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Perihilar cholangiocarcinoma and the Klatskin tumour | CION Cancer Clinics
A Klatskin tumour is a cancer of the bile duct where the left and right ducts join as they leave the liver. Its usual first sign is jaundice, often without pain. This page explains where it sits, how it differs from other bile duct cancers, why the jaundice is relieved first, and what decides whether it can be removed. At CION Cancer Clinics in Hyderabad, our oncologists explain liver cancer in plain words and plan care around you and your family.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is a Klatskin tumour?
- How is perihilar cancer different from other bile duct cancers?
- What happens after a Klatskin tumour is suspected?
- What changes if the tumour can or cannot be removed?
- What do families often get wrong about this cancer?
- What can this page not tell you?
- Common questions about the Klatskin tumour
The short answer
What is a Klatskin tumour?
A Klatskin tumour is the older name for perihilar cholangiocarcinoma: a cancer of the bile duct at the point where the ducts from the left and right sides of the liver join, just as they leave the liver. It usually shows itself as jaundice, often without pain, because a small tumour at this junction can block the bile from the whole liver.
Where exactly it sits
Bile is made in the liver and drains through a tree of ducts. The small branches inside the liver join into a left duct and a right duct. These meet at the hilum, the doorway of the liver, to form the common duct that runs down to the bowel. A cancer at that meeting point is called perihilar, which simply means "around the hilum". It is the most common place for bile duct cancer to start.
Why the name matters for you
Your report may say Klatskin tumour, hilar cholangiocarcinoma or perihilar cholangiocarcinoma. They mean the same thing. It is a primary cancer of the bile duct, not cancer that spread there from another organ, and it is not gallbladder cancer, which is covered separately under gallbladder cancer.
A blocked bile duct has several causes, including stones. Jaundice alone does not mean cancer.Three places, three cancers
How is perihilar cancer different from other bile duct cancers?
Doctors divide bile duct cancer by where it starts, because the place decides the operation and the problems it causes.
Intrahepatic
Starts in the small ducts deep inside the liver. It tends to form a mass and often causes no jaundice until late. Read more on intrahepatic cholangiocarcinoma.
Perihilar (Klatskin)
Starts where the left and right ducts join. It often grows along the duct wall rather than as a lump, so it can be hard to see on a scan even when it is causing deep jaundice.
Usually looks like
- Yellow eyes and skin, often without pain
- Dark urine and pale stools
- Itching all over
- Weight loss and tiredness
Distal
Starts lower down, near the pancreas. It also causes jaundice, and the operation is closer to the one used for pancreatic cancer. See distal bile duct cancer.
Who is more at risk
Primary sclerosing cholangitis, long-standing stones in the ducts, choledochal cysts and liver fluke infection raise the risk. Many people with this cancer have none of these, and none of them is anyone's fault.
Not sure whether this applies to you?
Ask an oncologist
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When to go to hospital today
Jaundice with a fever, shivering or confusion can mean the blocked bile has become infected. This is called cholangitis and it can become dangerous within hours. Go to hospital today. The same applies to anyone with a stent or drain who develops a fever. New jaundice without fever still needs a doctor this week, not a wait-and-see.
From jaundice to a plan
What happens after a Klatskin tumour is suspected?
Scans that map the ducts
An MRI with MRCP draws the bile ducts in detail, and a CT shows the blood vessels. CION arranges these through accredited diagnostic partners. The page on MRCP, ERCP and cholangioscopy explains each test.
Planning before the stent
Ideally the scans come before any stent, because a stent can blur the picture. The surgical team should see the images before the ducts are drained, if the patient is well enough to wait.
Relieving the jaundice
A stent placed through an endoscope, or a drain through the skin, lets bile flow again. This is done by partner specialists. It often comes first, as the page on why a stent comes before treatment explains.
Confirming the cancer
Brushings or a small biopsy are taken from the narrowed duct. They do not always find cancer cells, so a negative result does not settle the question.
The tumour board decides
CION's oncologists review the scans and pathology together and decide whether an operation is possible. Tissue is sent for molecular testing.
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What changes if the tumour can or cannot be removed?
If the tumour can be removed
If it cannot be removed
A major operation removes the duct junction and part of the liver
Treatment aims to control the cancer and keep bile flowing
Portal vein embolisation may be done first, to grow the liver that stays
Chemotherapy with immunotherapy is the usual starting point
Chemotherapy is usually offered afterwards
Targeted medicine may follow if a gene change is found
Your team will tell you where the operation takes place
Stents are replaced or cleared when they block
Commonly believed
What do families often get wrong about this cancer?
