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Tests for Bile Duct Cancer
Most bile duct cancers aren't found until a person has symptoms and goes to a doctor. To diagnose bile duct cancer, the doctor will ask about your medical history and do tests to find out if it’s cancer and plan next steps.
Medical history and physical exam
If there's reason to suspect you might have bile duct cancer, your doctor will talk to you about your medical history. They will check for risk factors and learn more about your symptoms.
They likely also will do a physical exam to look for signs of bile duct cancer or other health problems. The exam will focus mostly on your abdomen (belly) to check for any lumps, tenderness, or build-up of fluid. Your skin and the whites of your eyes will be checked for jaundice (a yellowish color). Your stool and urine will be checked for changes in color.
If your symptoms and/or the results of your physical exam suggest you might have bile duct cancer, your doctor will order tests. These might include blood tests, imaging tests, and other procedures.
Blood tests
Blood tests can show how well your liver is working and whether bile might be backing up because of a blocked bile duct. Your blood might also be tested for tumor markers. These are substances that can be higher in people with bile duct cancer, though they can also be high for other reasons.
Tests of liver and gallbladder function
Lab tests might be done to find out how much bilirubin is in your blood. Bilirubin is the substance that causes jaundice. Problems in the bile ducts, gallbladder, or liver can raise the blood level of bilirubin.
Your doctor may also do tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), coagulation studies (PT, PTT, INR), and other substances in your blood. Some of these tests may be called liver function tests. They can help diagnose bile duct, gallbladder, or liver disease.
Higher levels of these substances in your blood might mean you have a blockage in your bile duct. But these tests can’t show if the blockage is caused by cancer or something else.
Tumor marker tests
Tumor markers are substances made by cancer cells that can sometimes be found in the blood.
People with bile duct cancer may have high blood levels of the tumor markers CEA and CA 19-9. High levels of these can be a sign of cancer, but they can also be caused by other types of cancer. Or they might be from conditions other than cancer. And not all bile duct cancers make these tumor markers, so low or normal levels don't always mean cancer is not present.
Still, these tests can be useful after a bile duct cancer diagnosis. If marker levels are found to be high, your care team can track them over time to help see how well treatment is working.
Imaging tests
Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests can be done for several reasons, including to:
- Look for suspicious areas that might be cancer
- Help a doctor guide a biopsy needle into a suspicious area to take a sample for testing
- Learn how far cancer has spread
- Help make treatment decisions
- Help find out if treatment is working
- Look for signs of the cancer coming back after treatment
Imaging tests can show a bile duct blockage. But they often can’t show if the blockage is caused by a tumor or by a less serious problem like scarring.
If you have (or might have) bile duct cancer, you could have one or more of these tests:
Ultrasound
Ultrasound uses sound waves and their echoes to create images of the inside of the body. A small instrument called a transducer gives off sound waves and picks up the echoes as they bounce off organs inside the body. The echoes are converted by a computer into an image on a screen.
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This is often the first imaging test done in people who have symptoms such as jaundice or pain in the right upper part of their abdomen (belly). This is an easy test to have done, and it doesn't use radiation. You lie on a table while a technician moves the transducer on the skin over your abdomen.
Ultrasound can show if the bile ducts are wider than normal, which can be a sign that something is blocking them. It can also show gallstones and some tumors. But it can miss small tumors, so other imaging tests are often needed to find the cause of a blockage.
This type of ultrasound can also be used to guide a needle into a suspicious area or lymph node. The needle can remove cells or tissue to look at under a microscope. This is called an ultrasound-guided needle biopsy.
During these procedures, the doctor puts the ultrasound transducer inside your body and closer to the bile duct. This gives more detailed images than a standard ultrasound. The transducer is on the end of a thin, lighted tube that has a camera on it.
For an endoscopic ultrasound, the tube is passed through your mouth, down through your stomach, and into the small intestine near the bile ducts. For a laparoscopic ultrasound, the tube is passed through a small surgical cut in the skin on the side of your body.
