endoscope) into your bile duct, and using it to position a small metal or plastic tube called a stent, which will remove the blockage
  • A stent placed into the bile duct via an incision in the abdomen
  • Radiotherapy, where high-energy rays are used to destroy the cancer cells
  • Chemotherapy, which involves the use of chemical agents which are toxic to cancer cells, destroying them and preventing them from spreading to different areas. This can be given by injection or in tablet form
  • Biotherapy, which is the use of newer and more targeted therapies to assist the body in fighting the disease
  • Photodynamic therapy (PDT), which is an experimental treatment for symptoms of biliary cancer. A special chemical is injected into the bile duct, which makes the cancerous cells more sensitive to light. A laser is then passed through an endoscope and used to shrink the tumour. PDT is not a cure for biliary cancer, and it is important to be aware of the current uncertainties about the effectiveness and safety of the procedure


Support Services

Cancer doesn’t just leave a physical impact on an individual, it can have a huge emotional effect as well. Cancer and its treatment can be overwhelming, causing a wide variety of emotions, and it is important to remember that there is no right or wrong response. Reactions vary hugely from person to person, and most people find that it becomes easier to cope when they’re given additional support, so that’s what we do.

At CCL we provide support both physically and emotionally before, during and after treatment. We offer a wide range of services for patients, as well as their loved ones, designed to make a very difficult time as easy as possible, and to give our patients the best treatment and support possible. These include counselling, physiotherapy, Pilates, group sessions and many more.


Biliary / Bile Duct Cancer Consultants