Staging Perihilar 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 tissue. 

 

The tumor has grown through the wall of the bile duct and into surrounding fat.

The tumor has grown through the wall of the bile duct and into nearby liver tissue.

The cancer is growing into branches of the main blood vessels of the liver on one side (the main blood vessels of the liver are the portal vein and the hepatic artery).

 

The cancer is growing into the main blood vessels of the liver (the portal vein and or the common hepatic artery) or branches of these vessels on 2 sides, OR the cancer is growing directly into other bile ducts while part of the tumor is growing into one of the main blood vessels.

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, such as those along the cystic duct, the common bile duct, the hepatic artery, and the portal vein.

 

The cancer has spread to lymph nodes further away from the tumor, such as those around the major blood vessels of the abdomen (such as the aorta, the vena cava, the celiac artery, and the superior mesenteric artery).

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)

Cancer cells are only growing in the mucosa (the innermost layer of the bile duct) and have not grown into deeper layers of the bile duct. Cancer has not spread to nearby lymph nodes or distant sites.

 

(T1, N0, M0)

The cancer has grown into deeper layers of the bile duct wall, such as the muscle layer or the fibrous tissue layer. It has not spread to nearby lymph nodes or distant sites.

 

(T2, N0, M0)

The tumor has grown through the wall of the bile duct and into surrounding fat (T2a) or liver tissue (T2b). Cancer has not spread to nearby lymph nodes or distant sites.

 

(T3, N0, M0)

The cancer is growing into branches of the main blood vessels of the liver (the portal vein and/or the hepatic artery) on one side (T3). Cancer has not spread to nearby lymph nodes or distant sites.

 

(T1 to T3; N1; M0)

The cancer has grown into deeper layers of the bile duct wall (T1) and may have grown through the wall and into nearby fat or liver tissue (T2). The cancer may be growing into branches of the main blood vessels of the liver on one side (T3). Cancer cells are found in nearby lymph nodes (N1), but the cancer has not spread to distant sites (M0).

 

(T4, N0-1, M0)

The cancer is growing into the main blood vessels of the liver (the portal vein and or the common hepatic artery), is growing into branches of these vessels on 2 sides, or part of the cancer is growing directly into other bile ducts while another part of the tumor is growing into one of the main blood vessels (T4). The cancer may have spread to nearby lymph nodes (N0 or N1), but it has not spread to distant sites.

(any T, N2, M0) or (any T, any N, M1)

The cancer has either spread to lymph nodes away from the tumor (N2) or it has spread to distant sites (tissues or organs away from the bile duct) such as the lungs or bones (M1).


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