Biliary tract cancer.
A plain-language guide to bile duct and gallbladder cancer: the different types, why jaundice needs urgent attention, how it is diagnosed, and what treatment looks like in Australia.
What biliary tract cancer is.
Bile is made in the liver and carried to the small bowel by a branching network of ducts. The gallbladder stores bile between meals. Cancers of this system are called biliary tract cancers, and they are grouped by where they start.
Cholangiocarcinoma is cancer of the bile ducts. Intrahepatic tumours start in the small ducts inside the liver and are classified as a type of primary liver cancer. Perihilar tumours start where the left and right ducts leave the liver; they are also called Klatskin tumours. Distal tumours start in the common bile duct as it passes towards the bowel.
Gallbladder cancer is a separate disease that arises in the gallbladder wall, usually as an adenocarcinoma. It is often found unexpectedly when the gallbladder is removed for gallstones.
Australian national statistics report gallbladder and extrahepatic bile duct cancer together, and count intrahepatic cholangiocarcinoma within liver cancer. There is no clean national figure for all biliary cancers combined, and the subtypes have historically been misclassified. The average age at diagnosis is about 72.
What raises the risk.
Long-standing inflammation of the bile ducts is the main theme. Primary sclerosing cholangitis, a chronic inflammatory condition of the ducts, raises the risk of cholangiocarcinoma. So do choledochal cysts, chronic liver disease including cirrhosis and hepatitis B or C, and infection with liver flukes, which matters mainly for people who have lived in parts of Asia and Africa.
For gallbladder cancer, gallstones and chronic gallbladder inflammation are the main associations, along with gallbladder polyps and a calcified (porcelain) gallbladder. Age over 65 is a risk factor for bile duct cancer.
There is no routine screening test for biliary cancer. For people at higher risk, such as those with primary sclerosing cholangitis, annual ultrasound surveillance may be considered. Gallbladder polyps over 10 mm are usually an indication for removal of the gallbladder.
Most people with these risk factors never develop cancer. A risk factor is not a diagnosis, and most people with gallstones do not have gallbladder cancer.
Jaundice needs urgent assessment. Yellowing of the eyes or skin, especially with pale stools or dark urine, should be investigated promptly, whether or not it is painful.
Symptoms worth taking to a GP.
Early biliary cancer usually causes no symptoms. When it blocks the flow of bile, jaundice appears, and that is the symptom that most often brings people to care.
Jaundice
Yellowing of the whites of the eyes and skin. It may be less obvious on brown or black skin. It requires urgent investigation.
Itching
Generalised itch, often worse at night, caused by bile salts building up in the blood.
Pale stools and dark urine
Bile is not reaching the bowel, so stools become pale and urine darkens.
Pain in the upper right abdomen
A dull ache or discomfort under the right ribs, sometimes with nausea.
Unexplained weight loss
Often accompanied by loss of appetite and fatigue.
Fever or night sweats
Can indicate infection in blocked bile ducts (cholangitis), which is a medical emergency.
Found on a scan or after gallbladder surgery
Sometimes cancer is found when the gallbladder is removed for another reason, or on imaging done for something else.
Fever with jaundice is urgent. If you have jaundice and a fever, seek urgent medical care the same day, because it can mean an infected, blocked bile duct.
How it is diagnosed.
Biliary cancer is diagnosed with blood tests and imaging, and often needs specialist techniques to sample or drain the ducts. It should be managed by a specialist HPB team.
From jaundice to a treatment plan
Staging differs by type. Perihilar tumours are described by how far they extend into the ducts (Bismuth-Corlette), and all types are staged with TNM to record depth, nodes and spread.
What treatment looks like.
Surgery
Surgery is the only potentially curative treatment. The operation depends on where the cancer is: part of the liver (hepatectomy) for intrahepatic tumours, removal of the bile ducts and part of the liver for perihilar tumours, and a pancreaticoduodenectomy (Whipple procedure) for distal tumours. Gallbladder cancer usually requires removal of the gallbladder, part of the liver and nearby lymph nodes.
