Skip to Main Content

Cholangiocarcinoma

Overview

Cholangiocarcinoma is a rare cancer found in the tissue of the bile ducts, occurring in approximately two out of 100,000 people. Men and women are equally affected and most cases occur in people over age 65. The bile duct is a small tube that connects the liver and gallbladder to the small intestine. The ducts carry bile – the liquid that helps break down fat in food during digestion – out of the liver.

Tumors can develop anywhere on the bile ducts and are typically slow growing. However, by the time a diagnosis usually is made, many of the tumors are too advanced to be surgically removed. Other conditions such as primary sclerosing cholangitis, bile duct cysts and chronic biliary irritation, are associated with an increased risk of cholangiocarcinoma.

Our approach to cholangiocarcinoma

UCSF provides state-of-the-art care for cholangiocarcinoma, also called bile duct cancer. In addition to hepatobiliary surgeons, who specialize in the liver, gallbladder and bile duct, our team includes transplant surgeons, diagnostic radiologists, interventional radiologists, medical oncologists, hepatologists, gastroenterologists and anesthesiologists.

For patients who need major surgery, our transplant surgeons apply their expertise in living donor liver transplantation to perform complex reconstruction of the hepatic artery, portal vein or bile duct. This allows us to remove tumors that other centers may have deemed inoperable because they involve major vessels.

Our physician-scientists are dedicated to discovering additional treatments for cholangiocarcinoma through research. Interested patients may have the option to participate in clinical trials, which evaluate potential new therapies.

Beating bile duct cancer after a second opinion

Following a failed surgery for cholangiocarcinoma, a rare cancer, Michael sought a second opinion at UCSF. He was successfully treated by our surgical team.

Awards & recognition

  • usnews-neurology

    Among the top hospitals in the nation

  • Best in Northern California and No. 7 in the nation for cancer care

  • One of the nation's best in gastroenterology & GI surgery

  • NIH-2x

    Designated comprehensive cancer center

Signs & symptoms

Cholangiocarcinoma is a rare cancer found in the tissue of the bile ducts. Tumors produce symptoms by blocking the bile ducts. Common symptoms may include:

  • Clay colored stools
  • Jaundice, which is a yellowing of the skin and eyes
  • Itching
  • Abdominal pain that may extend to the back
  • Loss of appetite
  • Unexplained weight loss
  • Fever
  • Chills

Diagnosis

Your doctor will first ask about your medical history and perform a physical examination. In addition, he or she may order the following tests:

  • Computed tomography (CT) scan. An X-ray that uses a computer to provide an image of the inside of the abdomen.
  • Magnetic resonance imaging (MRI) scan. This test uses magnetic waves to create an image.
  • Ultrasound. This test uses high-frequency sound waves that echo off the body to create a picture.
  • Endoscopic retrograde cholangiopancreatography (ERCP). During an ERCP, a flexible tube is inserted down the throat and into the stomach and small intestine. By injecting dye into the drainage tube of the pancreas, your doctor can see the area more clearly.
  • Endoscopic ultrasound (EUS). EUS involves passing a thin, flexible tube called an endoscope through the mouth or the anus to exam the lining and walls of the upper and lower gastrointestinal tract and nearby organs such as the pancreas and gall bladder. The endoscope is equipped with a small ultrasound transducer that produces sounds waves that create a viewable image of the digestive track. When combined with fine needle aspiration, EUS becomes a state-of-the-art, minimally invasive alternative to exploratory surgery to remove tissue samples from abdominal and other organs. It also may be used to determine the cause of symptoms such as abdominal pain, to evaluate a growth, to diagnose diseases of the pancreas, bile duct and gall bladder when other tests are inconclusive and to determine the extent of certain cancers of the lungs or digestive tract.
  • Percutaneous transhepatic cholangiography (PTC). By injecting dye into the bile duct through a thin needle inserted into the liver, blockages can be seen on X-ray.
  • Bile duct biopsy and fine needle aspiration. A tiny sample of the bile duct fluid or tissue is removed and examined under a microscope.

Treatments

Surgery and radiation therapy are the two most common treatments for cholangiocarcinoma.

Surgery

If the cancer is small and has not spread beyond the bile duct, your doctor may remove the whole bile duct and make a new duct by connecting the duct openings in the liver to the intestine. Lymph nodes also will be removed and examined under the microscope to see if they contain cancer. If the cancer has spread and cannot be removed, your doctor may perform surgery to relieve symptoms.

If the cancer is blocking the small intestine and bile builds up in the gallbladder, surgery may be required. During this operation, called a biliary bypass, your doctor will cut the gallbladder or bile duct and sew it to the small intestine.

After complete removal of the tumor, 30 percent to 40 percent of patients survive for at least five years, with the possibility of being completely cured. If the tumor cannot be completely removed, it generally is not possible to cure the patient. In these cases, if you are not a candidate for surgery and have an obstruction, percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) can be used to place plastic or metal stents, which help to relieve obstructions.

