• Cancer of the bile ducts or gallbladder is rare.
• Ultrasonography can usually detect a tumor in the bile ducts or gallbladder.
• These cancers are usually fatal, but symptoms can be treated.

Cancer of the bile ducts (cholangiocarcinoma) can originate anywhere along the biliary tract, particularly outside of the liver to where it enters the small intestine. It can complicate primary sclerosing cholangitis (see Cirrhosis and Related Disorders: Primary Sclerosing Cholangitis)

Cancer of the gallbladder is rare. Nearly everyone with gallbladder cancer has gallstones. Many people live only a few months after this cancer develops.

Polyps, which are noncancerous (benign) outgrowths of tissue, may develop in the gallbladder. They rarely cause symptoms or require treatment. They are found in about 5% of people during ultrasonography.

Sometimes cancers can block the flow of bile, but most blockages are caused by gallstones. Even less often, cancer can spread (metastasize) from elsewhere in the body to adjacent structures or nearby lymph nodes, causing blockage. Noncancerous tumors in bile ducts also cause blockages.

Symptoms

Early symptoms include the following:

• Worsening jaundice (yellowish discoloration of the skin and whites of the eyes)
• Abdominal discomfort
• Loss of appetite
• Weight loss
• Itchiness

Symptoms gradually worsen. Abdominal pain may become severe and constant. It is usually caused by blockage of the bile ducts. People feel tired and uncomfortable. They may feel a mass in their abdomen.

Diagnosis

Doctors suspect bile duct cancer when no other cause of a bile duct blockage is identified, especially in people with primary sclerosing cholangitis. Ultrasonography is the first test to check for a tumor in the bile ducts. Magnetic resonance cholangiopancreatography (MRCP) or computed tomography (CT) may be done instead (see Diagnosis of Liver, Gallbladder, and Biliary Disorders: Imaging Tests).

If a tumor is found, doctors take a tissue sample by inserting a thin needle through the skin. Ultrasonography or CT is used to guide the needle. Endoscopic retrograde cholangiopancreatography (ERCP), using a flexible viewing tube inserted through the mouth and into the small intestine, may also be used to obtain images and a tissue sample (see Understanding Endoscopic Retrograde Cholangiopancreatography).

If gallbladder cancer is suspected, CT is usually done. It provides more information than ultrasonography.

Treatment

Most bile duct and gallbladder cancers are fatal, but treatment can help control symptoms.

Tubes (stents) inserted into a duct allows bile to flow past the blockage. This procedure helps control pain and relieves itchiness. Blockages can be opened during ERCP.

Surgery to remove a cancerous tumor may be done, but usually the tumor cannot be completely removed. Chemotherapy and radiation therapy for cholangiocarcinoma are being studied. If tumors have spread from other parts of the body (metastasized), chemotherapy may provide some symptom relief but does not dramatically improve survival.

Very early gallbladder cancer that is found during surgery for gallstones can often be cured by removing the gallbladder.

Last full review/revision December 2007 by Eldon A. Shaffer, MD