Bile duct cancer, although not among the common tumors, still accounts for more than 4,000 deaths a year in the United States. Clinicians caring for these patients are faced with difficulties in diagnosis, even with the best of modern imaging techniques, and if the tumor is not resectable (as is true for about 75 percent of all patients), the mean survival time is only a few months. Endoscopic diagnostic and therapeutic techniques have improved markedly. As with other malignant tumors, biliary cancer is best managed by a multidisciplinary team approach.