Staging Distal Extrahepatic Cholangiocarcinoma

T Categories for Distal Extrahepatic Bile Duct Cancer

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

There is no evidence of a primary tumor.

Cancer cells are limited to the mucosa (the innermost layer of the bile duct) and have not invaded deeper layers of the bile duct. This stage is also known as intramucosal carcinoma and was previously called carcinoma in situ

The cancer has grown into deeper layers of the bile duct wall, but it is still only in the bile duct.

The cancer has grown through the bile duct wall but has not started growing into nearby structures. 

The cancer has grown into nearby structures such as the liver, gallbladder, pancreas, or duodenum (the first part of the small intestine), but it is not growing into the main blood vessels supplying the stomach and intestines (the celiac artery and the superior mesenteric artery).

The cancer has grown into one or both of the main blood vessels supplying the stomach and intestines (the celiac artery and the superior mesenteric artery).

N Categories

Regional (nearby) lymph nodes cannot be assessed.

The cancer has not spread to nearby lymph nodes.

The cancer has spread to nearby lymph nodes.

M Categories

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

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

Stage Grouping

Once a patient’s T, N, and M categories have been determined, this information is combined in a process called stage grouping. The stage is expressed in Roman numerals from stage 0 (the least advanced stage) to stage IV (the most advanced stage). Some stages are subdivided with letters.

 (Tis, N0, M0)

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

 

(T1, N0, M0)

The cancer has grown into deeper layers of the bile duct wall (T1), but it has not grown all the way through the wall. It has not spread to lymph nodes or distant sites. 

 

(T2, N0, M0)

The cancer has grown through the bile duct (T2) but has not invaded nearby organs or structures and has not spread to nearby lymph nodes (N0) or distant sites (M0).

 

(T3, N0, M0)

The cancer has grown into nearby structures such as the liver, gallbladder, pancreas, or duodenum (the first part of the small intestine), but it is not growing into the main blood vessels supplying the stomach and intestines (the celiac artery and the superior mesenteric artery) (T3). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

 

(T1 to T3; N1; M0)

The cancer may or may not have spread outside of the bile duct to nearby organs. It has spread into nearby lymph nodes (N1) but not to distant sites.

 

(T4, any N, M0)

The cancer has grown into one or both of the main blood vessels supplying the stomach and intestines (the celiac artery and the superior mesenteric artery) (T4). It may (N1) or may not (N0) have spread to nearby lymph nodes but has not spread to distant sites.

 

(Any T, any N, M1)

The cancer has spread to distant sites (M1).

 


Adapted from The American Cancer Society:  http://www.cancer.gov/