Staging and grading of bile duct cancer
The stage and grade of bile duct cancer describes the cancer, whether it has spread and how quickly it may develop.
Staging of bile duct cancer
The stage of a cancer describes its size and whether it has spread from where it started.
There are different ways of staging cancers. Doctors usually use the TNM staging system and the number staging system for bile duct cancer.
TNM staging
TNM stands for tumour, node and metastases:
- T describes the size of the tumour.
- N describes whether the cancer has spread to the lymph nodes and which nodes are involved. For example, N0 means no lymph nodes are affected, while N1 means there are cancer cells in the lymph nodes.
- M describes whether the cancer has spread to another part of the body. This is called secondary or metastatic cancer. For example, M0 means the cancer has not spread to other parts of the body.
Number staging
There are 4 stages of bile duct cancer:
- Stage 1 cancer is small and only in 1 area of the bile ducts (localised cancer).
- Stage 2 or 3 cancer is larger and may have grown into part of the body close to the bile ducts. There may also be cancer cells in nearby lymph nodes (locally advanced cancer).
- Stage 4 cancer has spread to a part of the body far from the bile ducts (secondary or metastatic cancer).
Staging for bile duct cancer depends on where in the bile ducts the cancer started.
The bile ducts
We have information about staging for:
- intrahepatic bile duct cancer – (bile ducts inside the liver)
- perihilar bile duct cancer – (bile ducts just outside the liver)
- distal bile duct cancer – (bile ducts closest to the bowel).
Staging for intrahepatic bile duct cancer
Intrahepatic bile duct cancer starts in the bile ducts in the liver.
TNM staging
Tumour
T1 – there is 1 tumour in the bile duct. It has not spread into blood vessels. T1a is a tumour that is 5cm or less. T1b is a tumour that is more than 5cm.
T2 – there is 1 tumour that has grown into nearby blood vessels, or there is more than 1 tumour that may have grown into nearby blood vessels.
T3 – the tumour has grown into the tissue that covers organs such as the liver. This tissue is called the peritoneum.
T4 – the tumour has grown into nearby structures outside of the liver.
Nodes
N0 – the cancer has not spread to other parts of the body far away from the bile duct.
N1 – the cancer has spread to nearby lymph nodes.
Metastases
M0 – the cancer has not spread to other parts of the body far away from the bile duct.
M1 – the cancer has spread to other parts of the body far away from the bile duct.
Number staging
There are 4 main stages of intrahepatic bile duct cancer.
Stage 1
There is 1 tumour that has not spread into nearby blood vessels. Stage 1A is when the tumour is 5cm or less. Stage 1B is when the tumour is more than 5cm.
Stage 2
There is 1 tumour that has grown into nearby blood vessels, or there is more than 1 tumour which may have grown into blood vessels.
Stage 3
Stage 3A is when the tumour has grown into the peritoneum (the tissue that covers organs such as the liver). Stage 3B is when the tumour has grown into nearby structures outside of the liver, or it has spread to the lymph nodes. It has not spread to other parts of the body far from the liver.
Stage 4
The cancer has spread to a part of the body far from the liver, such as the lungs or bones.
Staging for perihilar bile duct cancer
Perihilar bile duct cancer starts in the bile ducts just outside the liver.
TNM staging
Tumour
- T1 – the tumour is only in the bile duct.
- T2 – a T2a tumour has grown through the bile duct wall and into nearby fatty tissue. A T2b tumour has grown through the bile duct wall and into the liver next to the bile duct.
- T3 – the tumour has grown into the main blood vessels leading to the portal vein or hepatic artery.
- T4 – the tumour has grown into 1 of the main blood vessels of the liver (the portal vein or its branches and the hepatic artery). Or it has grown into a bile duct in the liver on 1 side and a main blood vessel on the opposite side.
Nodes
- N0 – the cancer has not spread to nearby lymph nodes.
- N1 – the cancer has spread to 1 to 3 nearby lymph nodes.
- N2 – the cancer has spread to 4 or more nearby lymph nodes.
