Diagnosis of Gallbladder and Bile Duct Cancers: An Overview

Many types of tests are used to help diagnose bile duct cancer. These can be grouped as radiology, serology, and pathology.

Click the test name for detailed information.

RADIOLOGY TESTS

Ultrasound	An ultrasound examination of the right upper quadrant of the abdomen is generally one of the first tests done to evaluate patients with jaundice. It is useful for detecting some gallbladder cancers.
Computed Tomography (CT)	Scanning, which is essentially a detailed X-ray delineation of the body, is more sensitive for detecting both gallbladder and bile duct cancers.
MRI	Magnetic Resonance Imaging is becoming more sensitive than CT scanning, is less invasive and is slowly becoming more popular. CT and MRI have the added benefit of detecting enlarged lymph nodes near the tumors, which can suggest that a cancer has spread (metastasized) to the lymph nodes.
ERCP	(Endoscopic Retrograde Cholangio-pancreaticography) Cholangiography, which involves the injection of a radioopaque dye into the biliary system, is the procedure of choice for determining the extent of tumor in the biliary tract. The procedure is done either through the skin (Percutaneous Transhepatic Cholangiography-PTC) or through an endoscope fed through the esophagus and into the duodenum.

SEROLOGY TESTS

CA19-9

Serology refers to measurements of serum substances (markers) present in the blood which may predict the presence of tumor. The most commonly used marker is the serum CA19-9, which tends to be elevated in patients with bile duct cancer. However, this marker is not specific to bile duct cancer. It can be elevated in patients with other types of cancer and in patients without cancer. It is therefore not a very good screening test for the general public.

PATHOLOGY TESTS

Pathology is the gold standard for the diagnosis of cancer. The diagnosis can sometimes be made by cytopathology, the study of individual cells spread into a thin layer onto glass microscopic slides.
FNA Fine Needle Aspiration	Bile duct brushings can be performed through an endoscope (a special scope which is inserted into the mouth and passed into the first portion of the intestine) to detect malignant cells. If a mass is present, fine needle aspiration of it can be performed; this involves guiding a thin needle into the lesion, and gently sucking out cells for microscopic examination. These procedures have the benefit of not requiring an operation or general anesthesia.
Biopsy	Biopsy of the biliary tract is the more common means of detecting these tumors. Sometimes the biopsies can be performed through the endoscope; other times exploratory laparotomy, in which the surgeon makes an incision in the abdominal wall and enters the abdomen, is performed, under general anesthesia.