Also known as Bile Duct Cancer. The major function of the bile duct is to move a fluid called bile produced in the liver to the gallbladder



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  • Phonetic: \kə-ˌlan-jē-ō-kär-sə-ˈnō-mə\

Breakdown of the Word:

  1. Chole: Derived from the Greek word “cholē” meaning bile.
  2. Angio: Comes from the Greek “angeion” meaning vessel.
  3. Carcinoma: A type of cancer that begins in the skin or in tissues that line or cover internal organs. The word comes from the Greek “karkinoma,” meaning malignant tumor.

Names and Acronyms

CCA (Cholangiocarcinoma), BDC (bile duct cancer), and BTC (Biliary Tract Cancer) ‘CC’ is often used among patients abs ‘Cholangio’.

We use CCA and Cholangio as appropriate.  

Location of Primary Tumour

Cholangiocarcinoma is a cancer that forms in the bile ducts. The bile ducts are the drainage system for bile, a substance made by the liver to help digest fats. This cancer can occur in any part of the bile ducts, including:

  • Intrahepatic: Occurring within the liver. (Image – Red Section)
  • Extrahepatic: Occurring outside the liver, which can be further classified into:
    • Perihilar (hilar): Occurring at the junction where the left and right hepatic ducts join and leave the liver. (Image – Green Section)
    • Distal: Occurring further down the bile duct, closer to the small intestine. (Image – Orange Section)

Distal bile duct cancers are often initially confused with pancreatic cancer due to their anatomical proximity and similar symptoms. Intrahepatic cholangiocarcinoma is frequently mistaken for hepatocellular carcinoma. It is generally understood that extrahepatic cholangiocarcinomas are more likely pancreatic in origin, while intrahepatic cholangiocarcinomas are more likely hepatocellular in origin.

What Is Cholangiocarcinoma?

Cholangiocarcinoma is a rare and aggressive cancer. It usually shows up late because its early symptoms are vague and often overlooked. Common signs include yellowing of the skin and eyes (jaundice), itching, abdominal pain, weight loss, and fever.

Understanding the word’s origin helps us grasp the nature of this disease.

The term “cholangiocarcinoma” points directly to its roots in the bile ducts and its cancerous nature. The complexity of the word mirrors the complexity of the disease, which affects multiple systems and needs a comprehensive treatment approach.

Understanding Cholangiocarcinoma

The bile ducts are narrow, slender tubes responsible for transporting bile from the liver to the small intestine. Bile helps our digestion process by breaking down fats, making them easier for the intestines to absorb and pass through our bowels.

How Could This Cancer Occur?

Bile duct cancer can develop due to injury or chronic inflammation of the delicate epithelial layer that protects the ducts. This inflammation or injury may be caused by changes in bile composition, gallstones, or surgical procedures, which can irritate these cells.

Additionally, the cancer can arise directly from genetic mutations within the epithelial cells lining the ducts, disrupting their normal function and leading to uncontrolled cell growth.

Causes of Cholangiocarcinoma

Chronic Inflammation

Chronic inflammation of the bile ducts is a significant risk factor. This can be caused by conditions such as:

  • Primary Sclerosing Cholangitis (PSC): A chronic liver disease that causes scarring and inflammation of the bile ducts.
  • Liver Fluke Infections: Parasites like liver flukes can infect the bile ducts, causing long-term irritation and inflammation, particularly in parts of Asia.

Bile Acid Imbalance

An imbalance in bile acids can be toxic to the epithelial cells lining the bile ducts. Factors contributing to bile acid imbalance include:

  • Diet: High-fat diets and low-fiber diets can alter bile composition, increasing the concentration of harmful bile acids.
  • Obesity: Excess body fat influences bile acid metabolism and increases the risk of bile acid imbalance.
  • Medical Conditions: Conditions such as gallstones, biliary strictures, or surgical injuries can cause bile stasis, leading to concentrated and more toxic bile.

High concentrations of certain bile acids can cause direct damage to cell membranes and DNA, leading to mutations and cancer. This damage occurs through mechanisms such as:

  • Membrane Disruption: Bile acids can dissolve lipid membranes, causing cellular injury.
  • Oxidative Stress: Excessive bile acids generate reactive oxygen species (ROS), leading to oxidative stress and DNA damage.
  • Chronic Inflammation: Prolonged exposure to high bile acid levels triggers chronic inflammation, which can promote tumor development.

Genetic Factors

Genetic mutations within the epithelial cells of the bile ducts can predispose individuals to cancer. These mutations can be exacerbated or brought on by chronic irritation and inflammation caused by bile acid imbalance and other factors.

In Summary

Cholangiocarcinoma can develop due to a combination of chronic inflammation, bile acid imbalance, and genetic factors. Managing these risk factors, such as maintaining a healthy diet, managing weight, and treating underlying medical conditions, can help reduce the risk of developing bile duct cancer. Understanding these mechanisms provides a clearer picture of how this complex disease develops and highlights the importance of comprehensive risk management.

The Story We Share

Understanding the Biliary Tree:

Think of a Healthy Tree with Its Roots Embedded in Our Liver

  1. Bile is produced by our liver.
  2. Bile helps break down the food we eat.
  3. Bile ducts are like tree roots.
  4. Bile ducts collect the bile that the liver produces and transport it to the canopy of the tree—our small intestines.
  5. The bile and food combine in the small intestines (Duodenum) to aid in the digestion of our food.
  6. The tree has just one small but vital branch, the cystic duct, leading to the gallbladder. This is our storage branch, holding extra bile for when we consume fatty foods.

Now, in your mind, I want you to flip this tree upside down:

In our bodies, the liver sits under the right rib cage, above the stomach and intestines. A healthy bile duct tree is essential for our digestive system to function efficiently, just as a healthy tree is vital for its ecosystem.


When bile duct cancer affects our biliary system, it’s like a disease attacking a tree, disrupting its ability to transport nutrients. Understanding this structure helps us see why maintaining a healthy biliary tree is vital for digestion and overall health.

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