Your doctor will examine you and refer you for tests to see if you have cancer. This can be a worrying and tiring time, especially if you need to have several tests.
If the tests show you have or may have cancer, your doctor will refer you to a specialist, who will examine you and may ask you to have more tests.
You'll have blood tests to check your general health and liver function. You may also have a blood test to check for a chemical that's sometimes high in people with bile duct cancer. Doctors call this a ‘tumour marker'.
You may also have the following tests.
- ERCP (endoscopic retrograde cholangio-pancreatography): this test can help find any blockages in the bile duct and pancreatic duct. To do the test the doctor will pass a tube called an endoscope down your throat to take an x-ray of the pancreas and gallbladder. The endoscope is a long, flexible tube with a camera and light at the tip.
- PTC (percutaneous transhepatic cholangiography): this is another way doctors can look into the bile duct. You're given a sedative and an injection of dye into your tummy (abdomen). The doctor then takes x-rays to see if there are any blockages.
- You may also have a biopsy.
Your doctor may advise other tests such as a bone scan, MRI or CT scan if they think the cancer may have spread to other parts of the body.
Staging bile duct cancer
The test results will show whether you have cancer. They'll show where the primary cancer is and whether the cancer cells have spread to other parts of your body (this is known as metastasis). This helps your doctors ‘stage' the disease so they can work out the best treatment for you.
The staging system used for bile duct cancer is known as the ‘TNM system' (T=tumour, N=nodes, M=metastases).
T followed by a number between 1 and 4 describes how far the cancer has spread into the bile duct and nearby tissue. A higher number after the T (e.g. T3 or T4) means it has spread further.
N plus a number from 0 to 3 describes whether the cancer has spread to lymph nodes near the bile duct and, if so, the amount of cancer in the nodes. Higher numbers are used for nodes that are more affected by the cancer.
M followed by 1 shows that the cancer has spread to other organs or to lymph nodes that aren't near the bile duct. M0 means there's no sign of the cancer having spread in this way.
Doctors combine this information to work out the stage of the cancer, from Stage 1 (I) to Stage 4 (IV).
For example, a cancer assessed as T1, N0, M0 (tumour contained within the bile duct, lymph nodes not affected and no metastasis) would be called a Stage I cancer.
The lower the ‘number' stage, the less advanced the cancer is and the easier it will be to treat.
Ask your doctor to explain the stage of your cancer in a way you can understand. This will help you to choose the best treatment for your situation.
Expert content reviewers:
Annie Angle cancer nurse, Diploma Oncology Nursing, Royal Marsden, London