Bile Duct Cancer


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Bile duct cancer, also known as cholangiocarcinoma, is a rare cancer that forms in the tubes (ducts) that run in and out of your liver and carry bile, which helps you digest food. Bile duct cancer poses serious health risks if left untreated because it could block your bile ducts and spread to other organs, causing a range of problems from liver failure to sepsis. 

Duke’s team of bile duct cancer specialists includes surgeons, oncologists, radiologists, gastroenterologists, and pathologists who have advanced training in gastrointestinal cancer. This team approach ensures you receive an accurate diagnosis and the most effective treatment for your condition.

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Diagnosing Bile Duct Cancer

When diagnosing the stage and possible spread of bile duct cancer, your care team may suggest several tests to better understand how the disease is affecting you. This allows us to create a personalized treatment plan specific to your needs.

Physical Exam

Your doctor will first check for any visual or physical symptoms of bile duct cancer. These commonly include discolored urine, pain in your abdomen, and jaundice, which is the yellowing of your skin or whites of your eyes. You may also experience ongoing nausea or vomiting. Understanding your medical history may also help our diagnosis -- some digestive diseases, like colitis, or certain liver diseases can increase the risk of bile duct cancer.

Blood Tests

We'll check your blood for abnormal levels of certain enzymes or proteins to assess the health of your organs. A blood test will also confirm if your cancer is spreading. The results will help your doctor recommend the best treatments for you.

Advanced Imaging Studies

CT, MRI, positron emission tomography (PET), and X-ray scans identify the stage, type, and location of bile duct cancer. The scans help your doctors recommend the most appropriate treatments.

Endoscopic Retrograde Cholangiogram (ERCP)

Doctors use a flexible tube with a camera to view your bile ducts and other organs. They’ll inject a dye that flows through the bile ducts and use X-rays to view any blockages or tumors. 


A tissue sample may be removed and examined to determine if cancer is present. The procedure is typically performed via a minimally invasive process, and the tissue can be collected in different ways, including endoscopic retrograde cholangiogram or image-guided needle biopsy. We can also use an endoscopic ultrasound, which uses a probe to capture high-quality images, take tissue, or remove fluid samples. If it’s suspected that your cancer has spread, we may perform an additional minimally invasive biopsy to take a tissue sample from your liver.

Exploratory (Diagnostic) Surgery

If it’s believed your cancer has spread, we may perform exploratory surgery in place of a biopsy. This minimally invasive, inpatient procedure allows our surgeons to evaluate your gallbladder and surrounding organs thoroughly to ensure you are treated as quickly as possible. 

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

Bile Duct Cancer Treatments

Because your bile ducts function in coordination with nearby organs, some cancer treatments may affect your gallbladder, pancreas, and/or intestines. Cancers of the bile ducts often require liver surgery and sometimes surgery at the head of the pancreas. This is known as a Whipple procedure. The type of surgery performed depends on the stage and location of your cancer. Our experts in surgery, chemotherapy, interventional radiology, and radiation therapy use robotic procedures and advanced techniques to minimize the impact on other organs as much as possible.

Localized Cancer Surgery

The goal of this operation is to remove cancer found in the bile ducts before it spreads. Surgery may also be necessary to clear blocked bile ducts and treat conditions like jaundice, a common symptom of bile duct cancer that occurs when a bile duct is blocked and excess bile builds up.

Whipple Surgery

Also known as a pancreaticoduodenectomy, this complex procedure may be necessary if your cancer is in the lower part of the bile ducts. It removes the affected organs, which may include the gallbladder, lower part of the bile ducts, the head of the pancreas, and the first small part of the intestine, known as the duodenum. This procedure may be performed robotically, which involves smaller incisions that result in less blood loss and scarring. A robotic Whipple procedure may also shorten your recovery time and allow you to begin chemotherapy and radiation, if necessary, sooner.

Liver Surgery

If your cancer is in the upper part of the bile ducts, part of your liver may be removed to slow or stop its spread. 


A personalized chemotherapy plan kills or slows the growth of the tumor. It may be recommended as part of a comprehensive care plan, especially if your cancer has spread. Chemotherapy can be given through an IV or as a pill.

Radiation Therapy

Radiation is delivered directly to your bile ducts to slow or stop cancer growth. Radiation therapy is also used to help relieve pain and other symptoms of the cancer.


A small catheter is guided through an artery and into the liver, where radioactive particles are injected directly into the blood supply of the tumor to slow or stop cancer growth.

Microwave Ablation, Radiofrequency Ablation, and Cryoablation

In these minimally invasive procedures, special needles are inserted directly into the tumor to kill cancer cells with extreme heat or freezing. These procedures can be used instead of open surgery to remove the cancer. They can also be used to treat nearby nerves to relieve pain and other side effects of cancer. 

Clinical Trials at Duke

Our cancer doctors work to develop new therapies and novel approaches to treating cancer and related symptoms through our clinical trials, which includes bile duct cancer. View our ongoing clinical trials to see if you can participate in these studies.

Palliative Procedures and Surgeries

These procedures help relieve bile duct cancer pain and jaundice.

Biliary Bypass

In this procedure, the flow of bile is rerouted to healthy, unblocked portions of your bile ducts to ease pain and reduce the potential for infection or gallstones.

Percutaneous Transhepatic Biliary Drainage

A special catheter is inserted to drain bile from blocked bile ducts to relieve pressure and pain.

Endoscopic Stent Placement

A small plastic or metal mesh tube called a stent may be placed to open blocked bile ducts and relieve jaundice.

Jaundice Treatments

We use a range of specialized techniques, including stent placement and surgery, to open blocked bile ducts and help relieve jaundice.

Why Choose Duke

We offer a range of options to treat your bile duct cancer and help you stay healthy and active. We have the advanced training and expertise to perform complex surgeries and treatments, including liver and pancreatic surgeries, for tumors that have spread to other organs. 

A Team Approach
Your treatment and ongoing care are discussed every week during a meeting of our cancer specialists in surgery, radiology, medical oncology, and gastroenterology. This team evaluates the status of every patient, so your personalized care plan is always updated based on your needs. If you need to see more than one doctor, we can help you coordinate your appointments so that you visit with multiple experts on one day.

Nationally Ranked Program
We are a National Cancer Institute-Designated Comprehensive Cancer Center and are part of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers dedicated to improving care for our patients.

Expertise in Bile Duct Surgery
Surgery to remove cancer from your bile ducts is complex and requires a high degree of experience and expertise. Studies show that patients who undergo complex surgical procedures in major cancer centers like ours experience fewer surgical complications, shorter hospital stays, and a faster recovery.

Support for You
Our comprehensive support services range from helping patients minimize the side effects of treatment to coping with the emotional and psychological effects of diagnosis and treatment. View our cancer support groups in our event calendar.

Overcoming Dietary Challenges
Because gastrointestinal cancers have long-term impacts on your diet and health, your care team can refer you to Duke Health nutritionists who can help you find effective ways to eat well and feel your best. In addition to these experts, our providers at Duke Health & Well-Being use an integrative approach to complement care, that treats your mind and body.

This page was medically reviewed on 09/08/2021 by