Cholangiocarcinomas (Bile Duct Cancer)

Cholangiocarcinomas (bile duct cancer) - Diagnosis

There is a lack of effective non-surgical treatment options. It is important to get an accurate diagnosis of CCA so that your condition can be treated appropriately. Your doctor will ask questions about your medical and family history, lifestyle habits and perform a physical examination.

Ultrasound

An ultrasound uses high-frequency sound waves to scan, carries no radiation risk and can be done on a regular basis, especially in individuals who are at risk of cancer, for e.g. hepatitis C carriers. It is however not always accurate and or very specific and sometimes further CT or MRI scans may be indicated for better characterisation of the tumour.

CT scan

The CT scan is an x-ray procedure that produces detailed cross-sectional images of the body from different angles. It is a better way of detecting CCA and is crucial for treatment planning. In certain cases, a CT scan may not be enough or is inconclusive, and additional investigations like MRI / MRCP or a PET scan may be performed.

Blood test

A blood test that measures the tumour markers called Carbohydrate antigen 19–9 (CA 19-9) can indicate an association with CCA but it should not be used or as a routine screening test. Other tumour markers that are associated are carcinoembryonic antigen (CEA) and CA-125.

A blood test alone is usually not diagnostic and a further tissue sample or biopsy, i.e. a small tissue or cells sample from the bile duct may be collected through a needle procedure or via endoscopy brushing.

Other scans or investigations may be required if necessary for diagnosis, staging and/or to guide treatment strategy.

What are the stages of Cholangiocarcinomas (Bile Duct Cancer)?

Staging helps your medical team to assess the extent of the cancer in your body, plan treatment and determine your prognosis. Staging guidelines differ depending on the type of CCA. In general, CCA staging factors include:

Size of the tumour
Whether the cancer has spread from the bile ducts to the

blood vessels
lymph vessels and lymph nodes
nearby organs such as the liver or gallbladder
distant organs such as the lungs, bones or abdominal cavity

Early-stage CCA (stages 1 and 2) is often resectable, meaning it can be removed surgically. Stage 3 usually indicates the cancer has spread to nearby structures and/or lymph nodes. Stage 4, the most advanced, involves metastasis to distant organs and is typically unresectable. In such cases, treatment focuses mainly on palliative care to relieve symptoms and improve quality of life.