These are major operations, and only a minority of tumours can be completely removed. Assessment at a specialist centre matters.
Transplant
In highly selected perihilar cholangiocarcinoma, liver transplantation after strict chemoradiotherapy protocols is used in a small number of centres worldwide. It is not suitable for most patients.
Drainage and stenting
When a tumour blocks the bile duct, a stent can relieve jaundice, itching and infection risk. This may be done before surgery to improve your condition, or as palliation when surgery is not possible.
Chemotherapy
For advanced disease, gemcitabine with cisplatin is the standard first line, and adding durvalumab (an immunotherapy) improves survival in selected patients. After surgery, six months of capecitabine is standard for resected biliary cancer, based on the BILCAP trial.
Second-line options include FOLFOX. Radiotherapy is used selectively, often for pain or local control.
Palliative care
Management of jaundice, itching, pain, nausea and nutrition is a central part of care, alongside chemotherapy where appropriate. Palliative care teams can help at any stage, and advance care planning can start at any time.
Ask for a specialist HPB team. These cancers are uncommon, and outcomes are better when surgery and stenting are planned by people who do it regularly.
The research we fund.
HOPE Fund research supports recovery and decision-making in major HPB and upper GI surgery.
HIIT Cancer
A randomised trial of high-intensity interval training started immediately after major foregut surgery, testing whether early structured exercise speeds recovery.
Better decisions in surgery
Work using AI to support surgical decisions and improve consistency of care for HPB patients.
Plain-language patient guides
Kept free of the jargon that makes a diagnosis harder to carry.
Questions people actually ask.
Is bile duct cancer the same as liver cancer?
Partly. Intrahepatic cholangiocarcinoma starts in the bile ducts inside the liver and is classified as a primary liver cancer. Perihilar and distal cholangiocarcinomas start outside the liver and are not liver cancer, although they are often miscoded as such in statistics.
Does jaundice mean liver cancer?
No. Jaundice means bile is not flowing normally, which can be caused by gallstones, inflammation, or a tumour in the bile duct, gallbladder, pancreas or liver. It always needs urgent investigation.
Is a biopsy always done before surgery?
Not always. For a tumour that looks removable, the specialist team may proceed without a definitive biopsy, because sampling the ducts can be difficult and can complicate surgery. The decision is made case by case.
Can biliary cancer be cured?
It can be cured when the tumour is found before it has spread and can be completely removed. Most are found later, when treatment aims to control the cancer and relieve symptoms.
What is a Klatskin tumour?
A perihilar cholangiocarcinoma that starts where the left and right hepatic ducts join. The name comes from the surgeon who described it.
Is there a screening test?
No routine screening exists. People at higher risk, such as those with primary sclerosing cholangitis, may be offered annual ultrasound surveillance.
This page is general information, not medical advice. It is written for people in Australia and does not replace a conversation with your own treating team, who know your history and your scans. If you are worried about a symptom, see your GP. In an emergency, call 000.
Sources: Cancer Council Australia and Pancare, Optimal care pathway for people with biliary cancer (2026), Cancer Council NSW, Gallbladder cancer, Cancer Australia, Liver cancer statistics (includes intrahepatic cholangiocarcinoma, ICD-10 C22), AIHW, Cancer data in Australia (gallbladder and extrahepatic bile duct cancer, ICD-10 C23-C24), Cancer Research UK, Bile duct cancer: types, tests and survival, National Cancer Institute, Bile Duct Cancer (PDQ), eviQ, Biliary and gallbladder advanced cisplatin, gemcitabine and durvalumab protocol.
Related guides.
Liver cancer
Primary liver cancer begins in the liver itself, most often in people with long-standing liver disease or cirrhosis. The liver can also be a site where cancers from elsewhere spread, which your team will distinguish carefully.
Read the liver cancer guidePancreatic cancer
Begins in the pancreas, most commonly in the ducts that carry digestive enzymes. It tends to grow quietly and spread early, so research into earlier detection, such as our pancreatic cyst registry, is a priority.
Read the pancreatic cancer guideFund the work that finds it earlier.
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