Referral guidelines for suspected cholangiocarcinoma:
Cholangiocarcinoma, a cancer of the bile ducts, is closely related to pancreatic and biliary tract cancers in terms of diagnostic approach. Patients presenting with obstructive jaundice should be referred urgently using a suspected cancer pathway referral to specialist services for further assessment, as jaundice is a key symptom indicating possible biliary obstruction from cholangiocarcinoma or pancreatic cancer. This referral should be made within 1 working day once the decision is made.
Before any biliary drainage, a pancreatic protocol CT scan is recommended to assess the cause of obstruction and to help differentiate cholangiocarcinoma from pancreatic cancer. If the diagnosis remains unclear after CT, further imaging with fluorodeoxyglucose-positron emission tomography/CT (FDG-PET/CT) and/or endoscopic ultrasound (EUS) with EUS-guided tissue sampling should be offered to obtain a tissue diagnosis.
If endoscopic retrograde cholangiopancreatography (ERCP) is performed to relieve biliary obstruction and no tissue diagnosis is available, biliary brushing for cytology should be taken to aid diagnosis.
Patients with suspected cholangiocarcinoma should be informed about the referral process, the possible diagnoses, and what to expect from specialist services, including the types of tests and timelines involved.