Screening for Bile Duct Cancer
Currently, there are no standard bile duct cancer screening recommendations for the general public (like mammograms for breast or colonoscopies for colon cancer). However, if you are at an increased risk, you may benefit from specific diagnostic testing. This should be discussed with a gastroenterologist.
Diagnostic Tools for Bile Duct Cancer
Bile duct cancer is most often diagnosed when patients show symptoms of a blockage or narrowing of the bile ducts. When physicians suspect cancer, they may order several tests to make a diagnosis and stage the disease.
- Medical history and physical exam. Physicians examine patients for jaundice, or yellowing of the skin, which may be a sign that bile is not draining properly from the bile ducts.
- Lab tests. Lab tests can help a physician diagnose cancer, determine current organ function, learn how other organs may be affected and look for signs of reoccurrence. Lab tests can also look for elevated tumor markers such as carcinoembryonic antigen (CEA), cancer antigen (CA) 19-9 and liver function.
- Imaging tests. Pictures of the inside of the body can help find out whether a suspicious area might be cancerous, to learn how far cancer may have spread, and to help determine if treatment is working.
- Endoscopic retrograde cholangiopancreatography (ERCP). ERCP is the diagnostic test most performed to diagnose bile duct cancer. Performed while the patient is under sedation, the procedure combines endoscopy and fluoroscopy to diagnose cancer. If cancer is suspected, the physician may perform a biopsy or collect suspicious cells for further review.
- Endoscopic ultrasound (EUS). Also performed under sedation, this procedure combines endoscopy and ultrasound to provide images of the bile ducts and surrounding structures, and may also be used for tissue acquisition.
- Computed tomography (CT). Three-dimensional X-rays of the inside of the body are combined by a computer into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (dye) is used to provide better detail.
- Magnetic resonance imaging (MRI). Magnetic fields are used to create detailed images of the body. A contrast medium may be injected into a vein to create a clearer picture.
- Percutaneous transhepatic cholangiography (PTC). A thin needle is inserted via the liver into the biliary tree and dye is injected before an X-ray is taken. A stent may be left to drain bile if a blockage is found.
- Biopsy. If other tests find a change that is possibly cancer, a sample of the suspicious area is removed and viewed under a microscope. A biopsy is the only way to tell if cancer is really present.
- Brush cytology. Brush cytology is a type of procedure that collects suspicious cancer cells. During an ERCP, a physician may use a small brush passed through the endoscope to collect cells for the lab.
- Cholangioscopy. During an ERCP, a smaller endoscope is threaded through the larger one. The scope is inserted into the bile duct and, using a tiny camera, the physician can take a directed biopsy of the suspicious area. This procedure removes a larger piece of tissue, and may provide a more accurate diagnosis.
- Laparoscopy. A minimally invasive surgical procedure allows the physician to view the lymph nodes and other organs to see if cancer has spread. Biopsies may be taken of the organ tissue.