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PubMed This is a summary of 15 peer-reviewed journal articles Updated
Hepatobiliary Surgery

Building Your Care Team: The Power of the Multidisciplinary Approach

At a Glance

Research shows that patients with cholangiocarcinoma (CCA) have the best outcomes when treated by a multidisciplinary team at a high-volume cancer center. This team should include specialized surgeons, oncologists, and interventional radiologists working together on your care.

Because cholangiocarcinoma (CCA) is rare and biologically complex, your most important “treatment” isn’t a drug or a surgery—it is the team of experts you assemble [1][2]. Research consistently shows that patients with CCA have better outcomes when they are managed by a Multidisciplinary Team (MDT) [3]. This group of specialists works together to ensure that every angle of your health and your tumor’s biology is considered before a treatment plan is finalized [4][5].

Your Essential Care Team

A high-functioning MDT for bile duct cancer should include, at a minimum, the following experts:

  • Hepatobiliary (HPB) Surgeon: A surgical specialist who focuses exclusively on the liver, bile ducts, and pancreas [4].
  • Medical Oncologist: An expert in systemic treatments like chemotherapy, immunotherapy, and targeted therapies [6].
  • Interventional Radiologist: A doctor who uses imaging to perform minimally invasive procedures, such as placing stents to open blocked bile ducts or performing local-regional treatments directly to the tumor [7][8].
  • Hepatologist: A liver specialist who ensures your underlying liver function remains strong enough to tolerate treatment [9].
  • Pathologist: A diagnostic expert who identifies the specific “flavor” of your cancer and its molecular markers [10].

The “High-Volume” Advantage

For rare diseases like CCA, experience matters. You should seek care at a high-volume cancer center [11].

  • Lower Risk: Hospitals that perform these complex surgeries frequently have lower postoperative mortality rates and better “failure-to-rescue” scores—meaning they are better equipped to handle complications if they arise [12][13].
  • Access to Innovation: High-volume centers are more likely to have “Tumor Boards” (regular meetings where all specialists discuss cases) and offer access to the latest clinical trials and advanced molecular profiling [4][14].

Preparing for Your First Appointment

Your first visit is an opportunity to vet your team. To make the most of it, you must arrive prepared with “physical artifacts” of your diagnosis. Do not assume your records have been transferred electronically.

What to Bring:

  1. Imaging Files: Bring a CD or a digital link (DICOM format) of every CT, MRI, and PET scan you have had. The “raw” images are more useful than just the written report [7].
  2. Pathology Materials: Ask your original hospital for your physical “glass slides” or tissue blocks. Your new team’s pathologist will want to review these personally to confirm the diagnosis [10].
  3. Procedure Reports: Collect records from any ERCP or EUS procedures, especially if stents were placed.
  4. Complete Medication List: Include all supplements, as some can interfere with liver function or chemotherapy.

Empowerment Through Advocacy

You are the most important member of your own team. If a center does not have a dedicated MDT for biliary cancers, or if the surgeon only performs a few of these procedures a year, it is within your rights to seek a second opinion at a major academic medical center [3]. A coordinated, expert team is your best defense against this disease [6][15].

Common questions in this guide

Which doctors should be on my cholangiocarcinoma care team?
Your core team should include a hepatobiliary (HPB) surgeon, a medical oncologist, an interventional radiologist, a hepatologist, and a specialized pathologist. Together, they form a multidisciplinary team to address every aspect of your cancer care.
Why is it important to go to a high-volume cancer center for bile duct cancer?
High-volume centers treat more cases of this rare cancer, which is linked to lower surgical complication rates and better access to clinical trials. These hospitals also frequently hold Tumor Boards where experts review cases collaboratively.
What should I bring to my first oncology appointment?
Bring physical copies of your health records, rather than relying on electronic transfers. This includes a CD of your raw imaging files like CT or MRI scans, your original pathology glass slides, procedure reports, and a complete medication list.
What is a tumor board?
A tumor board is a regular meeting at major cancer centers where different specialists, including surgeons, oncologists, and pathologists, gather to discuss your specific imaging and pathology. This ensures all experts agree on the best treatment plan.
Should I get a second opinion for my bile duct cancer?
Yes, if your current center does not have a dedicated multidisciplinary team or sees very few cases of biliary cancer, seeking a second opinion at a major academic center is highly recommended to ensure you are receiving the best possible care.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How many patients with my specific subtype of cholangiocarcinoma do you treat each year?
  2. 2.Who are the specific members of the multidisciplinary team (MDT) that will be reviewing my case?
  3. 3.Does this center have a regular 'Tumor Board' where my imaging and pathology will be discussed by all specialists at once?
  4. 4.If my cancer is currently unresectable, what are the criteria your team uses to decide if I might become a candidate for 'conversion surgery' later?
  5. 5.Do you have interventional radiologists on the team who specialize in biliary procedures?

