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; 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 |
