Stages of bile duct cancer

Staging describes or classifies a cancer based on how much cancer there is in the body and where it is when first diagnosed. This is often called the extent of cancer. Information from tests is used to find out the size of the tumour, which bile ducts have cancer, whether the cancer has spread from where it first started and where the cancer has spread. Your healthcare team uses the stage to plan treatment and estimate the outcome (your prognosis).

The most common staging system for bile duct cancer is the TNM system. For bile duct cancer there are 5 stages – stage 0 followed by stages 1 to 4. Often the stages 1 to 4 are written as the Roman numerals I, II, III and IV. Generally, the higher the stage number, the more the cancer has spread. Talk to your doctor if you have questions about staging.

There are 3 different classifications to stage bile duct cancers depending on which bile duct the cancer started in – perihilar, distal extrahepatic or intrahepatic.

When describing the stage, doctors may use the words local, regional or distant. Local means that the cancer is only in the bile ducts and has not spread to other parts of the body. Regional means close to the bile ducts or around them. Distant means in a part of the body farther from the bile ducts.

Find out more about staging cancer.

The following stages are used for perihilar bile duct cancer. These ducts are just outside the liver and very close to it.

Stage 0 (carcinoma in situ) – The tumour is only in the innermost layer of the bile duct wall.

Stage 1 – The tumour has grown into deeper layers of the bile duct wall, up to the muscle layer or the fibrous tissue layer.

Stage 2 – The tumour has grown beyond the wall of the bile duct into surrounding fat or it has grown into the liver.

Stage 3A – The tumour has grown into branches of a main blood vessel (portal vein or hepatic artery) on only one side of the liver.

Stage 3B – The tumour has grown into any of the following:

• the portal vein (the blood vessel that carries blood from the digestive system to the liver) or branches of the portal vein on both sides of the liver
• the common hepatic artery (the blood vessel that carries oxygen-rich blood to the liver)
• other bile ducts on one side of the liver and a main blood vessel (portal vein or hepatic artery) on the other side of the liver

Stage 3C – The cancer has spread to 1 to 3 nearby lymph nodes.

Stage 4A – The cancer has spread to 4 or more nearby lymph nodes.

Stage 4B – The cancer has spread to other parts of the body (called distant metastasis), such as to the pancreas or small intestine. This is also called metastatic bile duct cancer.

The following stages are used for distal extrahepatic bile duct cancer. This duct is outside the liver and farther away from it.

Stage 0 (carcinoma in situ) – The tumour is only in the innermost layer of the bile duct wall.

Stage 1 – The tumour has grown into the bile duct wall by less than 5 mm deep.

Stage 2A – The tumour has grown into the bile duct wall by less than 5 mm deep. The cancer has also spread to 1 to 3 nearby lymph nodes.

Or the tumour has grown into the bile duct wall by 5 mm to 12 mm deep.

Stage 2B – The tumour has grown into the bile duct wall by 5 mm to 12 mm deep. The cancer has also spread to 1 to 3 nearby lymph nodes.

Or the tumour has grown into the bile duct wall by more than 12 mm deep.

Stage 3A – The tumour has grown into the bile duct wall by any depth. The cancer has also spread to 4 or more nearby lymph nodes.

Stage 3B – The cancer has spread into blood vessels in the abdomen such as the celiac axis, the superior mesenteric artery or the common hepatic artery. The cancer may have spread to nearby lymph nodes.

Stage 4 – The cancer has spread to other parts of the body (called distant metastasis), such as to the liver, pancreas or small intestine. This is also called metastatic bile duct cancer.

The following stages are used for intrahepatic bile duct cancer. These small ducts are within the liver.

Stage 1 – There is 1 tumour only in a bile duct. For stage 1A, the tumour is 5 cm or smaller. For stage 1B, the tumour is larger than 5 cm.

Stage 2 – There is 1 tumour that has grown into blood vessels in the liver. Or there are many tumours that may have grown into blood vessels in the liver.

Stage 3A – The tumour has poked through the membrane that covers and supports the liver (visceral peritoneum).

Stage 3B – The tumour has grown into surrounding tissues outside the liver. Or the cancer has spread to nearby lymph nodes.

Stage 4 –The cancer has spread to other parts of the body (called distant metastasis), such as to the pancreas or small intestine. This is also called metastatic bile duct cancer.

Recurrent bile duct cancer means that the cancer has come back after it has been treated. If it comes back in the same place that the cancer first started, it’s called local recurrence. If it comes back in tissues or lymph nodes close to where it first started, it’s called regional recurrence. It can also recur in another part of the body. This is called distant metastasis or distant recurrence.