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