request an appointment online.
- Diagnosis & Treatment
- Cancer Types
- Bile Duct Cancer
- Bile Duct Cancer Diagnosis
Get details about our clinical trials that are currently enrolling patients.
View Clinical TrialsBile Duct and Gallbladder Cancer Diagnosis
Bile duct tumors are often discovered during a CT scan or ultrasound for unrelated health reasons. They can also be found during routine gallbladder surgery. Because early stages of biliary cancer may not have symptoms, only a small number of cases are diagnosed before they have spread to other areas of the body.
Tools for diagnosing biliary cancer may include:
Blood tests: No one blood test can definitively detect bile duct or gallbladder cancer. However, your doctor may test your blood for elevated bilirubin levels or other substances. These can help doctors understand how well your liver and gallbladder are functioning. Blood tests can also give clues about the cause of your symptoms and rule out other possible causes, like infection.
Your doctor may also test your blood for tumor markers. Specific proteins that may be overproduced by cancerous bile ducts cells include carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). However, high levels of these markers do not definitively indicate cancer. They may be a sign of another condition, like bile duct obstruction.
Biopsy: A small tissue sample is surgically removed and examined under a microscope for the presence of cancer cells. There are several methods to conduct a bile duct biopsy. These include:
- Fine needle aspiration (FNA): A very small needle is placed into the tumor and suction is applied. CT (computed tomography) scans may be used to help guide the needle. Doctors trained to read these types of biopsies then review the small numbers of cells that are drawn into the needle.
- Endoscopic retrograde cholangiopancreatography (ERCP): ECRP uses a thin tube equipped with a camera to see inside your bile ducts. Your doctor will pass the tube through your mouth and thread it through your digestive tract to reach the bile ducts. A dye may also be injected into the bile ducts to make them easier to see on medical imaging exams like X-rays. An ERCP procedure may also be used to biopsy tissues.
Imaging tests: Your doctor may use imaging tests to see any abnormalities and determine whether and how far the cancer has spread. Tests may include:
- CT or CAT (computed axial tomography) scan: An x-ray takes pictures from different angles. This provides a highly detailed image of your body.
- MRI (magnetic resonance imaging): Magnetic fields and radio waves create a detailed image of your organs.
- Magnetic resonance cholangiopancreatography (MRCP): This procedure is a non-invasive alternative to ERCP. It creates a 3D image of your bile ducts without using dye.
- Abdominal ultrasound: A special instrument bounces high-energy sound waves off your internal organs. The resulting echo patterns create a picture on a screen. An ultrasound may be used to determine if your cancer has spread to surrounding tissue.
Bile Duct & Gallbladder Cancer Staging
Each type of biliary cancer has its own staging system based on where the tumor starts. Staging can help determine which treatments are right for a patient.
Intrahepatic Bile Duct Cancer Stages
(source: National Cancer Institute)
Stage 0: In stage 0 intrahepatic bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the intrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage 1: Stage 1 intrahepatic bile duct cancer is divided into stages 1A and 1B.
Stage 1A: Cancer has formed in an intrahepatic bile duct and the tumor is five centimeters or smaller.
Stage 1B: Cancer has formed in an intrahepatic bile duct and the tumor is larger than five centimeters.
Stage 2: In stage 2 intrahepatic bile duct cancer, either of the following is found:
- the tumor has spread through the wall of an intrahepatic bile duct and into a blood vessel
- more than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.
Stage 3: Stage 3 intrahepatic bile duct cancer is divided into stages 3A and 3B.
Stage 3A: The tumor has spread through the capsule (outer lining) of the liver.
Stage 3B: Cancer has spread to organs or tissues near the liver, such as the duodenum, colon, stomach, common bile duct, abdominal wall, diaphragm, or the part of the vena cava behind the liver, or the cancer has spread to nearby lymph nodes.
Stage 4: In stage 4 intrahepatic bile duct cancer, cancer has spread to other parts of the body, such as the bone, lungs, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.
Perihilar Bile Duct Cancer Stages
(source: National Cancer Institute)
Stage 0: In stage 0 perihilar bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.
