Little known warning signs of bile duct cancer after death of Game of Thrones star Ian Gelder

Game of Thrones star Ian Gelder has died age 74 following a five-month battle with cancer.

Ian – best known for playing Kevan Lannister in the mythical series – was diagnosed with bile duct cancer in December.

In England, around 2,800 people are struck down with bile duct cancer every year, according to Cancer Research UK. In the US about 8,000 people are diagnosed a year.

The number of people being diagnosed with bile duct cancer has increased in the last few years, with research suggesting smoking and drinking alcohol might be to blame.

The bile ducts are part of your digestive system and carry a substance of the same name, which is the fluid that helps to digest food by breaking down fat.

They connect the liver, where the bile is made, and gallbladder, where it is stored, to the small bowel.

Although bile duct cancer, or cholangiocarcinoma, rarely causes symptoms in the early stages, there are signs to watch out for…

Yellowing of the skin

Jaundice is when the skin and the whites of your eyes turn yellow. It can also cause your urine to be darker than normal and your bowel movements to be lighter.

It can happen if a tumour blocks the bile duct, stopping the flow of bile into the bowel. As such, it ends up in your bloodstream and body tissues instead. 

The yellowing is caused by the yellow pigments in the bile, Cancer Research UK explains. 

Jaundice can also cause a high temperature and make you feel cold and shivery. 

Weight loss

You may lose weight when you have bile duct cancer, typically because it can rob you of your appetite.

But unexplained weight loss is also a symptoms of the disease, Cancer Research UK says.  

That’s because some people lose weight even when they are eating normally. 

This is called cachexia, where your body doesn’t absorb all the fat, protein and carbohydrate from your food and burns calories faster than normal. 

Scientists say cancer releases chemicals into the blood that contribute to the fat and muscle loss. 

Doctors define unintentional weight loss as losing more than 10 per cent of your body weight. That is one stone for every 10 stones that you weigh or 6kg for every 60kg, the charity explains. 

Pain in your abdomen

A pain in your tummy is a common warning sign of bile duct cancer. 

It can cause pain specifically in your right hand side, just below the ribs, Cancer Research UK says.  

However, pain in this location isn’t always cancer. It can also be a sign of a less serious condition, such as gallstones.  

Itchy skin

Another symptoms of jaundice is itchy skin.

Although itchy skin can be caused by a number of skin problems, its can also be a warning sign of bile duct cancer.  

It can happen when the bile ducts become blocked, which causes a build up of bile.

It is this build up of bile in the bloodstream which can cause itching, Cancer Research UK explains. 

What are the causes and risks of bile duct cancer?

There are several risk factor associated with bile duct cancer. This includes age, as people over 65 have a higher risk of developing it.

Yet the cancer is still rare, Cancer Research UK explains. 

Another risk factor is having choledochal cysts, which are sacs that connect to the bile ducts and fill up with bile.

It’s also thought people with bile duct stones could be at an increased risk as they can irritate the ducts and cause inflammation. 

But eating raw fish could also put you at a higher risk of developing the cancer, in theory.

That’s because liver flukes, which are parasitic worms that invade the bile ducts, increase the risk of bile duct cancer. Flukes are typically ingested by eating raw or undercooked fish, health officials say. 

Although not usually the cause of bile duct cancer in the UK, the charity explains that liver flukes are a bigger problems in Asia where bile duct cancer is more common. 

However, researchers still do not have clear evidence that being overweight, smoking and drinking alcohol directly increases the risk of bile duct cancer.