Biomarkers and their Role in the Diagnosis and Treatment of Cholangiocarcinoma (CCA)

February 18, 2024

What is CCA?

Cholangiocarcinoma (CCA) is a cancer that starts in the biliary tract. The biliary tract includes the liver, gallbladder and bile ducts and is branched like a tree. There are different types of CCA, named according to the location of the cancer. The most common of these types is intrahepatic (iCCA – meaning that it occurs in the parts of the bile ducts within the liver).

What are biomarkers?

A biomarker is a biological molecule found in tissue, blood, or bodily fluids that can help with diagnosis and treatment.

Why are biomarkers so important with regard to CCA?

At the moment, CCA (and iCCA) is nearly always only diagnosed when the cancer is very serious (advanced-stage cancer). This means that it is already difficult to treat. Very few people (only 1 in 20 people – 5%) diagnosed with CCA survive to 5 years after diagnosis. Earlier diagnosis of CCA could really help improve survival. Discovering iCCA biomarkers and developing biomarker tests could help towards early diagnosis and, thus, much better outcomes. 

Also, because CCA has many different types, causes, and processes, this makes for a special challenge in developing general CCA treatments. Understanding CCA biomarkers will help to customise treatment for better outcomes.   

Which biomarkers are of interest from a CCA perspective?

The authors report in detail on about 20 biomarkers relevant to iCCA, with helpful tables that organise the information. They also list iCCA clinical drug studies that target biomarker signs.

  • Diagnosis biomarkers

The paper reports that although for the moment, researchers have not yet identified any biomarkers that can confidently be used for early CCA detection/diagnosis, there is ongoing research into biomarkers that could be used to help diagnose the condition. Current biomarker tests can be used together with assessments such as liver scans to help determine the cancer type.

  • Biomarkers that help with choosing the best treatment

Biomarker tests can find out whether iCCA is an “inflammation” or “proliferation” subtype, which then guides choices on surgery and drug treatment. There are also several drug studies aiming to provide further information on this.

  • Biomarkers that lead to better treatment options

As biomarker testing technology improves, this will not only help diagnosis and treatment planning but also treatment possibilities. When scientists learn more about biomarkers, they also learn about cancer biology, cancer genetics, and the body’s responses to cancer. This, in turn, can help the development of new treatments.


Capuozzo, M., Santorsola, M., Ferrara, F., Cinque, C., Farace, S., Patrone, R., … & Ottaiano, A. (2024). Intrahepatic cholangiocarcinoma biomarkers: Towards early detection and personalised pharmacological treatments. Molecular and Cellular Probes, 73, 101951.

Sarhadi, V. K., & Armengol, G. (2022). Molecular biomarkers in cancer. Biomolecules, 12(8), 1021.

Aronson, J. K., & Ferner, R. E. (2017). Biomarkers—a general review. Current protocols in pharmacology, 76(1), 9-23.

Fiona Beck

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