Radiation therapy

Radiation therapy is the use of high-energy X-rays to kill cancer cells and shrink tumors. There are two main types of radiation therapy:

  • External-beam radiation therapy. Radiation comes from a machine outside the body.
  • Internal radiation therapy. Materials that produce radiation, called radioisotopes, are put into the area where the cancer cells are found through thin plastic tubes.

Experimental therapy

There are a couple types of therapy that are currently being studied in clinical trials for the treatment of cholangiocarcinoma, including:

  • Chemotherapy. Uses drugs to kill cancer cells
  • Biological therapy. Uses the body's immune system to fight cancer
  • Photodynamic therapy. Uses a specific type of light and photosensitizing agent to kill cancer cells

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Recommended reading

FAQ: Cancer Pathology Tissue Slides

Find frequently asked questions regarding cancer pathology tissue slides, such as how to obtain the slides and what to do with them once you do.

FAQ: Cancer Radiology Scans and Reports

Learn the difference between a radiology report and radiology films or scans as well as why your doctor may be requesting these scans and more.

Self-Care for Caregivers

Caregiver fatigue can be brought on by the physical and emotional demands of caring for a loved one with a serious illness. Learn tips to combat caregiver fatigue here.

Communicating with Your Doctor

The relationship with a doctor is a very personal one, built on communication and trust. In choosing a doctor, the "chemistry" between the two of you must work.

Coping with Chemotherapy

Each person experiences side effects from chemotherapy differently, and different chemotherapy drugs cause different side effects. Learn more here.

Delegation to Help with Fatigue

Fatigue caused by cancer treatment can make it difficult to accomplish even the smallest of tasks. Learn how task delegation can help with this fatigue.

Diet for Cancer Treatment Side Effects

Nausea is a common side effect of chemotherapy and radiation therapy. Find practical tips and suggested foods to help with nausea here.

Managing Your Treatment

Living with or caring for someone with cancer can be a full-time job. Here are some tips to reduce stress and help navigate the disease more effectively.

Nutrition and Coping with Cancer Symptoms

Side effects of cancer treatment may affect your eating pattern, requiring new ways to get the calories, protein and nutrients that you need. Learn more.

Questions to Ask Your Doctor

Your time with the doctor is limited, thus it's helpful to prepare for the visit in advance by prioritizing the questions that are important to you. Learn more.

Resources for End of Life

The UCSF Cancer Resource Center has a list of bereavement support groups, counselors, hospice and others dealing with end-of-life issues. Learn more.

Tips for Conserving Your Energy

Cancer and cancer therapy can be accompanied by feelings of extreme fatigue. To help you deal with this fatigue, follow these easy tips help conserve energy.

Using a Medical Calendar and Symptom Log

Take time at the end of each day or each week to reflect back on the symptoms you've had. You can use a calendar to track your symptoms. Learn more here.

Where to get care (2)

    Related clinics (2)

    2

    Cancer Survivorship and Wellness Institute

    Cancer Survivorship and Wellness Institute

    See both of our San Francisco locations.

    3

    Psycho-Oncology

    Psycho-Oncology

    San Francisco

    Support services

    Support Group

    Art for Recovery

    Creativity can help people with serious illnesses cope, heal and express what they're going through. Find out about our program and how to join.

    Fitness

    Cancer Exercise Counseling

    Our one-on-one exercise training sessions, customized for your needs and abilities, can complement other cancer treatments and speed your recovery.

    Support Group

    Cancer Support Groups

    These groups offered by the Ida and Joseph Friend Patient and Family Cancer Support Center are free and available to all patients, whether or not you get your health care at UCSF.

    Fitness

    Core & More Class for Cancer Patients

    A strong body helps you fight cancer and enjoy life. Join this class to stabilize your core, strengthen your muscles and improve overall fitness. For cancer patients and caregivers!

    Patient Resource

    Friend to Friend Specialty Shops

    A one-stop boutique for patients with cancer. Get professional help with wigs, prostheses, sun-protective clothing, makeup, skin care and more.

    Class

    Meditation & Guided Imagery for Cancer Patients

    Drop in for a free class designed to help you heal, relax and find balance during your treatment. UCSF and non-UCSF patients are welcome.

    Patient Resource

    Oncology Social Work

    Social workers offer support, problem-solving, help accessing UCSF cancer-related resources and more. Find out how to contact the social worker for your clinic.

    Patient Resource

    Patient & Family Cancer Support Center

    The center offers wellness programming, community, support groups, classes, workshops and more at no cost to people facing cancer and their loved ones.

    Support Group

    Peer Support Programs for Cancer

    Patients are matched with peer support volunteers according to criteria such as diagnosis, cancer stage, age or gender. Speak to someone who's "been there."

    Share