Hepatobiliary and pancreatic cancers can cause malignant biliary constriction of the bile ducts, a lethal complication that leads to obstruction of the bile ducts, cholangitis, sepsis, and death. Patients may present with symptoms such as painless jaundice, dark or amber urine, light colored stools, and weight loss. These patients often have locally advanced disease at presentation, and surgical intervention is often not possible. Biliary stents or percutaneous transhepatic drains are often the treatment intervention to relieve biliary obstruction. This is a perspective educational paper providing an in-depth discussion on management strategies, care of the patient by oncology health providers, and important education for the patient and family.