Your doctor will ask about your medical history and examine you, focusing on your abdomen. He or she will check for masses, tender spots, fluid build-up, and enlarged organs. In addition, your doctor will check your skin and eyes for jaundice and feel lymph nodes for swelling.
Next, you will have blood tests. These tests can measure the levels of liver and gallbladder enzymes, and of bilirubin. Too much bilirubin in the blood may mean that your bile duct is blocked or that you have gallbladder or liver problems. An elevated level of an enzyme called alkaline phosphatase also can point to a blocked bile duct or gallbladder disease. A substance called CA 19-9 may be elevated in people with bile duct cancer.
But blood tests cannot determine why levels of these substances are elevated. To do that, your doctor may order one or more of these tests:
Ultrasound — Ultrasound uses sound waves to make pictures of internal organs. It can detect about half of gallbladder cancers. It can also help find a bile duct obstruction or tumor, if it's large enough.
Ultrasound can be combined with endoscopy and laparoscopy. During endoscopy, your doctor inserts a flexible viewing tube (an endoscope) into your mouth. He or she then feeds the tube through the stomach and into the first part of the small intestine, where the bile duct empties. Laparoscopy is a limited type of surgery. It involves placing a surgical instrument called a laparoscope through a small cut on the side of the body. Both procedures allow the ultrasound transducer to be placed closer to the gallbladder. This placement produces more-detailed images than a standard ultrasound.
Computed tomography (CT) — This test uses a rotating x-ray beam to make detailed, cross-sectional images of the body. A CT scan can identify a tumor inside the gallbladder or one that has spread outside of it. It also can help to determine whether the tumor has spread to the bile duct, liver, or nearby lymph nodes.
Magnetic resonance imaging (MRI) — These scans also create cross-sectional images of internal organs. However, they use radio waves and powerful magnetic fields instead of radiation. They can make more detailed images than ultrasounds and CT scans. That's why they are effective in showing whether a tumor is only in the gallbladder or has invaded the liver. A special type of magnetic resonance imaging — magnetic resonance cholangiopancreatography (ko-LAN-gee-o-PAN-cree-a-TOG-ruh-fee) (MRCP) — creates pictures that make the bile duct stand out. It's among the best noninvasive ways to check for bile duct cancer.
Endoscopic retrograde cholangiopancreatography (ERCP) — In this procedure, a flexible tube is passed down the throat, through the esophagus and stomach, and into the common bile duct. A small amount of contrast dye is used to help outline the bile duct in x-ray images. These pictures can show if the bile duct is narrowed or blocked. The advantage of ERCP is that it can be used to take biopsies of a blocked area and relieve the blockage. To do this, the doctor places a wire-mesh tube, called a stent, in the bile duct to keep it open. Sometimes, inserting a stent eliminates the need for surgery.
Surgery — Sometimes surgery must be done to determine if there is cancer in the gallbladder or bile duct.
Biopsy — To be certain of the diagnosis, a tissue sample will be taken from the tumor or mass and examined in a laboratory. Bile may be taken to see if it contains cancer cells. Tissue and bile samples can be taken during an ERCP, with a needle guided by a CT scan, by scraping the lining of ducts with a small brush, or during surgery.