If there's a tumor, the doctor might be able to see how far it has grown and spread. This can help in planning for surgery. Ultrasound may also be able to show if nearby lymph nodes are enlarged, which can be a sign that cancer has reached them. Needle biopsies of suspicious areas might also be done.
Computed tomography (CT) scan
You may hear your care team call this imaging test a CT scan or an MDCT (multidetector CT) scan.
A CT scan uses x-rays to make detailed cross-sectional images of your body. It can be used to:
- Help diagnose bile duct cancer by showing tumors in the area
- Help stage the cancer (find out how far it has spread). CT scans can show the organs near the bile duct (especially the liver), as well as lymph nodes and distant organs where cancer might have spread.
- Guide a biopsy needle into a suspected tumor. This is called a CT-guided needle biopsy. To do it, you stay on the CT scanning table while the doctor advances a biopsy needle through your skin and toward the mass. CT scans are repeated until the needle is inside the mass. A small amount of tissue is then taken out through the needle.
Magnetic resonance imaging (MRI) scan
Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. To see details better, a contrast material called gadolinium may be injected into a vein before the scan.
MRI scans can show a lot of detail, and they are very helpful in looking at the bile ducts and other organs. Sometimes they can help tell a benign (noncancerous) tumor from one that's cancer.
A special type of MRI scan may also be used in people who might have bile duct cancer. This test is called an MR cholangiopancreatography (MRCP), and it can be used to look at the bile ducts. It is described in the section on cholangiography.
Cholangiography
Cholangiography is an imaging test that looks at the bile ducts to see if they're blocked, narrowed, or dilated (widened). The image it produces is called a cholangiogram. This can help show if someone might have a tumor that's blocking a duct. It can also be used to help plan surgery. There are several types of cholangiography. Each has different benefits.
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This scan uses an MRI (magnetic resonance imaging) machine to get images of the bile ducts. Unlike other types of cholangiograms, this test doesn’t use an endoscope or an IV contrast agent. Because it's noninvasive (nothing is put in your body), doctors often use MRCP if they just need images of the bile ducts.
This test cannot be used to get biopsy samples of tumors or to place stents (small tubes) in the ducts to keep them open.
In this procedure, a doctor passes a long, flexible tube (endoscope) down your throat, through your stomach, and into the first part of the small intestine. A small catheter (tube) is passed out of the end of the endoscope and into the common bile duct. A small amount of contrast dye is injected through the catheter. The dye helps outline the bile ducts and pancreatic duct as x-rays are taken. The images can show narrowing or blockage of these ducts.
This is usually done while you are sedated (given medicine to make you sleepy).
This test is more invasive than MRCP. But it has the advantage of allowing doctors to take samples of cells or fluid for testing. ERCP can also be used to put a stent (a small tube) into a duct to help keep it open.
In this procedure, a doctor puts a thin, hollow needle through the skin of your belly and into a bile duct inside your liver. You're given medicines through an IV line to make you sleepy before this test. A local anesthetic is also used to numb the area before putting in the needle. A contrast dye is then injected through the needle, and x-rays are taken as it passes through the bile ducts.
Like ERCP, this test can also be used to take samples of fluid or tissues or to put a stent (small tube) in the bile duct to help keep it open. Because it's more invasive, PTC is not usually used unless ERCP has already been tried or can’t be done for some reason.
Endoscopic tests
Doctors may also use special instruments (endoscopes) to go into your body to get a more direct look at your bile duct and nearby areas. The scopes may be passed through small surgical cuts or through natural body openings like your mouth. These tests are not as commonly used, since noninvasive imaging tests (like MDCT and MRCP) allow for very detailed images.
Laparoscopy
Laparoscopy is a type of surgery. A doctor takes a laparoscope (a thin, lighted tube with a small camera on the end) and puts it through a small cut in the front of your belly. With the camera, the doctor looks at your bile ducts, gallbladder, liver, and other nearby organs and tissues. Sometimes more than one cut is made. This is typically done in the operating room using general anesthesia (medicine that puts you into a deep sleep so you don’t feel pain).
