Bile Duct Cancer (Klatskin Tumor)

Cholangiocarcinoma involving the hepatic bifurcation are categorized as hilar bile duct cancer or Klatskin tumors.

Klatskin tumors are a type of cancer located in the upper part of the bile duct affecting the right or left hepatic ducts as they enter the liver. Unfortunately, the hepatic ducts are found near blood vessels that supply blood to the liver, so if you’re diagnosed with Klatskin tumors, metastases into the liver is not uncommon.

The majority of tumors are perihilar involving the hepatic bifurcation. Bile duct cancer accounts for 3% of gastrointestinal malignancies yearly or 5,000 new cases a year.

Risk Factors

  • Primary Sclerosing Cholangitis (PSC)
  • Choledochal Cysts
  • Pyogenic Cholangiohepatitis
  • Biliary Parasites (Clonorchis sinensis)
  • Hepatolithiasis
  • Idiopathic

Clinical Presentation

  • Abdominal pain
  • Jaundice
  • Anorexia
  • Weight loss

Histopathology (adenocarcinoma)

  • Sclerosing
  • Nodular
  • Papillary

Preoperative Staging

  • Type 1- Below hepatic bifurcation
  • Type 2- At Hepatic bifurcation
  • Type 3- Extends up the right hepatic duct
  • Type 4- Extends up the left hepatic duct

Diagnosis for Klatskin Tumors

Diagnosing Klatskin cancer can be hard, and you may need to have some tests done including:

  • Blood Tests: With Klatskin tumors, the cancerous cells may release certain chemicals known as tumor markers that can be detected using blood tests. But, since tumor markers can be caused by other conditions, this test isn’t enough to positively diagnose Klatskin cancer.
  • Scans: There are several scans that can be used to detect Klatskin cancer by examining the bile and checking for lumps and other abnormalities. These include ultrasound scans, CT scans and MRI scans.

Stages of Klatskin Cancer

If you’re diagnosed with Klatskin cancer, it is possible to stage your cancer. We usually use a system called the TNM system to determine the stage of cancer.

  • T (tumor) describes the size of the tumor
  • N (node) describes whether cancer has spread to nearby lymph nodes
  • M (metastases) describes whether cancer has spread to nearby body parts

Knowing the stage of your cancer will help us decide on the best type of treatment for your condition.

Treatment for Klatskin Tumors

Klatskin tumor treatment is usually aimed at controlling the symptoms of cancer for as long as possible. But, if it’s caught early enough, there is a good chance that it can be cured completely.

The main types of treatments for Klatskin tumors are:

  • Surgery to remove the tumor
  • Stent insertion to widen and unblock the bile duct
  • Chemotherapy to kill cancer cells
  • Radiotherapy to destroy cancer cells

If bile duct cancer is found in the early stages, a cure is possible by removing the affected portion of the bile duct, gallbladder and some of the pancreas and liver. A cure is unlikely in late-stage cancer, but stent insertion, chemotherapy, radiotherapy and surgery may be used to relieve symptoms.


Surgery is often the best way to completely cure Klatskin cancer. Depending on the location of the cancer, it may be necessary to remove:

  • The affected portion of the bile duct
  • The gallbladder
  • Part of the liver
  • Part of the pancreas
  • Nearby lymph nodes

Surgery may be carried out through a single large cut in your abdomen or using specialized surgical tools inserted through tiny keyhole incisions. It is possible to live a normal life after surgery even without a gallbladder because you don’t need it. Your pancreas and liver will still work even if portions of them have been removed as well. Overall, about 50% of people who have surgery for Klatskin cancer live more than five years after their operation.

Stent Insertion

If the bile duct becomes blocked due to cancer, a stent can be inserted to unblock it. This will help reduce symptoms such as jaundice, itchy skin and abdominal pain. The stent helps widen the bile duct and keep it open. It is usually inserted using a long, flexible tube (endoscope) down your throat or through laparoscopic (minimally invasive) surgery.


Chemotherapy is mainly used to relieve the symptoms associated with Klatskin cancer and prolong life. It is used when surgery isn’t possible, provided you’re in good enough general health to have chemotherapy. Medication is administered through a drip into a vein in your arm.


Just like chemotherapy, radiotherapy is used to relieve the symptoms of Klatskin cancer, slow the progression of the disease and increase your quality of life. It is usually given using a machine that aims a beam of electromagnetic radiation at the affected regions in the bile duct.

Contact Our Klatskin Tumor Specialists Today

Overall, Klatskin cancer is a very serious disease. With a poor Klatskin tumor prognosis, it is essential that you entrust your care to the most qualified physician to help you get the best chance for recovery. With over 20 years of practice and having dealt with the most complex liver diseases, Dr. Fraiman and his multidisciplinary team can help you determine your next steps. Here at St. Joseph’s Medical Center, you can be assured that you’ll be in the best hands and that your treatment, health and recovery will be given priority.

Dr. Mark Fraiman discusses the surgical treatment of Klatskin Tumors or Bile Duct Cancer in Baltimore, MD.