Diagnosis of Extrahepatic Bile Duct Cancer

The following tests and procedures may be used for diagnosis if the symptoms suggest the possibility of extrahepatic bile duct cancer:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly
  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  • ERCP (endoscopic retrograde cholangiopancreatography): Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to identify stones, tumors, or narrowing in the bile ducts. The procedure is done through an endoscope.
  • PTC (percutaneous transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The sample may be taken using a thin needle inserted into the duct during an x-ray or ultrasound. This is called a fine-needle aspiration (FNA) biopsy.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by extrahepatic bile duct cancer.

Prognosis

The prognosis (chance of recovery) and treatment options depend on the following:
  • The stage of the cancer (whether it affects only the bile duct or has spread to other places in the body).
  • Whether the tumor can be completely removed by surgery.
  • Whether the tumor is in the upper or lower part of the duct.
  • Whether the cancer has just been diagnosed or has recurred (come back).

Stages of Extrahepatic Bile Duct Cancer

The process used to find out if cancer has spread within the extrahepatic bile duct or to other parts of the body is called staging. It is important to know the stage in order to plan treatment. Extrahepatic bile duct cancer is usually staged following a laparotomy. Laparotomy— A surgical incision is made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope. The results of the diagnostic imaging tests, laparotomy, and biopsy are viewed together to determine the stage of the cancer. The cancer spreads in the body through different ways such as:
  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, secondary tumor may form. This process is called metastasis. The secondary or metastatic tumor is the same type of cancer as the primary tumor. The following stages are used for extrahepatic bile duct cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the innermost layer of tissue lining the extrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA and stage IB.
  • Stage IA: Cancer is found in the bile duct only.
  • Stage IB: Cancer has spread through the wall of the bile duct.

Stage II

Stage II is divided into stage IIA and stage IIB.
  • Stage IIA: Cancer has spread to the liver, gallbladder, pancreas, and/or to either the right or left branch of the hepatic artery or to the right or left branch of the portal vein.
  • Stage IIB: Cancer has spread to nearby lymph nodes and:
    • is found in the bile duct; or
    • has spread through the wall of the bile duct; or
    • has spread to the liver, gallbladder, pancreas, and/or the right or left branches of the hepatic artery or portal vein.

Stage III

In stage III, cancer has spread:
  • to the main portal vein or to both right and left branches of the portal vein; or
  • to the hepatic artery; or
  • to other nearby organs or tissues, such as the colon, stomach, small intestine, or abdominal wall.
  • Cancer may have spread to nearby lymph nodes also.

 Stage IV

In stage IV, cancer has spread to lymph nodes and/or organs far away from the extrahepatic bile duct. Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups: Localized (and resectable) — The cancer is in an area where it can be removed completely by surgery. Unresectable— The cancer cannot be removed completely by surgery. The cancer may have spread to nearby blood vessels, the liver, the common bile duct, nearby lymph nodes, or other parts of the abdominal cavity.

Recurrent Extrahepatic Bile Duct Cancer

Recurrent extrahepatic bile duct cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the bile duct or in other parts of the body. If you have symptoms associated with extrahepatic bile duct cancer, contact us to request an appointment with our oncology specialists to begin diagnostic testing.