Diagnosing Cholangiocarcinoma

Diagnosing Cholangiocarcinoma
Cholangiocarcinoma can block the flow of bile from the liver to the intestine. This causes bile to flow back into the blood and body tissues, and the skin and whites of the eyes to become yellow (jaundice). The urine also becomes a dark yellow colour, stools (bowel motions) are pale and the skin may become itchy.  Other possible symptoms include discomfort in the abdomen, loss of appetite, high temperatures and weight loss.

These symptoms can be caused by many things other than Cholangiocarcinoma, but any of these symptoms should always be checked by a doctor.

How Cholangiocarcinoma may be diagnosed
Initially, a GP’s examination will be followed by referral to a hospital specialist for any tests that may be necessary and for expert advice and treatment.

As well as general health tests, including checking liver function, the following tests are commonly used to diagnose Cholangiocarcinoma:

Ultrasound scan
This test uses sound waves to build-up a picture of the bile ducts and surrounding organs.  The test is painless and takes 15-20 minutes.

CT (computerised tomography) scan
A CT scan takes a series of x-rays which build up a three-dimensional picture of the inside of the body. Usually a drink or injection is given before the scan to allow particular areas to be seen more clearly. The scan is painless and takes from 10-30 minutes.

MRI (magnetic resonance imaging)
This test is similar to a CT scan, but uses magnetic fields instead of x-rays and takes place with the patient lying on a couch inside a metal cylinder.  (The cylinder is a very powerful magnet, so patients with any metal inside their body (for example, a cardiac monitor, pacemaker, surgical clips, or bone pins) may not be able to have an MRI because of the magnetic fields.)

An injection is usually given to allow the images to be seen more clearly.  The test can take about 30 minutes and is completely painless.

ERCP (endoscopic retrograde cholangiopancreatography)
This procedure may be used to take an x-ray image of the pancreatic duct and bile duct. It can also be used to unblock the bile duct if necessary.

A thin flexible tube (an endoscope) is passed via the mouth down into the stomach and into the duodenum.  This enables the doctor to look down the endoscope to find the opening through which the bile duct and pancreatic duct drain into the duodenum. A dye which shows up on x-ray, may then be injected into these ducts which will help to show if there is any abnormality or blockage in the ducts.  If there is a blockage a stent (a small tube) may then be inserted.

A relaxing sedative and a local anaesthetic spray to numb the throat is given before this procedure, as well as antibiotics to help prevent any infection. An overnight stay in hospital is usual.

EUS (endoscopic ultrasound scan)
This scan is similar to an ERCP but involves an ultrasound probe being passed down the endoscope to take an ultrasound scan of the pancreas and surrounding structures.

PTC (percutaneous transhepatic cholangiography)
This procedure may be used to take an x-ray picture of the bile duct. It may also be used to take a biopsy (get a sample of tissue) from the tumour.

As with ERCP a relaxing sedative is given, and then an area on the right side of the abdomen is numbed with a local anaesthetic injection. A thin needle is then passed through the skin into the liver, and dye injected into the bile duct within the liver. X-rays are then taken to see if there is any abnormality or blockage of the duct.

Antibiotics are given before and after the procedure to help prevent infection, and an overnight stay in hospital is usual.

PET (positron emission tomography)
A PET scan is a special kind of imaging test which allows doctors to see how certain tissues and organs within the body are functioning. The most significant difference between a PET scan and other imaging tests such as MRI or CT scans is the ability to detect changes in the body at the cellular level rather than after a disease has progressed enough to actually affect the surrounding tissue or organs.

A PET scan is a complementary test. This means that it is usually used with other tests, such as X-rays or MRI scans.

The scan is performed by injecting a small amount of radioactive chemical into a vein. As the chemical travels through the body, it is absorbed by the organs and tissues. During the test, a scanner records the energy produced by the cells. A computer converts the recording into three-dimensional pictures of an area of the body and any cells that are changing show up at a brighter contrast to any surrounding, normal cells.

There is very little preparation involved prior to a PET scan and it is usually done on an outpatient basis. In general, most patients are simply given restrictions on food or drink for 6 to 12 hours prior to the test, which takes approximately 2 hours to complete.  A PET scan is painless and side effects are unlikely.

Angiogram
This is a test to look at blood vessels. The bile duct is very close to large blood vessels that carry blood to and from the liver. An angiogram may be used to check whether any of them are affected by the cancer.

Angiograms are carried out within the x-ray department. A fine tube is put into an artery in the groin and a dye is then injected into this tube. The dye circulates in the arteries so that they show up on x-ray.

Biopsy
The results of the previous tests may strongly suggest a diagnosis of cholangiocarcinoma, but the only way to be sure of this is a biopsy. Some cells or tissue are taken from the affected area of the bile duct and are then examined under a microscope.

A biopsy may be carried out during an ERCP or PTC.

CT or ultrasound may be used at the same time, to make sure that the biopsy is taken from the right place.

Laparotomy
A laparotomy operation is sometimes used to help diagnose cholangiocarcinoma and is carried out under a general anaesthetic.

The surgeon makes an incision in the abdomen to examine the bile duct and the tissue around it for cancer. Sometimes this operation is done through a smaller cut.

A tube with a laparoscope (a tiny camera) attached allows the surgeon to see inside the abdomen.  If a cancer is found, but looks as though it has not spread to surrounding tissues, the surgeon may be able to remove the cancer or relieve any blockage that it is causing.

Cholangiocarcinoma

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