Laparoscopy can help your healthcare team plan surgery or other treatments. It can also help determine the stage (extent) of the cancer. If needed, special instruments can be put in through the cuts to take biopsy samples for testing.
Cholangioscopy
This test allows your doctor to see inside the bile ducts. It can be done during an ERCP (endoscopic retrograde cholangiopancreatography).
The doctor passes a very thin tube into the mouth and down through the larger tube used for the ERCP. From there it can be moved into the bile ducts. The tube has a tiny camera on the end that lets the doctor see any blockages, stones, or tumors. They can take samples of (biopsy) any unusual tissue they find during this procedure.
Biopsy
Imaging tests might show signs of bile duct cancer. But to be sure of a diagnosis, doctors may need to remove (biopsy) a small sample of bile duct cells or tissue to look at under a microscope.
However, a biopsy isn't always done before surgery for a possible bile duct cancer. If imaging tests show a tumor in the bile duct, the doctor may go ahead with surgery and remove it.
Learn more about Surgery for Bile Duct Cancer.
Types of biopsies
There are many ways to take biopsy samples to diagnose bile duct cancer.
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If you are having certain imaging tests (ERCP or PTC), a sample of bile may be collected during the procedure to look for cancer cells in the fluid.
Your care team can also collect bile duct cells and tiny pieces of bile duct tissue using a process called biliary brushing. Instead of injecting contrast dye and taking x-ray pictures (as during ERCP or PTC), a small brush with a long, flexible handle is pushed through the endoscope or needle. The end of the brush is used to scrape cells and small pieces of tissue from the lining of the bile duct. This sample is then sent to be looked at with a microscope.
Biopsy samples can be taken during cholangioscopy. This test lets the doctor see the inside surface of the bile duct and take samples of areas that look unusual.
For this test, the skin is numbed first with a local anesthetic. Then, a thin, hollow needle is put through the skin and into the tumor without making a cut in the skin. The needle is usually guided into place using ultrasound or CT scans. When the images show that the needle is in the tumor, cells and/or fluid are drawn into the needle. This sample is sent to the lab to be tested.
In most cases, this is done as a fine needle aspiration (FNA) biopsy, which uses a very thin needle attached to a syringe to suck out (aspirate) a sample of cells. Sometimes, the FNA doesn’t get enough cells for a definite diagnosis. If this happens, a core needle biopsy may be done. A core needle biopsy uses a slightly larger needle to get a bigger sample.
Biomarker testing
Along with looking at the biopsy samples with a microscope to see if they contain cancer cells, other lab tests might also be done on the samples. This type of testing, sometimes called biomarker testing or molecular testing, can help guide treatment.
For example, your care team may test cancer cells in biopsy or surgery samples for gene or protein changes. They can check for changes in the FGFR2, NTRK, IDH1, BRAF, RET, KRAS, HER2, and NRG1 genes. Your doctor can also test for other genetic information, such as microsatellite instability (MSI) or mismatch repair (MMR) status.
The results of these tests can help determine if certain targeted drugs or immunotherapy might be helpful in treating the cancer.
For more on biopsies and how samples are tested, see Testing Biopsy and Cytology Specimens for Cancer.
Learn more about Biomarker and Tumor Marker Testing.
- Written by
- References
Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).
Banales JM, Rodrigues PM, Affò S, et al; International CCA Consensus Consortium. Cholangiocarcinoma 2026: status quo, unmet needs and priorities. Nat Rev Gastroenterol Hepatol. 2026;23(1):65-96.
Lleo A, Colapietro F, Maisonneuve P, et al. Risk stratification of cholangiocarcinoma patients presenting with jaundice: a retrospective analysis from a tertiary referral center. Cancers (Basel). 2021;13(9):2070.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Biliary Tract Cancers. Version 1.2026. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/btc.pdf on September 9, 2026.
Qurashi M, Vithayathil M, Khan SA. Epidemiology of cholangiocarcinoma. Eur J Surg Oncol. 2025;51(2):107064.
Last Revised: October 27, 2026
American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.
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