Stages of bile duct cancer

What staging is

Staging is a system doctors and researchers use to group cancers according to the size of the tumour and whether there is spread to lymph nodes or other body tissues. Through experience and research, doctors have found which treatments work best for each stage.

There are different staging systems. The commonest are:

• Number staging  – putting the cancer into groups, usually numbered between 1 and 4
• TNM staging – this stands for Tumour, Node (lymph nodes) and Metastasis (cancer spread)

What TNM means

Tumour – the T in TNM staging gives you the size of the cancer and how far it’s grown into nearby body tissues.

Lymph nodes – the N in TNM staging tells you whether there is cancer in lymph nodes or not.

Lymph nodes are important in cancer staging and treatment. They are the glands that you can sometimes feel under your arms and in your groin. There is a network of lymph nodes throughout the body. If cancer cells get into the lymph nodes, they can travel through this network and help the cancer to spread.

Metastasis – the M in TNM staging tells you whether the cancer has spread to another part of the body or body organ. Metastasis is the medical name for cancer spread.

In practice, the treatment for bile duct cancer is usually dictated by whether the cancer can be completely removed or not. This depends on how far it’s grown. Cancer that has spread into blood vessels, lymph nodes or other body organs can’t usually be completely removed.

Where the cancer started

In bile duct cancer, staging varies depending on where the cancer is – whether it is intrahepatic, perihilar (also called hilar) or distal extrahepatic bile duct cancer. Our information on types of bile duct cancer explains what these terms mean. Ask your doctor or specialist nurse if you’re not sure which one you have.

There is information below on:

• Intrahepatic bile duct cancer stages
• Perihilar (or hilar) extrahepatic bile duct cancer stages
• Distal extrahepatic bile duct cancer stages

Grade

You may also hear your doctor talk about the ‘grade’ of your cancer. This means what the cancer cells look like under a microscope. The lower the grade, the more normal looking the cancer cells are. Grade gives your doctor some idea of how quickly or slowly the cancer is likely to grow. Low grade cancers tend to grow more slowly and higher grade cancers more quickly.

Stages of perihilar bile duct cancer

Perihilar bile duct cancer means the cancer is in bile ducts just outside the liver. As well as the number and TNM staging systems, there is another called Bismuth-Corlette staging.

There are 4 number stages. In brackets, you’ll find the equivalent in TNM staging. So if you see that written in your notes you can check what number stage that is.

Number stages

Stage 1
The cancer is completely within the bile duct, with no spread into blood vessels or other body tissues (T1, N0, M0 in the TNM staging system)

Stage 2
There is no cancer in lymph nodes or other body organs, but the cancer has grown through the wall of the bile duct and into:

• surrounding tissues (T2a, N0, M0 in the TNM staging system) OR
• into the liver (T2b, N0, M0 in the TNM staging system)

Stage 3
This means the cancer has spread into nearby blood vessels or lymph nodes. There are 3 subgroups:

• Stage 3A – there is cancer in main blood vessels to the left or right of the cancer (T3, N0, M0 in the TNM staging system)
• Stage 3B – there is cancer in main blood vessels on both sides of the cancer (T4, N0, M0 in the TNM staging system)
• Stage 3C – there is cancer in up to 3 nearby lymph nodes (any T, N1, M0 in the TNM staging system)

Stage 4
This means the cancer has either spread to:

• 4 or more lymph nodes (4A or any T, N1, M0 in the TNM staging system) or
• to other body organs (4B) or any T, N0 or 1, M1 in the TNM staging system)

Bismuth-Corlette staging system

This is another staging system that is specifically for patients with perihilar bile duct cancer that you may hear about. This is called the Bismuth-Corlette staging system. It groups perihilar cancers according to exactly where the cancer is in the ducts. This system helps your surgeon plan an operation. Unlike the other staging systems, it doesn’t give them any indication about how your cancer may develop in the future.

Type 1 – the cancer is only in the common bile duct
Type 2 – the cancer has grown up to where the common bile duct divides into the right and left hepatic ducts
Type 3 – the cancer has grown into either the right (type 3A) or left (3B) hepatic ducts
Type 4 – the cancer has grown into both right and left hepatic ducts

Stages of distal bile duct cancer

Distal bile duct cancer means the cancer is in bile ducts outside the liver. The affected bile ducts are further from the liver and nearer to the bowel.

There are 4 number stages. In brackets, you’ll find the equivalent in TNM staging. So if you see that written in your notes you can check what number stage that is.

Stage 1
This means the cancer is completely within the bile ducts and has grown less than 5mm into bile duct wall (T1, N0, M0 in the TNM staging system)

Stage 2
The cancer has either grown further into the bile duct wall or there is cancer in nearby lymph nodes. There are 2 subgroups. Stage 2A means:

• the cancer is less than 5mm into the duct wall but there is cancer in up to 3 lymph nodes (T1, N1, M0) in the TNM staging system) OR
• the cancer has grown between 5mm and 12mm into the bile duct wall and there is no cancer in lymph nodes (T2, N0, M0 in the TNM staging system)

Stage 2B means:

• the cancer has grown between 5mm and 12mm into the bile duct wall and there is cancer in up to 3 lymph nodes (T2, N1, M0 in the TNM staging system)
• the cancer has grown further than 12mm into the bile duct wall and there may be cancer in up to 3 lymph nodes (T3, N0 or 1 depending on whether there is cancer in any lymph nodes, M0 in the TNM staging system)

Stage 3
This means there are cancer cells in lymph nodes or the cancer has grown into nearby blood vessels. There are 2 subgroups:

• 3A means the cancer has spread to 4 or more lymph nodes (any T, N2, M0 in the TNM staging system)
• 3B means the cancer has grown into nearby blood vessels (any T, N0, 1 or 2 depending on whether there is cancer in lymph nodes, M0 in the TNM staging system)

Stage 4
This means the cancer has spread to other body organs (This is any T, any N, M1 in the TNM staging system).