Biliary Tract Cancer Staging 

Updated: Oct 25, 2021
  • Author: Kirby Rebecca Walker, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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TNM Classification for Biliary Tract Cancers

The  tumor-node-metastasis (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, 2]

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; without involvement of serosa (visceral peritoneum) or liver extension

T2a Tumor invades into perimuscular connective tissue on peritoneal side, without serosal involvement
T2b Tumor invades into perimuscular connective tissue on hepatic side, without extension 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 two or more extrahepatic organs or structures

Regional lymph nodes (N)

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Metastasis to one to three regional lymph nodes 

N2

Metastases to four or more regional 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

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

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

IIA

T2a

N0

M0

IIB T2b 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

T1a Solitary tumor ≤ 5 cm in size, without vascular invasion

T1b

Solitary tumor > 5 cm in size, without vascular invasion

T2

Solitary tumor with intrahepatic vascular invasion or multiple tumors, with or without vascular invasion

T3

Tumor perforating the visceral peritoneum 

T4

Tumor involving local extrahepatic structures by direct invasion

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

GX Grade cannot be determined

G1

Well differentiated

G2

Moderately differentiated

G3

Poorly differentiated

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

Stage

T

N

M

0

Tis

N0

M0

IA

T1a

N0

M0

IB T1b N0 M0

II

T2

N0

M0

IIIA

T3

N0

M0

IIIB

T4

N0

M0

Any T

N1

M0

IV

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/ high grade dysplagia

T1

Tumor confined to the bile duct, with extension up to the muscle layer or fibrous tissue

T2 Tumor invades beyond the wall of the bile duct to surrounding adipose tissue, or tumor invades adjacent hepatic parenchyma

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, or the common hepatic artery; or second-order biliary radicals bilaterally; or  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

One to three positive lymph nodes involving the hilar, cystic duct, common bile duct, hepatic artery, posterior pancreatoduodenal, and portal vein lymph nodes

N2

Four or more positive lymph nodes from the sites described for N1

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

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

T4

N0

M0

IIIC Any T N1 M0

IVA

Any T

N2

M0

IVB

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

Tis

Carcinoma in situ/high-grade dysplagia

T1

Tumor invades the bile duct wall with a depth < 5 mm

T2

Tumor invades the bile duct wall with depth of 5-12 mm

T3

Tumor invades the bile duct wall with a depth > 12 mm

T4

Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery 

Regional lymph nodes (N)

NX Regional nodes cannot be assessed 

N0

No regional lymph node metastasis

N1 Metastasis in 1-3 regional lymph nodes

N2

Metastasis in 4 or more regional 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

IIB

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

Stage

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

IIA

T1

N1

M0

T2

N0

M0

IIB

T2

N1

M0

T3

N0-1

M0

IIIA

T1-3

N2

M0

IIIB T4 Any N M0

IV

Any T

Any N

M1