Stage 1: In stage 1 perihilar bile duct cancer, cancer has formed in the innermost layer of tissue lining the perihilar bile duct and has spread into the muscle layer or fibrous tissue layer of the perihilar bile duct wall.
Stage 2: In stage 2 perihilar bile duct cancer, cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to liver tissue.
Stage 3: Stage 3 perihilar bile duct cancer is divided into stages 3A, 3B and 3C.
Stage 3A: Cancer has spread to branches on one side of the hepatic artery or of the portal vein.
Stage 3B: Cancer has spread to one or more of the following:
- the main part of the portal vein or its branches on both sides;
- the common hepatic artery;
- the right hepatic duct and the left branch of the hepatic artery or of the portal vein;
- the left hepatic duct and the right branch of the hepatic artery or of the portal vein.
Stage 3C: Cancer has spread to one to three nearby lymph nodes.
Stage 4: Stage 4 perihilar bile duct cancer is divided into stages 4A and 4B.
Stage 4A: Cancer has spread to four or more nearby lymph nodes.
Stage 4B: Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.
Distal Bile Duct Cancer Stages
(source: National Cancer Institute)
Stage 0: In stage 0 distal bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the distal bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.
Stage 1: In stage 1 distal bile duct cancer, cancer has formed and spread fewer than 5 millimeters into the wall of the distal bile duct.
Stage 2: Stage 2 distal bile duct cancer is divided into stages 2A and 2B.
Stage 2A: Cancer has either spread:
- fewer than five millimeters into the wall of the distal bile duct and has spread to one to three nearby lymph nodes
- five to 12 millimeters into the wall of the distal bile duct.
Stage 2B: Cancer has spread five millimeters or more into the wall of the distal bile duct. Cancer may have spread to one to three nearby lymph nodes.
Stage 3: Stage 3 distal bile duct cancer is divided into stages 3A and 3B.
Stage 3A: Cancer has spread into the wall of the distal bile duct and to four or more nearby lymph nodes.
Stage 3B: Cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to one or more nearby lymph nodes.
Stage 4: In stage 4 distal bile duct cancer, cancer has spread to other parts of the body, such as the liver, lungs, or tissue lining the wall of the abdomen and most organs in the abdomen.
Gallbladder Cancer Stages
(source: National Cancer Institute)
Stage 0: In stage 0 gallbladder cancer, abnormal cells are found in the mucosa (innermost layer) of the gallbladder wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage 1: In stage 1 gallbladder cancer, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle layer of the gallbladder wall.
Stage 2: Stage 2 gallbladder cancer is divided into stages 2A and 2B, depending on where the cancer has spread in the gallbladder.
Stage 2A: Cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the side of the gallbladder that is not near the liver.
Stage 2B: Cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the same side as the liver. Cancer has not spread to the liver.
Stage 3: Stage 3 gallbladder cancer is divided into stages 3A and 3B, depending on where the cancer has spread.
Stage 3A: In stage 3A, cancer has spread through the connective tissue layer of the gallbladder wall and one or more of the following is true:
- Cancer has spread to the serosa (layer of tissue that covers the gallbladder).
- Cancer has spread to the liver.
- Cancer has spread to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver).
Stage 3B: In stage 3B, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle, connective tissue, or serosa (layer of tissue that covers the gallbladder) and may have also spread to the liver or to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver). Cancer has spread to one to three nearby lymph nodes.
Stage 4: Stage 4 gallbladder cancer is divided into stages 4A and 4B.
Stage 4A: In stage 4A, cancer has spread to the portal vein or hepatic artery or to two or more organs or structures other than the liver. Cancer may have spread to one to three nearby lymph nodes.
Stage 4B: In stage 4B, cancer may have spread to nearby organs or structures. Cancer has spread:
- to four or more nearby lymph nodes; or
- to other parts of the body, such as the peritoneum and liver.
Clinical Trials
MD Anderson patients have access to clinical trials offering promising new treatments that cannot be found anywhere else.
Becoming Our Patient
Get information on patient appointments, insurance and billing, and directions to and around MD Anderson.
Help #EndCancer
Give Now
Donate Blood
Our patients depend on blood and platelet donations.
Shop MD Anderson
Show your support for our mission through branded merchandise.