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Cholangiocarcinoma is a malignancy of the bile ducts. Globally, CCA is the second most common primary hepatic malignancy. These tumors usually progress insidiously, are difficult to diagnose, and have poor prognosis. Unfortunately, treatment options are discouraging. Data on the natural history of CCA in coastal Andhra Pradesh is limited. Our aim is to report the natural history of CCA in this region.