Bile duct cancer is a rare but very aggressive cancer. While survival rates are low, new advances in treatment may improve your life expectancy.

Bile duct cancer, also known as cholangiocarcinoma, is a rare type of cancer that grows in the bile ducts. These small tubes transport bile, a fluid made in the liver that helps with digestion. Bile ducts connect your liver to your gallbladder, which stores bile, or to your small intestine, which uses bile to break down food.

Doctors diagnose about 8,000 cases of bile duct cancer each year in the United States. Most people are over 65 years of age when they receive a diagnosis of bile duct cancer.

Although rare, bile duct cancer tends to be more aggressive than other types of cancer. It can be difficult to treat since it often spreads to nearby tissues and organs in other parts of the body. But recent medical advances, like targeted therapy and immunotherapy, may improve survival rates.

Bile duct cancer is slow growing. It often goes undetected in its early stages because it usually doesn’t cause symptoms. Bile duct tumors are also deep inside the body and can’t be felt by a doctor during a physical exam.

But these tumors can easily grow through the bile duct wall, where they have easy access to nearby blood vessels and organs.

For this reason, bile duct cancers tend to spread more quickly than other types of cancers.

Doctors only find a small number of bile duct cancers before they spread to other parts of the body.

Is bile duct cancer more aggressive than pancreatic cancer?

Both bile duct cancer and pancreatic cancer are aggressive cancers. Bile duct cancer is more deadly than pancreatic cancer but is less common.

Pancreatic cancer is the fourth leading cause of cancer death in the United States. According to the American Cancer Society, pancreatic cancer has an overall 5-year survival rate of about 11%, compared with about 9% for bile duct cancer.

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Bile duct cancer usually first spreads to a nearby blood vessel. It then spreads to nearby organs or tissues such as your:

  • liver
  • intestines
  • stomach
  • diaphragm
  • lymph nodes

In later stages, bile duct cancer can spread to more distant parts of the body, such as your:

Doctors group bile duct cancer into five major stages (0 to 4) based on the size of the tumor and how much the cancer has spread.

In the early stages (stages 0, 1, or 2), you might not have any symptoms of bile duct cancer unless a tumor has blocked a bile duct.

In later stages (stages 3 and higher), symptoms may include:

As bile duct cancer spreads to other parts of your body, you may have other symptoms related to the area in which it has spread.

In addition to using stages, doctors may refer to a bile duct cancer based on its treatment options. They may use the terms:

  • Resectable (localized): The cancer hasn’t spread and can be removed by surgery.
  • Unresectable but localized: The cancer hasn’t spread but can’t be removed by surgery.
  • Metastatic: The cancer has spread.

Surgery to remove your bile ducts is the primary treatment for early stage bile duct cancer. But only a small number of bile duct cancer cases are suitable for surgery.

Other treatments may include:

For example, if the cancer is unresectable but localized, a doctor may try combination chemotherapy, either on its own or with radiation.

In 2022, the Food and Drug Administration (FDA) approved the drug durvalumab (Imfinzi) as the first immunotherapy to treat bile duct cancer. There are also several other immunotherapies currently in development.

Another emerging treatment for bile duct cancer still under investigation is CAR T-cell therapy. This type of treatment engineers cells from your own immune system called T cells to fight cancer. The FDA has already approved CAR T-cell therapies to treat several other types of cancer.

Doctors use a 5-year relative survival rate to determine the outlook for people with cancer. The 5-year relative survival rate is an estimate of how many people with the cancer are still alive after 5 years compared with those who don’t have the cancer.

The survival rates are grouped by the stage of the cancer at diagnosis:

  • “Localized” means cancer is only found within the bile ducts.
  • “Regional” means cancer has spread to the lymph nodes or nearby organs.
  • “Distant” means cancer has spread to distant organs, like the lungs.

According to the American Cancer Society, the 5-year relative survival rates by stage are:

Intrahepatic (starts in the liver)Extrahepatic (starts outside the liver)

Keep in mind that these are just estimates. Your outlook also depends on your overall health, age, and other factors.

These numbers are also based on past data. New diagnostic techniques, medical advancements, and new treatments often improve your outlook over time. In fact, the rate of death from cancer has been steadily declining over the past 20 years.

End stage bile duct cancer

Chances for a cure are very low for end stage bile duct cancer. Despite this, doctors may still want to treat the cancer to help relieve symptoms and improve your quality of life.

Doctors may also focus on palliative care. These treatments help control symptoms like pain and nausea and improve overall wellness.

You can also speak with a doctor about joining a clinical trial.

Resources for support

Finding a supportive community can help you connect with others and manage the stress of a cancer diagnosis. There are resources to help support you before, during, and after treatment. Ask a doctor for a referral to a local support group, or try reaching out to the American Cancer Society for additional programs and resources.

Other resources include:

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Bile duct cancer is a rare and aggressive cancer. Doctors don’t usually diagnose it until it’s large enough to cause a blockage or has spread to other parts of your body. Because of this, it can be more challenging to treat than other types of cancer.

But despite these challenges, new and emerging treatments are constantly improving the outlook. Talk with a doctor about treatment options or clinical trials best suited to your situation.