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 |
Tables
- Table. Gallbladder cancer staging
- Table. Histologic grading
- Table. Anatomic stage/prognostic groups
- Table. Intrahepatic bile duct tumor staging
- Table. Histologic grading
- Table. Anatomic stage/prognostic groups
- Table. Perihilar bile duct tumor staging
- Table. Histologic grading
- Table. Anatomic stage/prognosis groups
- Table. Distal bile duct tumor staging
- Table. Histologic grading
- Table. Anatomic stage/prognosis groups
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 |
Histologic grading |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
G4 |
Undifferentiated |
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 |
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 |
Histologic grading |
|
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
G4 |
Undifferentiated |
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 |
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 |
Histologic grading |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
G4 |
Undifferentiated |
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 |
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 |
Histologic grading |
|
GX |
Grade cannot be assessed |
G1 |
Well differentiated |
G2 |
Moderately differentiated |
G3 |
Poorly differentiated |
G4 |
Undifferentiated |
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 |
