Staging Cholangiocarcinoma

The stage of a cancer is a term used to describe its size and whether it has spread beyond its original site. Knowing the stage of a cancer helps doctors to decide on the most appropriate treatment.

Cancer can spread in the body in the blood stream or through the lymphatic system. The lymphatic system is part of the body’s defence against infection and disease. It is made up of a network of lymph nodes connected by fine tubes.

By examining the lymph nodes close to the biliary system the stage of the cholangiocarcinoma can be assessed.

TNM Staging for cholangiocarcinoma

TNM stands for Tumour, Node and Metastasis.

T describes the size of the primary tumour

N describes whether the cancer has spread to the lymph nodes

M describes whether the cancer has spread to a different area of the body

 

Intrahepatic bile duct cancer:

T stages of intrahepatic bile duct cancer

  • Tis – the tumour is only within the top layers of cells lining the bile duct
  • T1– there is one tumour that is contained within the bile duct, but has grown deeper into the wall of the bile duct
  • T2a – there is one tumour and it has grown through the wall of the bile duct into a nearby blood vessel
  • T2b – there is more than one tumour which may or may not have grown into a nearby blood vessel
  • T3 – the tumour has either grown into the covering of the liver (the peritoneum) or has grown into nearby structures outside the liver, such as the bowel
  • T4 – the tumour has spread into the liver by growing along the ducts

N stages of intrahepatic bile duct cancer

  • N0 – there are no cancer cells in the lymph nodes
  • N1 – there are cancer cells in the lymph nodes

M stages of intrahepatic bile duct cancer

  • M0 – there is no sign of cancer spread
  • M1 – the cancer has spread to other parts of the body away from the bile duct

Perihilar bile duct cancer:

T stages of perihilar bile duct cancer

    • Tis – the tumour is only within the top layers of cells lining the bile duct
    • T1– the tumour has grown deeper into the wall of the bile duct
    • T2a – the tumour has grown through the wall of the bile duct into the fatty tissue around it
    • T2b – the tumour has grown into the main part of the liver next to the bile duct
    • T3 – the tumour has grown into one of the main blood vessels of the liver (the portal vein or hepatic artery)
    • T4 – the tumour has grown into the right and left hepatic bile ducts. Or it has grown into more than one of the blood vessels. Or it has grown into a hepatic bile duct and more than one blood vessel

N stages of perihilar bile duct cancer

  • N0 – there are no cancer cells in the lymph nodes
  • N1 – there are cancer cells in nearby lymph nodes
  • N2 – there are cancer cells in lymph nodes further away, such as the chest

M stages of perihilar bile duct cancer

  • M0 – there is no sign of cancer spread
  • M1 – the cancer has spread to other parts of the body far away from the bile duct

Distal bile duct cancer:

T stages of distal bile duct cancer

  • Tis – the tumour is only within the top layers of cells lining the bile duct
  • T1– the tumour is entirely inside the bile duct but has grown deeper into the bile duct wall
  • T2 – the tumour has grown through the wall of the bile duct
  • T3 – the tumour has grown into the gallbladder, pancreas, small bowel or other nearby organs
  • T4 – the tumour has grown into the major blood vessel in the abdomen (the aorta) where it joins the main blood vessel of the liver (the hepatic artery)

N stages of distal bile duct cancer

  • N0 – there are no cancer cells in the lymph nodes
  • N1 – there are cancer cells in the lymph nodes

M stages of distal bile duct cancer

  • M0 – there is no sign of cancer spread
  • M1 – the cancer has spread to other parts of the body away from the bile duct

Grading
Grading refers to the appearance of the cancer cells under the microscope and gives an idea of how quickly the cancer may develop.

Low-grade means that the cancer cells look very like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly and are more likely to spread.

Cholangiocarcinoma