After a thorough diagnosis has confirmed the presence of bile duct cancer, choosing the best bile duct cancer treatment option will mainly depend on the following factors: the location of the tumor and extent of spreading, overall health, potential side-effects that may arise from treatment, and lastly, whether or not the cancer is resectable, or removable by surgery. Once all of the staging has been complete, only then will both specialist and patient be able to weigh the best options. As with all rare cancers, research and getting second (or even third) opinions will help in selecting the best bile duct cancer treatment. 

Out of all bile duct cancer treatment options, surgery is the most common, as it provides the highest chance of completely removing a cancer. For procedures performed on resectable cancers- most stage 0, I, II, and some stage III bile duct cancers are considered resectable- a part, or several different parts, of the biliary system are subject to removal, including the bile duct, the liver, gallbladder, the nearby lymph nodes, pancreas, and small intestine. To ensure that such operations are as safe and effective as possible, surgeons will often perform a laparoscopy before surgery, during which a laparascope- a tube with both a light and video camera attached- is inserted through a small incision on the side of the body and to the bile duct, providing much needed views of internal organs and cancer spreading. A liver transplant is also an option for certain bile duct cancer patients.

Radiation therapy as well as chemotherapy are additional forms of bile duct cancer treatment. Radiation therapy is that which typically include either external beam radiation (including 3-D conformal radiation therapy) or internal beam radiation. Chemotherapy, on the other hand, usually involves the placement of a catheter into the hepatic artery of the biliary system, which is the vessel responsible for supplying blood to the majority of tumors in the bile duct. This procedure is known specifically as hepative artery infusion. Although these two forms of treatment may be done as the sole modes of care, they may also be used in conjunction with each other. Radiation therapy and chemotherapy  may also be combined with surgery in many cases. If either one of these bile duct cancer treatment methods is used before surgery, the term applied is neoadjuvant; neoadjuvant radiation and neoadjuvant chemotherapy usually aim at shrinking a cancer mass to facilitate surgery. If used after surgery, on the other hand, the term applied is adjuvant; adjuvant chemotherapy and adjuvant radiation are typically applied to assure that no cancerous cells in the bile duct remain after a surgery.

Even if a cancer is not likely to be cured through surgery and other bile duct cancer treatment methods, there are many procedures which can alleviate symptoms, and improve a patient's overall quality and comfort of life drastically. This is termed palliative therapy, and the procedures available in this bile duct cancer treatment area include: the insertion of a biliary stent or biliary catheter; biliary bypasses to remove a tumor block of the bile duct; alcohol injection into nerves; tumor ablation (by heating or freezing); and strong pain-relief medications, among many others.