The bile duct has a critical function of moving bile from the liver (where it is produced) and from the gallbladder (where it is stored), eventually emptying the bile into the duodenum (first part of the small intestine). Bile helps in the digestion of fats from the food that you eat.
The bile ducts start from the liver as tiny tubes called ductules. These ductules join together to form small ducts and, in turn, they merge into larger ducts and form the right and left hepatic ducts. These two ducts exit from the liver and join together as the common hepatic duct. Lower down, it unites with the cystic duct that comes from the gallbladder and is called the common bile duct. Then, the common bile duct traverses a part of the pancreas and joins the pancreatic duct. It empties into the duodenum, the first part of the intestines.
Cancer, just like anywhere in the body, can develop in any part of the bile ducts. They are classified into 2 types:
Bile duct cancers are also categorised according to cell type:
Worldwide, bile duct cancers are rare. However, they are common in Southeast Asia because of a parasitic infestation by a liver fluke.
Generally, conditions causing inflammation of the liver and the bile ducts increase the risk of developing bile duct cancer.
These conditions include:
Other risk factors include:
Like most cancers, signs and symptoms of bile duct cancer (cholangiocarcinoma) occur later in the course of the disease. However, if symptoms occur earlier, it may result in early diagnosis, better treatment, and better outcomes.
Most signs and symptoms occur due to the blockage of the bile duct. These symptoms include:
The following methods are used for diagnosing bile duct cancer:
History and Physical Examination
The doctor will assess the patient’s medical history and conduct a physical examination to identify symptoms and potential issues.
Blood Tests
Blood tests, including liver function tests, measure bilirubin levels. A high level of bilirubin may mean there may be problems with the liver, gallbladder or the bile duct. High levels can indicate a blockage in the bile duct.
Tumour Markers
In bile duct cancers, the tumour markers (CEA and CA 19-9) can be abnormally high, helping to identify the presence of cancer.
Abdominal ultrasound
This imaging technique uses sound waves to create images of the abdominal organs, helping to detect abnormalities in the bile ducts.
Computerised Tomography (CT) Scan
This scan presents detailed cross-sectional images of the patient’s body wherein a scanner takes pictures of the patient’s body to determine if tumours or masses are present in the bile duct. This procedure can stage the cancer and visualise blood vessels around the bile ducts. It can also guide a biopsy needle into the suspected tumour or metastasis called a CT-guided needle biopsy, where samples are taken for study.
Magnetic Resonance Scan
Including Magnetic Resonance Cholangiopancreatography (MRCP), which is a non-invasive type of imaging that visualises the bile ducts.
Endoscopic Ultrasound
This entails the use of an ultrasound probe with a viewing device at its end. This probe is passed through the mouth and into the small intestine near the bile ducts for formal evaluation of the tumour. Fine needle biopsy can be performed at the same sitting to aid in the diagnosis of tumours.
Endoscopic retrograde cholangiopancreatography (ERCP)
A flexible tube is passed down the throat to the duodenum. Then, a small catheter is passed from the end of the endoscope and into the common bile duct. A contrast dye is introduced to outline the bile and pancreatic ducts and X-rays are taken. This identifies the blockage of the ducts. The doctor can take samples of cells or fluid with this technique. Additionally, a stent can be introduced to keep the duct open.
Other tests may be done to take a direct look at the bile duct including:
Laparoscopy
In this procedure, small cuts are made on the abdomen, and a thin lighted tube equipped with a video camera (called a laparoscope) is inserted to look at the gallbladder, bile duct and liver and the surrounding tissues and organs. This is usually performed in an operating room under general anaesthesia. This is useful in assessing the stage of the cancer and helps in the treatment plan.
Cholangioscopy
This can be performed during ERCP. A thinner fibre optic tube with a tiny camera is passed down through the larger tube used for ERCP and inserted in the bile ducts. This method is used to examine blockages, stones or tumours.
By using the above techniques, your doctor makes a diagnosis and stages bile duct cancer. From the staging, the treatment options can be planned. Usually, treatment consists of surgery if the cancer is operable but surgery can also be palliative. Additionally, radiation and chemotherapy may be utilised as part of the treatment.
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New DLS Group Office
We have opened a new administrative office to support our operations.
The address is:
545 Orchard Road
#10-09 Far East Shopping Centre
Singapore 238882
All medical services continue as usual at our four clinics.
Thank you!
Senior Consultant Surgeon
Senior Consultant Surgeon