Cholangiocarcinoma (CCA) is cancer of the bile duct epithelium and can arise anywhere from the periphery of the liver to the intrapancreatic segment of the common bile duct. These tumors spread along the biliary tree and directly invade adjacent portal structures. The anatomic structures involved by bile duct cancers often require complex surgical procedures to clear the resection margin and reconstruct the biliary tree. Metastatic spread to the liver and peritoneum is less frequent compared to gallbladder tumors. Involvement of cystic, hilar and celiac lymph nodes is found in 30-50% of patients at the time of diagnosis, while 30% have distant metastases. The rarity of bile duct cancers has impeded randomized clinical trials to evaluate chemotherapy and radiation options for patients with advanced or recurrent disease. The prognosis and rates of curative resection for bile duct cancer are highly dependent on the location of the tumor in the biliary tree. CCA is a rare tumor, but the incidence is increasing worldwide. PSC is an important risk factor for CCA, with poor outcomes. The mainstay of therapy is surgery, although up to 30% of the patients considered resectable may have intraoperative findings that preclude resection. Bismuth-Corlette classification and Blumgart T-staging criteria are often used to assess surgical resectability. Preoperative biliary drainage of obstructed patients are recommended with serum bilirubin levels > 15 mg/dl. Portal vein embolization is recommended when the FLR is less than 25%. Portal vein resection may be performed in select cases. OLT is currently not considered a standard option for CCA. Metallic stents provide more durable palliation than plastic stents. PDT is a very useful option in the palliative setting.