Questions For You

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References

References (15)
  1. 1

    Dual HER2 Blockade: An Emerging Option in Metastatic Biliary Tract Cancer?

    Ricci AD, Rizzo A

    Medicina (Kaunas, Lithuania) 2021; (57(12)) doi:10.3390/medicina57121301.

    PMID: 34946246
  2. 2

    Cholangiocarcinoma 2026: status quo, unmet needs and priorities.

    Banales JM, Rodrigues PM, Affò S, et al.

    Nature reviews. Gastroenterology & hepatology 2026; (23(1)):65-96 doi:10.1038/s41575-025-01153-w.

    PMID: 41372578
  3. 3

    Opportunities and Approaches to Optimising Advanced Cholangiocarcinoma Outcomes in the Era of Targeted Therapies: A Narrative Review.

    Macarulla T, Neuzillet C, Prager GW, et al.

    Oncology and therapy 2025; (13(4)):939-962 doi:10.1007/s40487-025-00370-2.

    PMID: 41060610
  4. 4

    Setup of multidisciplinary team discussions for patients with cholangiocarcinoma: current practice and recommendations from the European Network for the Study of Cholangiocarcinoma (ENS-CCA).

    Casadio M, Cardinale V, Klümpen HJ, et al.

    ESMO open 2022; (7(1)):100377 doi:10.1016/j.esmoop.2021.100377.

    PMID: 35093741
  5. 5

    EASL Clinical Practice Guidelines on the management of extrahepatic cholangiocarcinoma.

    Journal of hepatology 2025; (83(1)):211-238 doi:10.1016/j.jhep.2025.03.007.

    PMID: 40348685
  6. 6

    Molecular Testing for Intrahepatic Cholangiocarcinoma: What, When, How?

    Barsch M, Dopfer EP, Schultheis AM, Quante M

    Journal of gastrointestinal cancer 2026; (57(1)):15 doi:10.1007/s12029-026-01397-y.

    PMID: 41535645
  7. 7

    Aggressive local treatment for recurrent intrahepatic cholangiocarcinoma-Stereotactic radiofrequency ablation as a valuable addition to hepatic resection.

    Braunwarth E, Schullian P, Kummann M, et al.

    PloS one 2022; (17(1)):e0261136 doi:10.1371/journal.pone.0261136.

    PMID: 34982804
  8. 8

    New Imaging Techniques.

    Chamadol N, Syms R, Laopaiboon V, et al.

    Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer 2023; (219()):109-145 doi:10.1007/978-3-031-35166-2_6.

    PMID: 37660333
  9. 9

    Hepatobiliary Cancers, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

    Benson AB, D'Angelica MI, Abbott DE, et al.

    Journal of the National Comprehensive Cancer Network : JNCCN 2021; (19(5)):541-565.

    PMID: 34030131
  10. 10

    Other Primary Epithelial Neoplasms of the Liver.

    Szeto W, Mannan R

    Advances in anatomic pathology 2025; (32(5)):338-348 doi:10.1097/PAP.0000000000000494.

    PMID: 40202295
  11. 11

    Surgery for cholangiocarcinoma.

    Cillo U, Fondevila C, Donadon M, et al.

    Liver international : official journal of the International Association for the Study of the Liver 2019; (39 Suppl 1()):143-155 doi:10.1111/liv.14089.

    PMID: 30843343
  12. 12

    Failure to Rescue After Resection of Perhilar Cholangiocarcinoma in an International Multicenter Cohort.

    Olthof PB, Bouwense SAW, Bednarsch J, et al.

    Annals of surgical oncology 2025; (32(3)):1762-1768 doi:10.1245/s10434-024-16293-7.

    PMID: 39404989
  13. 13

    Nationwide in-hospital mortality rate following rectal resection for rectal cancer according to annual hospital volume in Germany.

    Diers J, Wagner J, Baum P, et al.

    BJS open 2020; (4(2)):310-319 doi:10.1002/bjs5.50254.

    PMID: 32207577
  14. 14

    Volume-outcome relationship in anatomical and non-anatomical liver resections: a rapid systematic review.

    Campione A, Modrow J, Eckhardt H, et al.

    BMC gastroenterology 2026; (26(1)).

    PMID: 41742074
  15. 15

    Efficacy and Safety of Gemcitabine Plus Cisplatin as Potential Preoperative Chemotherapy in Locally Advanced Intrahepatic, Perihilar, and Mid-Cholangiocarcinoma: A Retrospective Cohort Study.

    Nooijen LE, Franken LC, Belkouz A, et al.

    American journal of clinical oncology 2021; (44(10)):526-532 doi:10.1097/COC.0000000000000861.

    PMID: 34469345

This page provides educational information about assembling a care team for cholangiocarcinoma. Always consult your healthcare provider for medical advice and personalized treatment recommendations.

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