SEOM‑GEMCAD‑TTD clinical guidelines for biliary tract cancer - 2025

Sep 23, 2026

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Biliary tract cancers (BTC) are aggressive and often fatal. Early recognition of symptoms and proper diagnostic work up enables precise histopathological and molecular classification, as well as accurate assessment of disease extent. Surgery is the only potentially curative option in localized stages, yet recurrence is common and adjuvant chemotherapy can improve survival. For unresectable locally advanced and metastatic disease, upfront systemic chemotherapy combined with immunotherapy is the preferred treatment. Advances in molecular biology have yielded new therapeutic targets with promising results.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Incidence and epidemiology

Biliary tract cancer subtypes and age distribution

Trends, rates, and factors affecting reported incidence

Etiology and risk factors across regions

Methodology

Systematic review basis and expert consensus

Clinical and Translational Oncology (2025) 27:3293–3306 [https://doi.org/10.1007/s12094-025-03916-y](https://doi.org/10.1007/s12094-025-03916-y) SEOM‑GEMCAD‑TTD clinical guidelines for biliary tract cancer (2025) Teresa Macarulla1 · Jorge Adeva2 · Maria Teresa Cano Osuna3 · Ana Ruiz Casado4 · Ana María Jiménez Gordo5 · Angela Lamarca6 · Ana María López Muñoz7 · Roberto Antonio Pazo Cid8 · Tamara Saurí9 · Javier Gallego Plazas10 Received: 17 March 2025 / Accepted: 18 March 2025 / Published online: 30 May 2025 © The Author(s) 2025 Abstract Biliary tract cancers (BTC) are aggressive and fatal. Early recognition of symptoms and proper diagnostic work up allow for precise histopathological and molecular classification as well as accurate evaluation of the extent of disease. Surgery is the only potentially curative therapy in localized stages; however, disease recurrence is common and adjuvant chemotherapy appears to improve survival. Upfront systemic chemotherapy with immunotherapy is the treatment of choice in unresectable locally-advanced and metastatic disease. Inroads made in understanding its molecular biology has enabled new therapeutic targets to be identified with current indications and encouraging results that could further improve BTC patients’ survival and quality of life. Keywords Biliary tract cancer · Cholangiocarcinoma · Diagnosis · Treatment · Precision medicine Incidence and epidemiology Cholangiocarcinoma (CCA) that includes intrahepatic cholangiocarcinoma (iCCA), perihiliar cholangiocarcinoma (pCCA) and extrahepatic cholangiocarcinoma (eCCA), gallbladder cancer (GBC), and ampullary cancer (AoVC) constitute the group of malignancies known as biliary tract cancer (BTC) . They account for 1% of all cancers, 3% of gastrointestinal cancers, and typically occur between 65 and 84 years of age. Incidence is higher among males than females except for GBC [1] . * Teresa Macarulla[tmacarulla@vhio.net](tmacarulla@vhio.net) * Javier Gallego Plazas[j.gallegoplazas@gmail.com](j.gallegoplazas@gmail.com) Jorge Adeva [drcofi@hotmail.com](drcofi@hotmail.com) Maria Teresa Cano Osuna[maytecano79@gmail.com](maytecano79@gmail.com)[ ](maytecano79@gmail.com)Ana Ruiz Casado [arcasado@salud.madrid.org](arcasado@salud.madrid.org)[ ](arcasado@salud.madrid.org)Ana María Jiménez Gordo [anajgordo@hotmail.com](anajgordo@hotmail.com) Angela Lamarca [angela.lamarca@quironsalud.es](angela.lamarca@quironsalud.es)[ ](angela.lamarca@quironsalud.es)Ana María López Muñoz [alopezmu@saludcastillayleon.es](alopezmu@saludcastillayleon.es)[ ](alopezmu@saludcastillayleon.es)Roberto Antonio Pazo Cid [rapazocid@hotmail.com](rapazocid@hotmail.com) Tamara Saurí [sauri@clinic.cat](sauri@clinic.cat) 1 Medical Oncology Department, Hospital Universitario Vall D’Hebron, Barcelona, Spain 2 Medical Oncology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain 3 Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain 4 Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain 5 Medical Oncology Department, Hospital Universitario Infanta Sofía, Madrid, Spain 6 Medical Oncology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain 7 Medical Oncology Department, Hospital Universitario de Burgos, Burgos, Spain 8 Medical Oncology Department, Hospital Universitario Miguel Servet, Saragossa, Spain 9 Medical Oncology Department, Hospital Clínic, Barcelona, Spain 10 Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain Epidemiologic research of BTC is limited by the fact that they involve distinct locations and are known to be underreported and misclassified in cancer registries. Challenges in registering them hinder their true incidence to be estimated. The highest age-standardized incidence rate (ASIR) of BTC was reported in Chile (14.3/100,000 inhabitants and year) and the lowest in Vietnam [1]

FAQs

Why is early recognition and accurate diagnosis important in biliary tract cancer?

Early symptom recognition and appropriate diagnostic work up enable precise histopathological and molecular classification and a more accurate evaluation of disease extent.

What treatment offers potential cure for localized biliary tract cancer?

Surgery is the only potentially curative therapy for patients with localized disease.

How is treatment approached for unresectable locally advanced or metastatic biliary tract cancer?

Upfront systemic chemotherapy with immunotherapy is recommended as the treatment of choice.

Sep 23, 2026

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