Bile Duct Cancer (Cholangiocarcinoma)

Cholangiocarcinoma (bile duct cancer) and gallbladder cancer are rare, related tumors. Both types of cancer are difficult to detect until they are advanced. At UCLA, our Gastrointestinal Oncology Program oversees treatment for these challenging conditions.

Our experienced doctors are at the forefront of new developments and clinical trials. We work closely with surgeons who are highly skilled in the delicate bile duct area, including minimally invasive and robotic options. And we have the largest interventional endoscopy team in Los Angeles for minimally invasive diagnosis without surgery. Together, your care team will discuss all of your options and provide the best possible outcome.

What Is Cholangiocarcinoma?

Cholangiocarcinoma, or bile duct cancer, is a malignant (cancerous) growth in one of the bile ducts. The bile ducts are tiny tubes that connect the liver and the gallbladder to the small intestine. They carry bile, a fluid that helps break down fat in the intestines. Bile is made in the liver but stored in the gallbladder.

Bile duct cancer is very rare, but doctors have found several risk factors. These include:

• Primary sclerosing cholangitis
• Bile duct cysts (choledochal cysts)
• Chronic ulcerative colitis
• Liver fluke disease, a parasitic infection
• Hepatitis B or hepatitis C
• Cirrhosis

What Is Gallbladder Cancer?

Gallbladder cancer is related to bile duct cancer because these two organs are closely connected. The bile ducts carry bile from the liver to the gallbladder, where it is stored before moving to the small intestine. 

What Are the Symptoms of Cholangiocarcinoma and Gallbladder Cancer?

Symptoms of bile duct cancer or gallbladder cancer may include:

• Abdominal (belly) pain
• Jaundice (yellow skin and eyes, and dark urine)
• Loss of appetite and weight loss
• Fever and chills
• Itching
• Clay-colored stools

How Are Cholangiocarcinoma and Gallbladder Cancer Diagnosed?

Gallbladder cancer is often found incidentally, during another test. Doctors usually diagnose advanced gallbladder cancer and cholangiocarcinoma because of symptoms.

Doctors use several tests to identify tumors or bile duct blockages. Your diagnosis might involve:

• Blood tests: Your doctor will order blood tests to check the amount of bilirubin, a chemical that causes jaundice, and analyze your liver function. These tests provide an important indicator of how a gallbladder tumor or cholangiocarcinoma are affecting your liver.
• Imaging: To get clear images of your liver, gallbladder and bile ducts, your doctor may order advanced CT and MRI scans, along with an abdominal ultrasound, which uses sound waves to create pictures of shapes in your abdomen. Read more about our advanced imaging and diagnosis. 
• Minimally invasive interventional endoscopy: Endoscopy shows your doctor the tiny bile ducts, gallbladder and liver. Interventional endoscopists can remove bile duct stones or take a tissue sample (biopsy) without surgery. You might have endoscopic ultrasound (EUS) or endoscopic retrograde cholangiopancreatography (ERCP). Learn more about interventional endoscopy.
• Percutaneous transhepatic cholangiography (PTC): PTC uses a dye (contrast medium) so that your doctor can see bile duct blockages on an X-ray. During the procedure, the doctor may take cell samples or biopsy tissue. If there is a blockage, the doctor may insert a stent (a drain or tube) to open the duct.

How Are Cholangiocarcinoma and Gallbladder Cancer Treated?

Treatment for gallbladder cancer or cholangiocarcinoma depends on whether the tumor is confined to the bile duct or gallbladder or has spread to other parts of your body. If the cancer is in just one area, surgeons can remove (resect) it. These cases are considered highly curable.

Unfortunately, only a small percentage of these tumors are resectable. After surgery, most people get chemotherapy and radiation to lower the chances of the cancer returning. Our full scope of treatment includes:

Chemotherapy

Chemotherapy floods your body with cancer-killing medicines. UCLA doctors are investigating new forms of chemotherapy, including treatments that involve biologic agents. Biologic therapy stops cancer from growing by changing how cancer cells function. Read more about biologics and chemotherapy for pancreas and bile duct cancer.

HIPEC

UCLA is one of only a few centers in the region to offer hyperthermic intraperitoneal chemoperfusion (HIPEC). HIPEC bathes your abdominal cavity in a chemotherapy solution to destroy as many cancer cells as possible.

HIPEC can be more effective than other medicines to treat cancer in the abdomen. Your doctor may use it for metastatic cholangiocarcinoma or gall bladder cancer (cancer that has spread).

Radiation therapy

With precisely shaped, high-power X-rays, radiation oncologists try to reduce the tumor size and make you more comfortable. Read more about radiation oncology.

Options for Unresectable Cholangiocarcinoma and Gallbladder Tumors

Some tumors are unresectable (cannot be removed surgically). UCLA offers the full scope of treatment for even the most challenging tumors. Your doctor will discuss your options, which may include:

Liver transplantation

Some people may be candidates for a liver transplant if the tumor is early stage but unresectable. Your doctor will discuss this option with you if you might be a candidate. UCLA offers a world-class liver transplant program that accepts patients with bile duct cancer, gallbladder cancer and liver cancer. Find out more about liver transplantation at UCLA.

Symptom relief

If a tumor is unresectable, your therapy will focus on relieving symptoms. Your care may involve:

• Interventional endoscopy treatments, including placing stents
• Surgery to remove blockages
• Radiation therapy
• Chemotherapy

Clinical trials

UCLA doctors are conducting clinical research to find new therapies for gallbladder cancer and cholangiocarcinoma. Doctors also work with precision medicine, which uses your DNA to find the best treatment for you. See our clinical trials.

Contact Us

To schedule an appointment with the UCLA Gastrointestinal Oncology Program, please call the UCLA Cancer Hotline at 888-ONC-UCLA (888-662-8252) Monday through Friday, 9am to 5pm, or our Physician Referral Service at 1-800-UCLA-MD1 (800-825-2631).