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Bile Duct Cancer

The American Joint Committee on Cancer (AJCC) TNM system for bile duct cancer

There are 3 different staging systems for bile duct cancers, depending on their location:

  1. Intrahepatic bile duct cancers (those starting within the liver)

  2. Extrahepatic bile duct cancers - perihilar tumors

  3. Extrahepatic bile duct cancers - distal tumors


Intrahepatic bile duct cancer

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 growing in 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.

T1

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

A single tumor that has grown through the wall of the bile duct and into a blood vessel.

T2b

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, or lymph nodes around the portal vein.

T4

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

N categories

NX

Regional (nearby) 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.



Intrahepatic bile duct cancer

Stage grouping

Stage 0

(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).

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 lymph nodes or distant sites.

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 (N0) spread to nearby lymph nodes or distant sites.

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, OR the cancer has spread to nearby lymph nodes. It has not spread to distant sites.

Stage IVB

(Any T, any N, M1)

The cancer has spread to distant sites (M1).



Extrahepatic bile duct cancer of the perihilar bile ducts

T categories for perihilar bile duct cancer

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 growing in 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.

T1

The cancer has grown into deeper layers of the bile duct wall, such as the muscle layer or the fibrous tissue layer.

T2

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

T2a

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

T2b

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

T3

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).

T4

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 for perihilar bile duct cancer

NX

Regional (nearby) lymph nodes cannot be assessed.

N0

The cancer has not spread to nearby lymph nodes.

N1

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.

N2

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

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 for Extrahepatic bile duct cancer of the perihilar bile ducts

Stage 0

(Tis, N0, M0)

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

Stage I

(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.

Stage II

(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.

Stage III

Split into 2 substages

Stage IIIA

(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.

Stage IIIB

(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).

Stage IV

Split into 2 substages

Stage IVA

(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.

Stage IVB

(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).


Distal extrahepatic bile duct cancer

T categories for distal extrahepatic bile duct cancer

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 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.

T1

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

T2

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

T3

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).

T4

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 for distal extrahepatic bile duct cancer

NX

Regional (nearby) 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 for distal extrahepatic bile duct cancer

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 for distal extrahepatic bile duct cancer

Stage 0

(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).

Stage IA

(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.

Stage IB

(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).

Stage IIA

(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).

Stage IIB

(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.

Stage III

(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.

Stage IV

(Any T, any N, M1)

The cancer has spread to distant sites (M1).