Overview
Cholangiocarcinoma arises in the bile ducts, either inside the liver or in the ducts outside it. Because bile flow is obstructed early, painless jaundice with itching is often the first sign.
Relieving the obstruction comes first — usually by ERCP or PTBD stenting — because chemotherapy cannot be given safely while bilirubin is high. Once bilirubin falls, gemcitabine and cisplatin chemotherapy is started, with immunotherapy added for suitable patients.
Molecular profiling is particularly worthwhile in this cancer: FGFR2 fusions, IDH1 mutations, HER2 amplification and MSI-high tumours all have specific drug options that would otherwise be missed.
Symptoms to watch for
- Yellowing of the eyes and skin without pain
- Intense itching, dark urine and pale stools
- Discomfort in the upper right abdomen
- Fever with chills if the bile duct becomes infected
- Weight loss and fatigue
How we treat it
- MRCP or CT staging with tissue or brush biopsy confirmation
- Biliary stenting by ERCP or PTBD to clear jaundice before treatment
- Gemcitabine and cisplatin chemotherapy, with immunotherapy where suitable
- FGFR2, IDH1, HER2 and MSI testing for targeted therapy options
- Adjuvant chemotherapy after curative surgery
- Infection prevention, nutrition and pain management
Frequently asked questions
Why must jaundice be treated before chemotherapy?+
Chemotherapy drugs are cleared by the liver. Giving them while bilirubin is high risks serious toxicity, so a stent to drain bile comes first.
Is molecular testing worth the cost?+
In bile duct cancer, a meaningful minority of tumours carry treatable alterations such as FGFR2 fusions or IDH1 mutations, so testing often changes the plan.
Can bile duct cancer be cured?+
Cure is possible when the tumour is localised and can be completely removed by surgery. Most cases are diagnosed later, where treatment aims at control and quality of life.
This page is for information only and does not replace a medical consultation. Please speak to a qualified doctor for advice specific to your condition.