Gastrointestinal cancers
Cancer types
Gallbladder and bile duct cancer
Gallbladder cancer, cholangiocarcinoma.
Gallbladder cancer, cholangiocarcinoma.
This map explains gallbladder and bile duct cancer step by step: what it is, the types, the tests, the stages, the treatment and its side effects.
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Starts in the bile ducts inside the liver. Most likely to have a treatable mutation.
Starts in the bile ducts outside the liver: near the liver (perihilar, also called Klatskin tumour) or near the pancreas (distal). Usually causes jaundice early.
Tap a test on the map to see why it is done.
Please wait for all the reports. Why we wait
CT or MRI with MRCP (pictures of the bile ducts) shows the tumour and whether it can be removed. PET-CT checks for spread.
A needle biopsy, or brushings from the bile duct taken during ERCP. Sometimes surgery is done without a biopsy if the scans are clear.
A stent (by ERCP) or a drain through the skin (PTBD) relieves jaundice. Bilirubin must come down before chemotherapy.
A tumour marker in the blood, used to follow treatment.
In advanced cancer, NGS finds treatable mutations in about 4 out of 10 patients:
| Mutation | Treatment |
|---|---|
| FGFR2 fusion | Pemigatinib, futibatinib (mainly intrahepatic). |
| IDH1 | Ivosidenib (mainly intrahepatic). |
| HER2 | Zanidatamab, trastuzumab deruxtecan, or trastuzumab with pertuzumab (common in gallbladder cancer). |
| BRAF V600E | Dabrafenib with trametinib. |
| MSI-high, NTRK | Immunotherapy; NTRK inhibitors. |
A keyhole look inside the abdomen before major surgery, to find small spread that scans miss.
Before starting chemotherapy, immunotherapy or targeted therapy, these tests check that you are fit for treatment, and give a starting point to compare with later.
| Test | Why it is done |
|---|---|
| CBC (complete blood count) | Haemoglobin, white cells and platelets. Treatment can lower them. |
| RFT (kidney function) | Many medicines are cleared by the kidneys; the dose may need to change. |
| LFT (liver function) | Many medicines are processed by the liver. |
| Viral markers: HBsAg, anti-HCV, HIV | Hepatitis B can flare up during treatment. If positive, a tablet is given to prevent this. |
| Blood sugar (and HbA1c if diabetic) | Steroids given with chemotherapy can raise blood sugar. |
| ECG and 2D Echo | Check the heart rhythm and pumping before treatment, as some medicines affect the heart. |
Before immunotherapy, also:
| Test | Why it is done |
|---|---|
| Serum TSH (thyroid) | Immunotherapy can affect the thyroid gland. |
| Serum cortisol (morning sample) | Immunotherapy can affect the adrenal and pituitary glands. |
Sometimes needed, depending on your treatment:
Your doctor will choose the tests that apply to you. Some of them are repeated during treatment.
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Limited to the wall of the gallbladder or bile duct. The aim is cure.
Grown deeper, possibly into the nearby liver. The aim is cure.
Grown into nearby organs or major blood vessels, or spread to nearby lymph nodes.
Spread to distant lymph nodes, the peritoneum, or other organs. Not curable; treatment controls it.
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Side effects: surgery · chemotherapy
Your doctor will advise NGS testing. Why
Side effects: chemotherapy · immunotherapy
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Fever with shivering, increasing yellowness, a drain that stops draining or falls out, severe tummy pain, or fever of 38°C or more during chemotherapy need urgent care.
This information is general. Your own treatment plan may be different. Please discuss it with your doctor.
Written and medically reviewed by Dr Prathyusha Eaga, MD, DM (Medical Oncology). Last reviewed: 12 October 2026. Based on NCCN and ESMO guidelines.
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