Blood tests

The doctor will take a sample of blood and analyze it in a laboratory for any signs of the disease. The doctor will first determine the level of bilirubin in the blood. High levels of this substance may indicate gallbladder, liver, or bile duct problems. The doctor will usually measure the levels of the CEA, AFP, and CA 19-9 tumor markers. High levels of these substances may indicate bile duct cancer or another type of cancer. The doctor will also perform a blood chemistry test, which measures the levels of various substances such as sodium and potassium and provides important information on organ function.

• Please see Understanding Tumor Markers for more information

Ultrasound

Ultrasounds send out sound waves and pick up the echoes as they bounce off body tissues to create a black and white image of a part of the body. An ultrasound can be used to detect dilatation of the bile duct obstructed by tumors, to determine how far a tumor has grown or spread, and to determine if any nearby lymph nodes are enlarged.

Computed tomography (CT) scan

A computerized tomography (CT) scan uses X-rays to create detailed images of your internal organs. CT scans can help the doctor detect tumors in the bile ducts and determine if the cancer has spread to any other organs or lymph nodes. A CT scan is an important part of staging and surgical treatment planning for bile duct cancer, and can help the doctor determine if surgery is an option.

Magnetic resonance imaging (MRI) scan

An MRI scan uses radio waves and a strong magnet to create clear and detailed images of body parts. Radio waves are absorbed by the body and then released in a certain pattern, which is translated by a computer in order to show “slices” of the body. An MRI scan produces detailed images of the pancreas, gallbladder, and bile ducts, and can help the doctor better examine these areas. The doctor may also perform a specialized MRI scan called MRCP to examine the bile ducts. This procedure is discussed in the next section.

Endoscopic Retrograde Cholangiopancreatography (ERCP) study

Cholangiograms are specialized imaging tests used to examine the bile ducts. ERCP provides an X-ray image of the duct that carries bile through the abdomen. During ERCP, your doctor will inject a dye into the bile duct through a catheter inserted in an endoscope. The endoscope is placed through the mouth down through the stomach and into the small intestine to access the bile duct. Dye highlights the bile duct in the X-ray pictures your doctor will take as part of the procedure. The X-ray images can indicate the presence of a tumor. Additionally, if the duct is blocked by a tumor, a stent can be put in place to open the duct.

Magnetic Resonance Cholangiopancreatography (MRCP)

An MRCP scan is a specialized type of MRI scan used to examine the bile ducts. An MRCP uses magnetic resonance imaging to produce detailed images of the liver, gallbladder, bile ducts, and pancreas. An MRCP is less invasive than an ERCP. Unlike ERCP, MRCP does not require an IV or catheter but it cannot be used to place a stent to open a blocked duct.

Percutaneous Transhepatic Cholangiogram (PTC)

During PTC, a dye is injected through the skin into the liver. A special X-ray machine will determine if this dye is flowing freely through the bile ducts. If not, the X-ray pictures can show whether the blockage is caused by a tumor or another condition. At this time, your doctor can insert a small draining tube called a catheter to help with drainage of the bile if necessary.

Biopsy

A biopsy consists of the removal of a sample of tissue to help determine the diagnosis and treatment of the tissue. The doctor may perform a biopsy during ERCP or PTC. In this case, the doctor passes an instrument through the endoscope and uses it to scrape cells from the inside of the bile ducts. The doctor may also perform a needle biopsy, using a CT scan or ultrasound probe at the tip of an endoscope to guide the needle to the area of abnormal tissue.
Usually, the tissue sample from the biopsy will be examined under a microscope to determine if the tissue is cancerous.