"There is no pain, so it cannot be serious."
Jaundice without pain is the classic way this cancer shows itself. Pain often comes with stones, not cancer. Painless jaundice should always be checked, and the page on why painless jaundice is the warning sign explains why.
"The stent has fixed it."
A stent clears the jaundice. It does not treat the cancer. Once the bilirubin falls, the real treatment decision still has to be made.
"The biopsy was negative, so it is not cancer."
Brushings from a narrow duct often miss cancer cells. When the scans look like cancer, doctors may treat it as cancer, or repeat the sampling, rather than rely on one negative test.
"A liver transplant will solve it."
Transplant is used for this cancer only rarely, in a small group, at licensed transplant centres. Most patients are not suitable, and CION has no influence over who is listed.
Being straight with you
What can this page not tell you?
It cannot tell you whether your jaundice comes from cancer. Stones, inflammation and narrowing from old surgery can all block the bile duct at the hilum. Only scans, sampling and a specialist review can answer that. This page also cannot tell you how long anyone will live with this cancer, and no figure you read online applies to one person.
It cannot tell you whether surgery is possible
Whether a Klatskin tumour can be removed depends on how far it runs up each duct, which blood vessels it touches, and how much healthy liver would be left. That is decided by surgeons looking at your own scans. The page on surgery for perihilar cancer explains how they weigh it.
Who this does not apply to
This page is not about cancer deep inside the liver, about cancer in the lower duct near the pancreas, or about gallbladder cancer. It does not cover cancer that spread to the liver from elsewhere.
If you have been told about a narrowing at the hilum, call the helpline and ask for a tumour board review of the scans.Questions we are asked
Common questions about the Klatskin tumour
Why is it called a Klatskin tumour?
It is named after the American doctor who first described a series of these tumours in detail, last century. The modern name is perihilar cholangiocarcinoma. Both names describe the same cancer at the junction of the left and right bile ducts, just outside the liver.
Is a Klatskin tumour liver cancer?
It is a bile duct cancer that sits at the edge of the liver, so doctors often treat it within liver cancer care. It is not the same as HCC, which starts in the main liver cells, and it is not secondary cancer that has spread from another organ.
Is perihilar cholangiocarcinoma curable?
It can be curable when the whole tumour can be removed with a clear margin, which is a large operation. Many people are found when the cancer has spread along the ducts or to vessels, and then treatment aims to control it. Your team will tell you which applies after a full review.
What is the Bismuth classification on my report?
It describes how far the tumour runs up the left and right ducts, from type one, below the junction, to type four, deep into both sides. It helps surgeons plan, but it is not the same as stage, and it does not decide on its own whether surgery is possible.
Why must the jaundice come down before treatment?
A liver full of trapped bile copes badly with major surgery and with chemotherapy. Draining the bile lets the liver recover and the itching ease. It also lowers the risk of infection while the treatment plan is made.
Does this cancer need gene testing?
Yes. Bile duct cancers should have their DNA tested, because some carry changes that a targeted medicine can act on. Fewer perihilar tumours carry these changes than intrahepatic ones, and testing may find nothing, but it is worth doing.
What treatment is given if surgery is not possible?
Usually chemotherapy combined with immunotherapy, given at CION centres, with stents kept working. Radiation is sometimes added through partner hospitals. The page on treatment when it cannot be removed explains the options.
What should we bring to a second opinion?
Bring the scan discs, not just the reports, and the dates of any stent or drain. Bring biopsy or brushing reports and recent blood tests, including bilirubin. A list of current medicines, including any herbal tonics, helps the team plan safely.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- American Cancer Society — What Is Bile Duct Cancer?
- American Cancer Society — Bile Duct Cancer Surgery
- National Cancer Institute — Bile Duct Cancer Treatment
- Cancer Research UK — Symptoms of bile duct cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
How perihilar bile duct cancer is stagedWhat the stage and the Bismuth type mean togetherWhy a stent comes before any cancer treatmentThe first step most families meetSurgery for perihilar bile duct cancerWhat the operation involves and who it suitsBlocked stents, fever and when to come back urgentlyThe warning signs after a stent
Talk to us
Told there is a narrowing where the bile ducts join?
Send us the scans and reports and our tumour board will review them with you, including whether surgery should be assessed. We will explain each next step in plain words. One helpline serves every CION centre.