Bile Duct Cancer Stages / Staging
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The goal of bile duct cancer staging is to assess the location, size and extent of the primary tumor. Our cancer doctors use a variety of imaging tests to evaluate bile duct cancer and develop the best treatment plan for you.
The TNM System
The American Joint Committee on Cancer (AJCC) TNM system, also accepted by the International Union Against Cancer (UICC), is the most widely accepted method for staging bile duct cancer. This system bases the staging criteria on the evaluation of three primary factors:
- Tumor (T) describes the number and size of the original tumor.
- Lymph Node (N) indicates whether the cancer is present in the regional (nearby) lymph nodes.
- Metastasis (M) refers to whether cancer has spread to distant parts of the body.
A number (0-4) or the letter X is assigned to each factor. A higher number indicates increasing severity. For instance, a T1 score indicates a smaller tumor than a T2 score. The letter X means the information was insufficient and could not be adequately assessed.
Once the T, N and M scores have been assigned, the overall bile duct cancer stage is determined.
Stages of Bile Duct Cancer
Intrahepatic bile duct cancers are staged separately from extrahepatic bile duct cancers. The stage groupings for the most common of the bile duct cancer types – the extrahepatic perihilar bile duct cancer is described here.
- Stage 0: The cancer is found only in the innermost layer of the bile duct (mucosa) and has not spread to the deeper layers of the bile duct. In this stage of bile duct cancer, the disease has not invaded lymph nodes or any other distant sites in the body (Example Grouping: Tis, N0, M0).
- Stage I: Still contained within the bile duct, the cancer now extends into the deeper layers of the bile duct wall (muscle or fibrous tissue layer). It has not spread to lymph nodes or other distant sites (Example Grouping: T1, N0, M0).
- Stage II: The cancer has now spread through the wall of the bile duct into nearby fat (IIB) or liver tissue (IIB) (Example Grouping: T2, N0, M0).
- Stage IIIA: In this bile duct cancer stage, the disease has spread to the main portal vein, the common hepatic artery, duodenum (first part of the small intestine), colon, stomach or abdominal wall, but not beyond. The cancer has not spread to the lymph nodes or distant sites (Example Grouping: T3, N0, M0).
- Stage IIIB: Cancer cells are found in nearby lymph nodes, but the cancer has not spread to distant sites (Example Grouping: T3, N1, M0).
- Stage IVA: The cancer is growing and has spread to the main blood vessel and the lymph nodes but not to distant sites (Example grouping: T4, N1, M0).
- Stage IVB: The cancer has either spread to lymph nodes away from the tumor (N2) or it has spread to distant sites (M1) (Example grouping: any T, N2, M0; any T, any N, M1).
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