Bile Duct (Cholangiocarcinoma) Cancer

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Early Detection, Diagnosis, and Staging TOPICS

Staging of intrahepatic bile duct cancers

T categories

TX: No description of the tumor’s extent is possible because of incomplete information.

T0: There is no evidence of a primary tumor.

Tis: Cancer cells are only in the mucosa (the innermost layer of the bile duct) and have not grown into deeper layers of the bile duct. This stage is also known as intramucosal carcinoma and was previously called carcinoma in situ.

T1: There is a single tumor that has grown into deeper layers of the bile duct wall, but it is still only in the bile duct. The cancer has not grown into any blood vessels.

T2: Split into 2 groups:

  • T2a: There is a single tumor that has grown through the wall of the bile duct and into a blood vessel.
  • T2b: There are 2 or more tumors, which may (or may not) have grown into blood vessels.

T3: The cancer has grown into nearby structures such as the intestine, stomach, common bile duct, abdominal wall, diaphragm (the thin muscle that separates the chest from the abdomen), or lymph nodes around the portal vein.

T4: The cancer is spreading through the liver by growing along the bile ducts.

N categories

NX: Nearby (regional) lymph nodes cannot be assessed.

N0: The cancer has not spread to nearby lymph nodes.

N1: The cancer has spread to nearby lymph nodes.

M categories

M0: The cancer has not spread to tissues or organs far away from the bile duct.

M1: The cancer has spread to tissues or organs far away from the bile duct.

Stage grouping

Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping. The stage is expressed as stage 0 (the least advanced stage) or as Roman numerals up to stage IV (the most advanced stage). Some stages are subdivided with letters.

Stage 0 (Tis, N0, M0): The cancer is only growing in the innermost layer of the bile duct (Tis) and has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage I (T1, N0, M0): The cancer is a single tumor that has grown into deeper layers of the bile duct wall (T1), but it has not grown into any blood vessels. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): The cancer is either a single tumor that has grown into a blood vessel (T2a) or there are multiple tumors (T2b). The cancer has not grown into any nearby organs or structures. It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage III (T3, N0, M0): The cancer has grown into nearby structures such as the duodenum (first part of the small intestine), colon, stomach, abdominal wall, diaphragm, or lymph nodes around the portal vein (T3). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage IV: Split into 2 groups:

  • Stage IVA (T4, N0, M0) OR (Any T, N1, M0): Either the cancer is spreading through the liver by growing along the bile ducts (T4), OR the cancer has spread to nearby lymph nodes (N1). It has not spread to distant sites (M0).
  • Stage IVB (Any T, any N, M1): The cancer has spread to distant sites (M1).

Last Medical Review: 11/01/2014
Last Revised: 11/01/2014