Biliary tract tumours comprise neoplasms of the gall-bladder, cystic duct, extra-hepatic bile ducts, and intra-hepatic bile ducts. Most are malignant (gall-bladder carcinoma, cholangiocarcinoma) and present late; benign lesions are rare and usually detected incidentally. Symptom patterns reflect anatomical location, growth morphology, and degree of biliary obstruction.

1. Painless obstructive jaundice
   Progressive conjugated hyper-bilirubinaemia with scleral icterus, dark urine, and acholic stools is the hallmark of hilar or distal cholangiocarcinoma and of advanced gall-bladder carcinoma. Pruritus is often intense and may precede visible icterus.
2. Right-upper-quadrain pain
   A constant dull ache or vague heaviness is typical of gall-bladder cancer; intermittent colicky pain suggests concomitant cholelithiasis or cholangiocarcinoma mimicking biliary colic.
3. Systemic features
   Fatigue, early satiety, unintentional weight loss, and low-grade night sweats reflect tumour cachexia and chronic cholestasis.
4. Recurrent cholangitis
   Intermittent fever with rigors, elevated C-reactive protein, and right-sided tenderness occur when malignant obstruction becomes super-infected, fulfilling Charcot triad.
5. Palpable gall-bladder (Courvoisier sign)
   A distended, non-tender gall-bladder may be felt below the right costal margin in distal bile-duct obstruction where the cystic duct remains patent.
6. Hepatomegaly and lobar atrophy–hypertrophy complex
   The obstructed lobe atrophies while the contralateral lobe enlarges, producing a firm, nodular liver edge and visible abdominal asymmetry.
7. Laboratory cholestasis
   Serum alkaline phosphatase and γ-glutamyl transferase are elevated in > 90 % of cases; total bilirubin climbs steadily as ductal involvement extends.
8. Advanced disease indicators
   Persistent fever, ascites, palpable left-supraclavicular node, or rapidly rising bilirubin suggests unresectable disease or distant spread.