Diagnosis

It can be difficult to diagnose bile duct cancer. You may need to have a number of different tests.

Some of the teststhatmay be carried outare described below.

Blood tests

In bile duct cancer, the cancerous cells may release certainchemicals that can be detected using Blood tests . These are known as tumour markers.

Buttumour markers can also be caused by other conditions, so this test can'tbe used to sayfor certainwhether or not youhave bile duct cancer.

Scans

Severalscans can be used to examine your bile ducts in detail and to check for lumps or other abnormalities that could be the result of cancer.

These include:

• an ultrasound scan high-frequency sound waves are used to build up a picture of the inside of your body
• a computerised tomography (CT) scan a series of X-rays of your liver and bile ductare taken and a computer is used to assemble them into a more detailed three-dimensional image
• a magnetic resonance imaging (MRI) scan a strong magnetic field and radio waves are used to producean imageof the inside of your liver and bile duct

ERCP test

Endoscopic retrograde cholangio-pancreatography (ERCP) allows your bile ducts to be seen clearly on an X-ray scanner.

During the test:

• an endoscope (asmall, flexible tube with a camera at the end) is passed down your throat to the opening of yourbile ductthe X-ray scanner helpsguide it to the right place
• a special dye is injected into the bile duct, so it shows up clearly on the scanner and any abnormal areas are easier to spot
• a small sample of tissue maybe removed (a biopsy ) so it can be checked under a microscope for signs of cancer
• a stent (hollow tube) may be inserted to hold the bile duct open and stop it becoming blocked

You'll be awake while the test is carried out,but you'llnormally be given an injection of sedative medication to make you very drowsy and your throat will be numbed with local anaesthetic spray.

PTC test

Percutaneous transhepatic cholangiography (PTC) may alsobe used toget a detailed image of your bile duct.

During the test:

• a needle is passed through your skin and used to inject a special dyeinto yourbile duct
• detailed X-rays are taken of your bile duct
• a small sample of tissue from your bile ductmay be removed so it can be studied under a microscope
• a stent may be inserted to hold the bile duct open

You'll be awake while this is carried out, but you'll usually have sedative medication to make you drowsy andlocal anaestheticto numb the area where the needle is inserted.

Stages of bile duct cancer

If you're diagnosed with bile duct cancer, it will be possible to give your cancer a "stage". This is a number that indicates how far the cancer has spread.

Doctors use a system called the TNM system to stage bile duct cancer. This consists of three numbers:

• T (tumour) describes the size of the tumour
• N (node) describes whetherthe cancer has spread to nearby lymph glands
• M (metastases) describes whetherthe cancer has spread to another part of the body

Knowing the stage of your cancer will help your doctors decide on the best treatment for you.

Cancer Research UK has more detailed information about the stages of bile duct cancer .