Bile duct carcinoma most often causes death by obstructing bile flow; relief of this obstruction extends survival. Options include passage of tubes through the tumor to maintain internal bile drainage, hepatic-enteric bypass, and percutaneous tube drainage. As experience with liver surgery has grown, the number of bile duct carcinomas that have been successfully resected has increased. Complete removal of the tumor produces more long-term survivors than other procedures, but most patients still succumb to their disease. Nevertheless, aggressive treatment to excise the lesion or bypass the biliary obstruction significantly improves quality and length of life for many patients.