Bile Duct Cancer

Diagnosis

Diagnosis of bile duct cancer can be made through the following techniques:

• Medical history and physical examination: The patients undergo evaluation of symptoms, medical history, and family history of the patient as a part of the bile duct cancer screening procedure. Through the physical examination, the oncologists will check the presence of any lump in the abdomen, accumulation of fluid, or tenderness. The cancer specialist will also check signs of other liver and bile duct disorders, such as jaundice. If the patient is believed to have cancer or other liver or bile duct-related conditions, he may be advised to undergo further examination.
• Laboratory analyses: The patients are also advised to have detailed liver and gallbladder function tests. These tests include detecting the level of bilirubin, liver enzymes, such as AST, GGT, ALT, and phosphatase, albumin and some other chemicals in the blood. Elevated liver enzymes or bilirubin indicate a problem in the liver or bile ducts. There are several substances (markers) secreted by cancer cells. Detecting these substances may indicate the presence of cancer. However, the levels of these substances may also be elevated due to conditions other than cancer. Patients with bile duct cancer may have high levels of CA 19-9 and CEA in the blood. However, the absence of these markers in the blood does not always indicate the absence of cancer.
• Ultrasound: Ultrasound may be an abdominal ultrasound or endoscopic ultrasound. The patients are recommended to undergo an abdominal ultrasound to determine the cause of abdominal pain or jaundice. The patients may also undergo endoscopic ultrasound that involves the insertion of an ultrasound transducer through the mouth and guiding it near the bile duct. An ultrasound determines the presence and spread of the tumor. It also helps to plan surgery effectively. Further, ultrasound also detects the enlargement of surrounding lymph nodes, which indicates that cancer has spread out of the bile ducts.
• Computed tomography scan: CT scan determines the presence of bile duct cancer by showing the presence of abnormal tissues. It also assists in determining the stage of cancer. CT scan detects the areas where cancer has spread, including surrounding lymph nodes, nearby as well as distant organs. CT scan also finds applications during angiography (CT angiography) and biopsy (CT-guided biopsy).
• Magnetic resonance imaging: MRI uses magnets and radio waves to provide detailed images of the bile ducts and nearby organs. In some cases, the cancer specialist may differentiate between the cancerous and non-cancerous tumors through the images obtained from MRI. Special MRI techniques may also be recommended for diagnosing bile duct cancer. These are magnetic resonance cholangiopancreatography and magnetic resonance angiography.
• Cholangiography: Cholangiography is a technique to comprehensively evaluate the bile ducts to determine any narrowing, blockage, or widening of the ducts. A cholangiography also helps to plan the surgery. There are various types of cholangiography techniques. MRI cholangiopancreatography (MRCP) does not use any contrast agent or endoscope. However, this technique is not effective when there is a need to obtain a tissue sample. Endoscopic retrograde cholangiopancreatography (ERCP) involves using an endoscope and contrast agent. ERCP is more invasive than MRCP but offers the advantage of taking samples. Percutaneous transhepatic cholangiography is done by sedating the patients. The oncologist inserts a needle into the abdominal skin and guides it to the bile duct. Contrast dye is administered through the needle, and the x-ray is taken. This technique also allows for taking samples.
• Angiography: Angiography helps in obtaining information about the spread of cancer into the walls of blood vessels surrounding the liver and bile ducts. Angiography may be done with the assistance of a CT scan or MRI. The cancer specialist inserts a catheter into the artery and administers a small amount of contrast dye. The x-ray is then taken to determine if there is any blockage in the blood flow.
• Biopsy: Biopsy is generally performed to confirm the diagnosis of bile duct cancer. It also helps to determine the stage of cancer. However, not all bile duct tumors require biopsy. In such cases, the oncologists may directly perform the surgery. There are several biopsy techniques available, such as needle biopsy and biopsy during cholangioscopy and cholangiography. The technique used depends on the type and site of the bile duct tumor.