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How is cholangiocarcinoma (CCA) diagnosed?

How is CCA Diagnosed
Diagnosing CCA can be difficult. Your doctor may need to consult different types of healthcare experts regarding your care and treatment.1–4 In some hospitals, these experts form a multidisciplinary team (or MDT for short)
What is an MDT?
An MDT is a group of healthcare experts who specialise in different areas of medicine.1,3 The team will meet regularly and together help to decide the best plan of action for your treatment and care
These experts usually include:
Radiologist Nurse Oncologist Surgeon Gastroenterologist Molecular pathologist Histopathologist
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Click on an icon to learn more about each expert
A healthcare professional who treats gastrointestinal (stomach and intestines) and hepatological (liver, gallbladder, biliary tract and pancreas) diseases
A healthcare professional who uses images to diagnose and treat medical conditions and injuries
A healthcare professional who diagnoses and treats people with cancer
A healthcare professional who examines samples of tissues/cells for the diagnosis and treatment of medical conditions
A healthcare professional who performs laboratory tests, examines the DNA, RNA and/or protein within cells taken by biopsy, and supports other healthcare professionals in the diagnosis and treatment of medical conditions
A healthcare professional trained to support the care and treatment of medical conditions
A healthcare professional who performs operations in planned and/or emergency situations
What tests might be carried out in the diagnosis of CCA?
  • Not all patients will undergo all tests –
    this could be due to differences in individual cases (such as disease stage), familiarity of tests among the healthcare team or differences in healthcare systems (for example, access to services)
Icône d'informations If you see a test here that you have not had, you can ask your doctor to help you understand why
The most common imaging tests (that take images of the inside of your body) for diagnosing CCA include:5–10
A painless process where a handheld scanner is placed onto the abdomen and produces sound waves to create an image of structures (such as organs or glands) inside the body; commonly used during pregnancy
A process that uses X-rays taken from many angles to create computerised, 3-dimensional images of the inside of the body
A process that uses a magnetic field and radio waves to create computerised, 3-dimensional images of the inside of the body. An MRI scan might be used when a doctor wants to see more accurate, detailed images of the body
A process that uses a long, thin, flexible telescopic camera (an endoscope) that is gently passed through your mouth into your stomach and the first part of the small intestine (duodenum). A small tube is passed down the endoscope and some dye is injected, which shows up on X-rays. This allows the doctor to look at the bile and pancreatic ducts inside your body. Biopsies can be taken at the same time
A process that also uses an endoscope that is passed through to the duodenum; an ultrasound probe attached to the tip of the endoscope creates detailed images of organs and structures inside your body. Biopsies can be taken at the same time
A process that uses ultrasound to allow a long, thin, flexible needle to be inserted through your skin and into the liver. Dye is then injected through the needle, which shows up on X-rays and allows the doctor to look at the bile ducts inside your body. Biopsies can be taken at the same time
A process where a small amount of a radioactive drug (tracer) is injected into blood vessels in your arm or hand, which will then accumulate in areas of your body that have higher levels of metabolic or biochemical activity. This can often pinpoint the location of the cancer as cancer cells are more active than normal cells
  • Angiography – Dye is injected into the blood vessels, which shows up on X-rays to determine any blockages in the blood vessels in and surrounding the liver and bile ducts. This may be performed with CT or MRI
  • Laparoscopy– A minor operation during which a small cut is made (usually near the belly button) to insert a long, thin tube with a high-intensity light and a high-resolution video camera at the front (a laparoscope), which allows a doctor to see inside your body
Icône d'informations Your healthcare team will also run general health tests to see how fit you are. This can help you and your doctor to understand how well you may be able to cope with certain treatments and will help guide your treatment plan
What are the different stages of CCA?
Staging is used to describe the size of the cancer and whether it has spread. The cancer can spread in the body through the blood stream or the lymphatic system11
The TNM staging system is specific for each type of CCA (intrahepatic, perihilar and distal)2,11
TNM staging can be used to decide on an overall stage of cancer:12
The cancer is located only within the bile duct with no evidence of spreading to areas outside of the bile duct. These cancers can often be removed surgically (known as resectable cancer)
The cancer is located only in the area around the bile duct, with no evidence of spreading to distant parts of the body
The cancer has spread to distant parts of the body. It is unlikely that surgery can remove all of the cancer, as it has spread too far or is in too difficult a location to remove (known as unresectable cancer)
What is molecular profiling?
Molecular profiling is a type of test that looks for gene changes in cancer cells taken from a biopsy8
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Your healthcare team is responsible for ordering your molecular profiling test. This is performed using a sample of your cancer (biopsy)8. Your doctor will then receive a report with the results of your molecular profiling, which can help them decide the next steps in your treatment plan

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Molecular profiling can be done at any time in your treatment journey. However, the sooner it can be performed the better, as it can provide your doctor with important information to help guide treatment decisions14,15

Watch the animated video below for the perspectives of a patient and a doctor on the importance of molecular testing
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