Staging
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Percy, thanks for your comments.
This recent paper contains a very detailed, technical discussion of various staging systems:
Clinical diagnosis and staging of cholangiocarcinoma
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3331791/#S6titleHi,
The stage (TNM) has both pTNM=pathologic( pT1N1MX in your case) and cTNM= clinical classification.
And as you may understand that two classifications may be different upon surgical results returned and clinical presentation.
Currently AJCC staging Manual,7th edition(2010) is the one that American physicians used.Personally ,I do not think the p-staging is as important as the c-staging classification. In this sense, your surgeon’comment after the resection was more important than the pTNM staging itself.
Anyway, based on the messages you wrote on this board; your wife might have ECCA .”” according to your description,spread to the liver and one hilar lymph node”. And resection was performed with the right lobe completely removed along with some bile ducts and part of the left lobe and the affected lymph node. If this is correct, then your wife will have a better chance not to have recurrence than ICCA.But it will be still in the 50% as compare to 75% for ICCA.
If you worry about the MX staging; ask the oncologist to order a PET scan and you will know the results.(but please remember PET is not 100% proof of the findings that some one has cancer ;it can be other problems as well)
I rotate my q3-4month scan between PET and Ct scan to get a better picture of my disease condition.
chemoradiation treatment after adjuvant chemotherapy is acceptable. I only had Gemzar after the first surgery and Xeloda after the 2nd resection. No radiation was provided.
The question you should seriously considerNOW is what should you do after the chemoradiation? Follow the doctors recommendations of Ct scan every 3-6month and then after a year or two, change to every year and hope the cancer will not return; or be more progressive in the anticipation of the return of the cancer and refine your thinking and research toward prevention or delay such outcome.
I am happy that you devote so much energy to take care of your wife and she is very lucky to have you at her side. You and Eli are the few men that is details oriented and precise in your pursuit of information and knowledge and in so doing directly and indirectly contribute to this board substantially.
God bless.Oh Oh! I went back and looked at PCL1029’s comments about ICC which are,
“The staging (TNM) for ICC are Stage 0,I,II,III,IVA and stage IVB.”
The foundation’s discussion on staging, linked in previous post, shows,
The staging (TNM) for ICC are Stage I,II,IIIA,IIIB,IIIC and stage IV.
So now I’m really confused.
Bruce
Thanks Eli.
The main point of my original post was that the foundation’s discussion of staging, which is at http://www.cholangiocarcinoma.org/staging.htm , should be revised to include the earlier staging system (AJCC 6th edition) since posts (2006 through 2009)on the discussion boards include staging comments which were made while that system was in effect. I think this is still good, regardless of the Stage IIB comments.
Another thing, my wife’s pathology report states the findings are consistent with intrahepatic cholangiocarcinoma and shows pT1N1MX but did not provide a stage. I understand the T1 (single 6.4 cm mass forming tumor totally contained in liver and not involving blood vessels) and N1 (spread to a hilar node), but MX means the tumor cannot be accessed. Does that mean they don’t know if the tumor has metasized to another part of the body? Does it mean the liver is not counted as another part of the body for ICC? I can understand how they can determine M1, but can they really determine M0 without a full body scan or something like that?
In any case it appears my wife’s stage is either Stage IIIC or Stage IV.
Bruce
Just realized something:
The current staging system (AJCC 7th edition) was published in 2010.
Prior to 7th edition, intrahepatic CC didn’t have its own staging system. It was staged the same way as liver cancer (hepatocellular carcinoma = HCC).
2009 diagnosis of ICC must have used HCC staging.
But…
HCC doesn’t have stage IIB either. It has stages I, II, IIIa, IIIb, IIIc, IVa and IVb.
Hi Bruce,
The article that you linked talks about stages of bile duct cancer in general. It doesn’t make the distinction between intrahepatic, perihilar and extrahepatic CC. This is not quite accurate.
Each sub-type of CC has its own staging system. You can find the staging systems in the NCCN Guidelines. Stage IIB is a valid stage for ECC, but not for ICC.
Hope this helps,
EliI been reviewing old messages to build a cc database based on the experience posted by foundation subscribers. The stage IIB reference was from a 5/12/12 post by PCL1029, Subject; Re: Help! Post Recent Liver Resection – Benefits of Chemo?? It was,
“May 2009 diagnosis= intrahepatic CC stage IIB”
The following article listed this as an appropriate stage for Bile Duct Cancer, so I assumed it was correct.
Bruce Baird
Hi,
The staging (TNM) for ICC are Stage 0,I,II,III,IVA and stage IVB.The staging(TNM) for perihilar CCA are stage0,I,II,IIIA,IIIB,IVA, and IVB.
The stageing(TNM) for distal CCA are stage0,IA,IB,IIA,IIB,III, and IV.
from uptodate.com 9/14/2012 literature review and Eli is right that they can change frequently ,and there are new staging system proposed by the ASIA medical group and the Barcelona system of Spain.
I never ask oncologist what stage I was . My surgeon told me the stage which was different than before my second resection.
God bless.Bruce,
The post that you found could have been in error. Another possibility, Stage IIB referred to an older, outdated staging system. Staging systems went through many updates.
You can find the current staging systems for ICC and ECC in the NCCN Guidelines. ICC system is on slide 27 (labelled ST-3). There is no Stage IIB.
Stage II is T2 N0 M0. Stage III is T3 N0 M0. There is nothing in between.
The foundation’s discussion on Cholangiocarcinoma discusses the TNM system of staging where the staging description is different for intrahepatic and extrahepatic cholangiocarcinoma. On some of the discussion boards, it appears the same staging system is used for both intrahepatic and extrahepatic cholangiocarcinoma. For example I found a staging of intrahepatic cholagioncarcinoma of Stage IIB for a cancer diagnosed in May 2009 and this description is not included in the TNM system for ICC. Perhaps the foundation’s discussion on staging should include this other staging system also.
Bruce Baird
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