What is Biliary Cancer

Biliary cancers include cholangiocarcinoma (cancer of the bile ducts) and gallbladder cancer. These malignancies are rare but often aggressive. They can occur within the liver (intrahepatic), along the bile ducts outside the liver (extrahepatic), or in the gallbladder. Risk factors include primary sclerosing cholangitis, chronic biliary inflammation, congenital bile duct anomalies, liver fluke infection, and exposure to certain toxins.

Symptoms

• Jaundice (yellowing of the skin and eyes) and dark urine due to bile duct obstruction.
• Itching and pale stools.
• Upper abdominal pain or weight loss.
• Fever or chills if infection (cholangitis) develops.

Diagnosis

• Blood tests including liver function tests and tumor markers such as CA 19‑9.
• Imaging studies such as ultrasound, CT scan, MRI, or MRCP to visualize the biliary system.
• Endoscopic retrograde cholangiopancreatography (ERCP) with brushings or biopsy to obtain tissue.
• Percutaneous or endoscopic ultrasound‑guided biopsy for histologic confirmation.

Treatment

• Surgical resection: The only potential cure is complete surgical removal of the tumor, which may involve removing part of the liver or bile duct system.
• Liver transplantation: In selected cases of early‑stage perihilar cholangiocarcinoma, often combined with neoadjuvant therapy.
• Chemotherapy and radiation therapy: Used for unresectable or metastatic disease, often in combination. Targeted therapies and immunotherapy may be options.
• Palliative care: Endoscopic or percutaneous stenting to relieve obstruction, pain management, and supportive care.

Because biliary cancers are complex and uncommon, care typically involves a multidisciplinary team including surgeons, medical oncologists, radiation oncologists, and interventional endoscopists.