Biliary Tract Cancer Staging 

Updated: Dec 30, 2015
  • Author: Jeffrey B VanDeusen, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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TNM Classification for Biliary Tract Cancers

The TNM staging classifications for biliary tract cancers are provided below, including those for biliary tract cancer, intrahepatic bile duct tumors, perihilar bile duct tumors, and distal bile duct tumors. [1]

Gallbladder cancer staging

Table. Gallbladder cancer staging (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor invades lamina propria or muscular layer
T1a Tumor invades lamina propria
T1b Tumor invades muscular layer
T2 Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver
T3 Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts
T4 Tumor invades main portal vein or hepatic artery or invades 2 or more extrahepatic organs or structures
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein
N2 Metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

Table. Histologic grading (Open Table in a new window)

Histologic grading
GX Grade cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
IIIA T3 N0 M0
IIIB T1-3 N1 M0
IVA T4 N0-1 M0
IVB Any T N2 M0
  Any T Any N M1

Intrahepatic bile duct tumor staging

Table. Intrahepatic bile duct tumor staging (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ (intraductal tumor)
T1 Solitary tumor without vascular invasion
T2a Solitary tumor with vascular invasion
T2b Multiple tumors, with or without vascular invasion
T3 Tumor perforating the visceral peritoneum or involving the local extrahepatic structures by direct invasion
T4 Tumor with periductal invasion (the pathologic definition of periductal invasion is the finding of a longitudinal growth pattern along the intrahepatic bile ducts on both gross and microscopic examination)
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis present
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis present

Table. Histologic grading (Open Table in a new window)

Histologic grading
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Table. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
III T3 N0 M0
IVA T4 N0 M0
  Any T N1 M0
IVB Any T Any N M1

Perihilar bile duct tumor staging

Table. Perihilar bile duct tumor staging (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor confined to the bile duct, with extension up to the muscle layer or fibrous tissue
T2a Tumor invades beyond the wall of the bile duct to surrounding adipose tissue
T2b Tumor invades adjacent hepatic parenchyma
T3 Tumor invades unilateral branches of the portal vein or hepatic artery
T4 Tumor invades main portal vein or its branches bilaterally; the common hepatic artery; the second-order biliary radicals bilaterally; or the second-order biliary radicals unilaterally, with contralateral portal vein or hepatic artery involvement
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis (including nodes along the cystic duct, common bile duct, hepatic artery, and portal vein)
N2 Metastasis to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

Table. Histologic grading (Open Table in a new window)

Histologic grading
GX Grade cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Table. Anatomic stage/prognosis groups (Open Table in a new window)

Stage T N M
0 Tis N0 M0
I T1 N0 M0
II T2a-b N0 M0
IIIA T3 N0 M0
IIIB T1-3 N1 M0
IVA T4 N0-1 M0
IVB Any T N2 M0
  Any T Any N M1

Distal bile duct tumor staging

Table. Distal bile duct tumor staging (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor confined to the bile duct histologically
T2 Tumor invades beyond the wall of the bile duct
T3 Tumor invades the gallbladder, pancreas, duodenum, other adjacent organs without involvement of the celiac axis, or the superior mesenteric artery
T4 Tumor involves the celiac axis or the superior mesenteric artery
Regional lymph nodes (N)
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

Table. Histologic grading (Open Table in a new window)

Histologic grading
GX Grade cannot be assessed
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated

Table. Anatomic stage/prognosis groups (Open Table in a new window)

Stage T N M
0 Tis N0 M0
IA T1 N0 M0
IB T2 N0 M0
IIA T3 N0 M0
IIB T1 N1 M0
  T2 N1 M0
  T3 N1 M0
III T4 Any N M0
IV Any T Any N M1