Bile duct cancer (Cholangiocarcinoma)
Advanced bile duct cancer means the cancer has spread either:
outside the bile ducts into nearby or organs - this is called locally advanced bile duct cancer
to another part of the body such as the lungs – this is called metastatic or secondary cancer
Unfortunately, most people with bile duct cancer already have advanced cancer when they are diagnosed. This is because bile duct cancer usually doesn’t cause symptoms early on. And when it does, they can be vague and difficult to spot.
The only potential cure for bile duct cancer is having surgery to remove it. If you can’t have surgery, or if the cancer comes back after the operation, the aim of treatment is to control the symptoms and improve your quality of life.
Bile duct cancers tend to spread locally along the bile ducts into lymph nodes or organs nearby. The cancer might have spread into the:
liver
small bowel
pancreas
nearby major blood vessels
The tests you had to stage the cancer show whether surgery might be possible or not. Unfortunately, if you are not well enough to have the operation you won’t be able to have the cancer removed. This is because surgery for bile duct cancer is a major operation
This means that the bile duct cancer cells have spread through the bloodstream or to organs further away.
The most common places for bile duct cancer to spread are the:
lining of the abdomen (peritoneum)
liver further away from the bile ducts
lymph nodes away from the bile ducts
lungs
bones
brain
skin
Deciding which treatment to have, or whether to have treatment at all, can be difficult.
Unfortunately, treatment for advanced bile duct cancer may affect your quality of life. It is important to understand what the aim of treatment is and what the side effects are. It is also important to think about other factors. This includes the amount of time you’ll spend in hospital or travelling to appointments.
Your doctor and specialist nurse will talk this through with you and answer any questions you have. You might also find it helpful to talk things over with a close relative or friend. Or there may be a counsellor at the hospital you can talk to.
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The best treatment for you depends on:
if you can have surgery to remove locally advanced bile duct cancer
where the cancer has spread to
the size and number of any secondary cancers
if there are changes (mutations) in the cancer cells
your general health
any treatment you have already had
your symptoms
your wishes
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells.
You normally have a combination of chemotherapy drugs as your first treatment for advanced bile duct cancer. You might have them with an immunotherapy drug. Immunotherapy uses the immune system to attack cancer cells.
If the cancer starts to grow after you’ve had chemotherapy, you might have a different chemotherapy drug combination. This depends on whether the cancer has any gene changes or not.
Read more about chemotherapy for bile duct cancer
People with advanced bile duct cancer have the cancer checked for gene changes (mutations). These changes can make the cancer grow.
If the bile duct cancer has a gene change, targeted cancer drugs or immunotherapy can slow its growth. You may have them if the first chemotherapy treatment doesn’t work.
Which treatment you have depends on which gene has the change.
Read more about targeted and immunotherapy drugs for bile duct cancer
Radiotherapy uses high energy x-rays to treat cancer cells. Some people might have radiotherapy to help control the symptoms of bile duct cancer.
Read more about radiotherapy for bile duct cancer
Bile duct cancer can block the bile ducts. This can cause yellowing of the skin and white of the eyes (jaundice). Your doctor usually puts in a small tube called a stent to relieve the blockage.
You can also have medicines such as painkillers or anti sickness drugs to help relieve symptoms.
Read more about controlling the symptoms of advanced bile duct cancer
Your doctor might ask if you’d like to take part in a clinical trial for advanced bile duct cancer. Researchers do trials to make existing treatments better and develop new treatments.
Find out about research and clinical trials for bile duct cancer
Finding out that you have advanced bile duct cancer, or that your cancer has come back, can be devastating. You may feel shocked and confused. And you may find it difficult to take in anything that is being said to you.
There is support available to help you cope with the effects of advanced cancer. You can read more about it on our coping with advanced bile duct cancer page.
Last reviewed: 14 Oct 2024
Next review due: 14 Oct 2027
You may need help and support to cope when you have bile duct cancer. There are people, resources and organisations who can help you and your family.
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. You might have chemotherapy after surgery or to help control the cancer if it has spread.
Radiotherapy isn't a very common treatment for bile duct cancer. You may have it to help control symptoms of bile duct cancer, or to areas the cancer has spread to.
Your healthcare team can give you medicines to help control some of the symptoms of bile duct cancer. There are also practical things you can try.
Bile duct cancer can block your bile duct making your skin and eyes go yellow (jaundice). Your doctor might put a small tube called a stent into your bile duct to relieve the blockage.
There is support to help you cope with advanced bile duct cancer. And the symptom control team can help you feel as well as possible.
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What to ask your doctor about clinical trials.
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