Bile Duct Cancer

Bile duct cancer (cholangiocarcinoma) is cancer arising from the tubes that carry bile from the liver to the intestine. It is less common than liver or pancreatic cancer but carries a poor prognosis when diagnosed late. Certain Indian and Asian regions have higher rates linked to specific risk factors.

Types by location

• Intrahepatic — inside the liver.
• Perihilar (Klatskin tumour) — at the junction where the main bile ducts meet.
• Distal — near the duodenum.

Symptoms

• Painless jaundice, dark urine, pale stools.
• Itching.
• Right-upper abdominal pain.
• Weight loss, loss of appetite.
• Fever with chills (if bile obstruction causes cholangitis — can be urgent).

Risk factors

• Primary sclerosing cholangitis (uncommon in India).
• Choledochal cysts and bile duct anomalies.
• Chronic hepatitis B and C, cirrhosis, fatty liver.
• Chronic liver fluke infection (Opisthorchis, Clonorchis) — prominent in parts of south-east Asia; some limited exposure possible in certain Indian populations.
• Hepatolithiasis (liver bile duct stones).
• Diabetes, obesity, smoking, alcohol.
• Age over 60.

Evaluation and treatment

• Imaging: MRI/MRCP, CT, endoscopic ultrasound.
• ERCP with brushing, sometimes biopsy.
• Tumour markers (CA 19-9) — supportive.
• Surgery — when possible, the only curative treatment.
• Chemotherapy, targeted therapy (FGFR, IDH1), immunotherapy — for advanced disease.
• Biliary stenting — often essential to relieve jaundice.
• Palliative care from the start — meaningful difference in quality of life.

Bile duct cancer is best managed at a hepatobiliary / pancreatic surgery centre. Any unexplained jaundice — especially painless — deserves urgent proper evaluation, not repeated "natural" treatments.