Bile Duct Cancer Diagnosis & Detection

At Cancer Treatment Centers of America (CTCA) our team of cancer doctors uses sophisticated, minimally invasive technology to help them make an accurate bile duct cancer diagnosis and evaluate the disease.

During your first visit to a CTCA hospital, you’ll undergo a comprehensive exam to precisely diagnose your bile duct cancer and determine if it has spread to any other part of your body. This helps your care team formulate an individualized treatment plan that is best suited to your needs.

Throughout your treatment, we will use diagnostic imaging and a variety of laboratory tests for bile duct cancer that allow your care team to monitor how the disease is responding. If the cancer is resisting treatment, we will modify your treatment plan or recommend using a different therapy.

How Is Bile Duct Cancer Diagnosed? 

• Physical Exam: When bile duct cancer is suspected, your doctor will perform a physical exam of the abdomen to check for any masses, tenderness or build-up of fluid that might suggest signs of cancer. He/she will also check the skin and the white part of the eyes for jaundice.
• Liver Function Tests (LFTs): To test for abnormalities in the bile duct, gallbladder or liver, your doctor might order a number of laboratory tests, including blood counts of bilirubin, albumin, alkaline phosphatase, aspartate transaminase (AST), alanine transaminase (ALT) and gamma glutamyl transpeptidase (GGT). High levels of these substances in the blood indicate problems with the bile duct, gallbladder or liver.
• Blood Tests for Tumor Markers: High blood levels of the carcinoembryonic antigen (CEA) and CA 19-9 tumor markers may be found in people with bile duct cancer. However, problems of the bile duct other than cancer can also increase the levels of these tumor markers in the blood, and not all bile duct cancers make these tumor markers. Therfore, when making a bile duct cancer diagnosis, your team will combine these test results with results from other diagnostic tests.

Diagnostic Imaging Tests and Biopsy Techniques for Bile Duct Cancer 

To ensure an accurate bile duct cancer diagnosis, your doctor may use a variety of imaging tools to confirm the presence of a tumor, and to determine whether the cancer has spread beyond the bile duct:

• Ultrasound: Sound waves and their echoes produce an image of internal organs or masses.
• Endoscopic or Laparoscopic Ultrasound: These techniques allow your doctor to produce more detailed images of the bile duct than a standard ultrasound. A thin, lighted tube with a small video camera is inserted through the mouth and esophagus into the small intestine near the bile duct (endoscopic ultrasound) or through a small incision in the front of the abdomen (laparoscopic ultrasound) so that the doctor can examine the bile duct and other internal organs.
• Computed Tomography (CT) Scan: This is an X-ray test that produces detailed cross-sectional images of the organ under study. It can provide precise information about the size, shape and position of any tumors in the bile duct or elsewhere in the abdomen, as well as nearby blood vessels. CT scans can also be used to guide a biopsy needle precisely into a suspected tumor (CT-guided needle biopsy). At CTCA, you will have the benefit of newer and advanced technologies such as the spiral CT, which uses a faster machine that reduces the dose of radiation and yields more detailed images.
• Magnetic Resonance Imaging (MRI): Like CT scans, MRI scans provide detailed images of soft tissues in the body. But, instead of X-rays, MRI scans use magnetic energy and radio waves to create cross-sectional images or "slices" of the human body. A contrast material called gadolinium is often injected into a vein before the scan to see details more clearly. MRI scans may sometimes be able to distinguish between benign and malignant tumors. They can also be used to look at blood vessels in and around the bile duct (MR angiography).
• Cholangiography: A cholangiogram is an imaging test specifically designed to identify abnormalities in the bile ducts such as a block, narrowing or dilation (widening) of the bile duct.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): This uses a procedure similar to endoscopic ultrasound to reach the bile or pancreatic duct where X-ray images are taken to recognize the problems in the bile duct. The ERCP procedure may be used to obtain biopsies of tissue or fluid, or to place stents in the bile duct to keep it open.
  • Percutaneous Transhepatic Cholangiography (PTC): This method uses a thin, hollow needle to gain access to the bile duct through the skin. X-ray images are taken when the needle passes through the bile ducts. Similar to ERCP, this procedure is used to perform biopsies and place stents in the bile duct.
  • Magnetic Resonance Cholangiopancreatography (MRCP): The procedure for an MRCP is similar to the standard MRI scans and is a less invasive way to image the bile ducts than ERCP.

Next Topic: Bile Duct Cancer Staging