Due to its special location, hepatobiliary cholangiocarcinoma often has no specific clinical manifestations before the bile duct is completely blocked by the tumor, which is not easy to attract the attention of patients and surgeons. Early clinical symptoms are mostly non-specific symptoms such as poor appetite, loss of appetite, aversion to greasy food, indigestion and epigastric distention and discomfort, and some patients may have recurrent bile duct infections. As the lesion progresses, signs and symptoms of obstructive xanthogranuloma may appear, but the most important thing for patients to notice is progressive xanthogranuloma, skin scratching and weight loss, which are also the characteristic clinical signs of HCCA. Jaundice is the earliest and most important symptom of cholangiocarcinoma. About 90%-98% of cholangiocarcinoma patients have different degrees of yellow staining of skin and sclera. Jaundice is characterized by progressive aggravation and is mostly painless, while a few patients have fluctuating jaundice. Jaundice appears earlier in upper segment bile duct cancer, while it can appear later in middle and lower segment bile duct cancer because of the buffer of gallbladder. However, before the appearance of jaundice, patients often have non-specific symptoms of “gastric disease” such as upper abdominal fullness and discomfort, aversion to grease, loss of appetite and weight loss. “Some patients are easily misdiagnosed as “xanthogranulomatous hepatitis” even though they have symptoms of xanthogranuloma. 2.Abdominal pain About half of the patients have symptoms such as right upper abdominal pain and distension or discomfort, weight loss and loss of appetite, which are often regarded as early warning symptoms of bile duct cancer. At the beginning of abdominal pain, there is pain similar to gallstone disease and cholecystitis. According to clinical observation, abdominal pain and jaundice can appear in only 3 months after the onset of bile duct cancer. 3.Itchy skin It may appear before or after the appearance of jaundice, and may also be accompanied by other symptoms such as tachycardia, bleeding tendency, mental atrophy, weakness and fatty diarrhea, abdominal distension, etc. The itchy skin is caused by the increase of bilirubin content in blood, which stimulates the peripheral nerves of skin. 4.Other symptoms include jaundice, abdominal pain, nausea, vomiting, emaciation, dark yellow urine like soy sauce or strong tea, light yellow stool or even clay color, etc. When the tumor breaks down in late stage, there may be black stool and positive stool occult blood test, or even anemia; if there is liver metastasis, liver enlargement and liver cirrhosis may appear.