Your doctor can begin to diagnose bile duct cancer through a series of tests, examinations, and by reviewing your medical history. Your doctor will feel your abdomen for masses or enlarged organs. Blood tests will evaluate your liver function and bilirubin. Your blood may be tested for tumor markers, which some people produce in the presence of bile duct cancer.
Imaging tests are used to identify the location and size of tumors and blockages. Common imaging tests include ultrasound, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, endoscopic retrograde cholangiopancreatography (ERCP), positron emission tomography (PET) scans, cholangiography, and angiography. Ultrasound uses sound waves to produce images of internal organs and detect abnormal tissues. An ultrasound device may be placed over the abdomen area, inserted through the mouth and into the stomach (endoscopic ultrasound), or through an incision in the side of the body (laparoscopic ultrasound).
CT scans take cross-sectional images of the body. They may be used with a contrast agent or dye to take pictures of your bile duct and nearby organs. CT scans are useful for determining if cancer has metastasized. MRI scans produce even more detailed images and can outline the exact site of bile duct blockage.
An ERCP uses an endoscope to view the biliary system. An endoscope is a thin tube with a light and viewing instrument at the end of it. After you are sedated, the thin tube is passed through your mouth and into your small intestine. An endoscope is used to take tissue samples with biliary brushing. It can administer dye to enhance views.
A cholangiography can determine the exact location of bile duct cancer. It is helpful for determining if the cancer can be treated with surgery. For this procedure, contrast dye is injected into the bile duct before X-rays are taken.
Angiography is used to show surgeons the location of blood vessels that are near the bile duct cancer for surgical planning. Angiography involves inserting a small tube into a blood vessel to inject contrast dye near the suspected site before X-rays are taken.
A PET scan is an imaging test that uses a radioactive sugar substance. A PET scan determines how quickly the cells metabolize the sugar. Cancer cells and normal cells metabolize sugar at different rates.
A laparoscopy is a procedure used to view the bile duct, gallbladder, liver, and other internal organs. It uses a thin-lighted instrument, a laparoscope, which is inserted through an incision in the abdomen. A laparoscope can take a biopsy. A biopsy is a tissue sample that is taken for evaluation of cancer cells. A CT scan is used to guide needle biopsies.
If you have bile duct cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the cancer and how it has metastasized. Staging is helpful for treatment planning and recovery prediction.
There is more than one type of staging system for cancer, and you should make sure that you and your doctor are referring to the same one. Generally, lower numbers in a classification system indicate a less serious cancer, and higher numbers indicate a more serious cancer. The stages may be subdivided into grades or classifications that use letters and numbers.