Metastases
- M0 – the cancer has not spread to parts of the body that are far away from the bile duct.
- M1 – the cancer has spread to parts of the body that are far away from the bile duct, such as the lungs.
Number staging
There are 4 main stages of perihilar bile duct cancer.
Stage 1
The tumour is only in the bile duct.
Stage 2
The tumour has grown through the bile duct wall and into nearby fatty tissue or liver tissue.
Stage 3
Stage 3A is when the tumour has grown into the main blood vessels leading to the portal vein or hepatic artery.
Stage 3B is when the tumour has grown into 1 of the main blood vessels of the liver (the portal vein or its branches or hepatic artery). Or it has grown into a bile duct in the liver on 1 side and a main blood vessel on the opposite side.
Stage 3C is when the tumour has spread into 1 to 3 nearby lymph nodes.
Stage 4
Stage 4A is when the cancer has grown into 4 or more lymph nodes.
Stage 4B is when the cancer has spread to parts of the body, such as the lungs.
Staging for distal bile duct cancer
Distal bile duct cancer starts in the bile ducts below the gallbladder.
TNM staging
Tumour
- T1 – the tumour is in the bile duct wall. It is less than 5mm deep.
- T2 – the tumour is in the bile duct wall. It is between 5 and 12mm deep.
- T3 – the tumour has grown more than 12mm into the bile duct wall.
- T4 – the tumour has grown into 1 or more of the main blood vessels nearby.
Nodes
- N0 – the cancer has not spread to nearby lymph nodes.
- N1 – the cancer has spread to 1 to 3 nearby lymph nodes.
- N2 – the cancer has spread to 4 or more nearby lymph nodes.
Metastases
- M0 – he cancer has not spread to parts of the body that are far away from the bile duct.
- M1 – the cancer has spread to parts of the body that are far away from the bile duct, such as the lungs.
Number staging
There are 4 main stages of distal bile duct cancer.
Stage 1
The tumour has grown up to 5mm into the bile duct, but is not anywhere else.
Stage 2
Stage 2A is when the tumour is less than 5mm deep but has spread into 1 to 3 nearby lymph nodes. Or the tumour is between 5 and 12mm deep but has not spread to nearby lymph nodes.
Stage 2B is when the tumour is between 5 and 12mm deep in the bile duct wall and the cancer has spread to 1 to 3 nearby lymph nodes. Or the tumour has grown more than 12mm into the bile duct wall. It may have spread to nearby lymph nodes.
Stage 3
Stage 3A is when the tumour is any size but has not grown into blood vessels. There is cancer affecting 4 or more nearby lymph nodes.
Stage 3B is when the tumour has grown into a main blood vessel nearby, and affects lymph nodes nearby.
Stage 4
The cancer has spread to organs that are far away from the bile duct, such as the lungs.
Grading of bile duct cancer
Grading gives an idea of how quickly a cancer may develop. It is based on the way cancer cells look under a microscope:
- In low-grade tumours, the cancer cells look very much like normal cells. They are usually slow-growing and are less likely to spread.
- In high-grade tumours, the cells look very abnormal. They are more likely to grow more quickly and to spread.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
Vogel, A. et al. Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. ESMO Annals of Oncology. 2022. 34,2; 127-140. Available at: pubmed.ncbi.nlm.nih.gov/36372281/ [accessed March 2023]
Lowe, R.C. et al. Clinical manifestations and diagnosis of cholangiocarcinoma. UpToDate 2023. Available at: www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-cholangiocarcinoma [subscription only, accessed March 2023]
Pemigatinib for treating relapsed or refractory advanced cholangiocarcinoma with FGFR2 fusion or rearrangement 2021. National Institute for Health and Care Excellence (NICE). Available at: www.nice.org.uk/guidance/ta722/resources/pemigatinib-for-treating-relapsed-or-refractory-advanced-cholangiocarcinoma-with-fgfr2-fusion-or-rearrangement-pdf-82611190679749 [accessed March 2023]
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