The clinical examinations carried out for the diagnosis of bile duct/bladder cancer focus on jaundice, tumors in the epigastrium, and enlargement of the liver and gallbladder. Work-up using CT, MR, ERCP and EUS has improved the selection of resectable patients.
- EUS (endoscopic ultrasound) is a relatively simple method for assessing local invasion and allows for taking specimens for cytology.
- CT is sensitive for detection of the primary tumor and metastasis. The examination provides good information about the extent of the tumor, especially the tumor's relation to surrounding vessels, and is the standard for diagnostics and stage determination.
- MRCP (magnetic resonance cholangio pancreaticography) is an MRI examination of the bile ducts and the duct system in pancreas. A contrast agent is usually used.
- ERCP (endoscopic retrograde cholangio-pancreatic ductography), possibly with brush cytology, is recommended when the common bile duct is dilated, and the cause is not revealed by ultrasound or CT.
- PTC (percutaneous transhepatic cholangiography) may be appropriate if the level of the tumor in the bile duct is unclear.
- Tumor marker CA19–9 is of limited value, but may cause suspicion of bile duct cancer. Tumor marker CEA and CA 19–9 may be a sign of gallbladder cancer with sensitivity and specificity of 50–70 %. Bilirubin > 75 µmol/l and elevated CA 19–9 is often a sign of a more advanced stage. CA 19–9 values > 400 U/ml are associated with an inoperable illness.
A stricture in the middle of the common bile duct is often a sign of gallbladder cancer. It is not uncommon that gallbladder cancer is first detected by histological examination after a regular cholecystectomy.