Get the facts on bile duct cancer


By pH health care professionals

According to the American Cancer Society, 2,000 to 3,000 people in the U.S. develop bile duct cancer per year and the incidence has been rising steadily during the last twenty years in the United States, Europe, Australia, Japan and Asia. It has been reported that this cancer affects mostly the older population -- the average age being 70. However, we have become increasingly aware of its effect on much younger individuals, including Daisy Llewelyn and, more recently, Japanese actress Naomi Kawashima. It is therefore critical that we learn about this cancer so we can be proactive.

Types of bile duct cancers

Cancer can originate in a few different places within the bile drainage system:

  • Within the liver, or intrahepatic, affecting the smaller bile ducts in the liver.
  • Outside the liver, or extrahepatic, affecting the bile duct located at the notch of the liver where the bile ducts exit. This is the most common type of bile duct cancer, accounting for more than half of all bile duct cancers.
  • Far outside the liver, or distal extrahepatic, located further down the bile ducts, closer to the small intestine.

Symptoms of bile duct cancer

Symptoms of bile duct cancer may include:

  • Jaundice (yellowish discoloration of the skin, mucous membranes and the whites of the eyes)
  • Abdominal pain
  • Extreme fatigue
  • Nausea and vomiting
  • Fever
  • Poor appetite
  • Light-colored/greasy stools
  • Dark urine
  • Weight loss
  • Weakness
  • Itching, caused by a buildup of bile salts and bilirubin in the body that is then deposited in the skin

What are the risk factors?

Risk factors for bile duct cancer include:

  • Primary sclerosing cholangitis (PSC), which is a rare inflammatory condition of the bile ducts (cholangitis) leading to the formation of scar tissue (sclerosis). The cause of the inflammation is not usually known.
  • Choledochal cyst, which is a congenital disorder (an abnormality that a person is born with) causing a swollen area on the part of the bile duct outside the liver.
  • Liver fluke infection, which is more common in Asian countries as a result of eating raw or poorly cooked fish infected with these tiny parasite worms.
  • Cirrhosis of the liver due to alcohol or hepatitis, which causes scar tissue to form.
  • Bile duct stones (similar to, but much smaller than, gallstones) can also cause inflammation that increases the risk of bile duct cancer.
  • Bile reflux due to abnormalities where the bile duct and the pancreatic duct normally meet, causing backflow (reflux) of the pancreatic juices into the bile ducts.
  • Hepatitis B and C infection due to the fact that long-term infections with hepatitis B and C may lead to liver cirrhosis.
  • Certain chemicals, including nitrosamine (in some cosmetics, pesticides and most rubber products), polychlorinated biphenyl (coolants and insulating fluids), and dioxins (environmental pollutants).
  • Obesity can increase the risk of cancers of the gallbladder and bile ducts because of the increased risk of gallbladder stones and bile duct stones.
  • Inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease, increase risk.
  • Alcohol users are more likely to get intrahepatic bile duct cancer, with higher risk among individuals who have liver problems from drinking alcohol.

How can you be proactive?

  • Blood test. Certain blood tests may be used to assist in detecting bile duct cancer. Early diagnosis may lead to better outcomes.
  • Manage your weight. Getting to and staying at a healthy weight is one important way a person may reduce their risk of bile duct cancer, as well as many other types of cancer.
  • Watch the alcohol. Avoid excessive alcohol use to help prevent cirrhosis.
  • Reduce toxins in your life. Avoid exposure to toxic chemicals. You can test for toxins too!
  • Be cautious. Take precautions to prevent blood-borne and sexually transmitted diseases (STDs), like the hepatitis C virus, to help prevent cirrhosis.
  • Research before you travel. Drink only purified water and foods that have been cooked thoroughly in areas of the world where liver flukes are common.
  •  Find support. Be knowledgeable about reputable non-profit organizations that provide support and funding for this rare cancer, such as The Bili Project and The Cholangiocarcinoma Foundation.

Enjoy Your Healthy Life!

The pH professional health care team includes recognized experts from a variety of health care and related disciplines, including physicians, attorneys, nutritionists, nurses and certified fitness instructors. This team also includes the members of the pH Medical Advisory Board, which constantly monitors all pH programs, products and services. To learn more about the pH Medical Advisory Board, click here.

Comments (2)


My reading has confirmed fresh water fish, raw or undercooked as a source. But saltwater fish (sushi and sashimi) are not confirmed as sources. Is this article changing that position intentionally?  If so, may we see the supporting data?


Thank you so much for that observation because we pondered that issue carefully before we made the statement.  You are correct in that the majority of the research suggests that eating fluke-infested, fresh-water raw or undercooked fish as a cause.  However,  when we dug deeper, we found that there is research that may suggest that salt water fish could also be a cause,  So the distinction between fresh water fish and salt water fish may not be as clear cut as previously reported.  See e.g.  As a result of the ambivalence in the data, we chose not to make the distinction between fresh and salt water fish and err on the side of caution given the gravity of the disease at issue.