Wherever possible the treatment for a cancer of the bile duct is an operation to remove the tumour.

Bile duct cancers do not usually spread to other parts of the body but they can invade the surrounding organs, such as the liver and the pancreas. They also often send seedlings of cancer into the nearby lymph nodes. When this has happened it may not be possible to remove all of the tumour with an operation. Overall only about 1 in 5 cancers in the upper part of the bile ducts (nearest to the liver) are suitable for surgery, whereas in the middle and lower part of the bile ducts around about half the cancers can be operated on.

If it is not possible to remove the cancer then the main aim of treatment is to relieve the jaundice caused by the tumour. There are a number of different ways of doing this, including:

• an operation to by-pass the blockage caused by the tumour, joining the end of the bile duct nearest the liver to a loop of small intestine. This allows the bile to flow again and so the jaundice will decrease.
• an operation to open up the bile duct and insert a tube through it, past the blockage, so the bile can flow again.
• percutaneous stenting: this is where a fine tube is inserted through the skin of the lower part of the chest, into the liver, and passed through into the bile ducts. A guide wire is threaded through this tube, which is then removed, a metal coil, or stent, is then slipped over the guide wire and slid along to where the tumour is in the bile duct. The stent can then be expanded to open up the duct and relieve the blockage. The guide wire is then removed and the stent is left in the bile duct.
• endoscopic stenting: this is a very similar process but this time the stent is introduced through an endoscope, a flexible tube which swallowed and reaches the bile duct by passing through the gullet, the stomach and the first part of the small intestine: the duodenum.

The choice of which method is used varies from person to person, depending on things like the size of the cancer and its position in the bile ducts.

Usually bile duct cancers quite resistant to both chemotherapy and radiotherapy but occasionally drug treatment may be help. Drugs that have been used include the combination of Fluorouracil, Adriamycin and Mitomycin (FAM) and the newer drug gemcitabine.