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Bile Duct Cancer Stages

Bile Duct Cancer Stages

The stage of bile duct cancer is defined by the findings of the physical exam, imaging, another testing, and the outcome of surgery if it has been performed. Cancer’s stage reflects how much cancer is present in the body. It aids in determining the severity of cancer and how best to treat it. Doctors also utilize cancer’s stage when discussing survival rates.

A staging system is a common method for a cancer care team to summarise the degree of malignancy. The American Joint Committee on Carcinoma (AJCC) TNM classification is the primary method used to define the stages of bile duct cancer. Depending on where the disease begins, there are three distinct staging systems for bile duct cancer:

  • Intrahepatic bile duct cancers (those starting within the liver)
  • Perihilar (hilar) bile duct cancers (those starting in the hilum, the area just outside the liver)
  • Distal bile duct cancers (those starting farther down the bile duct system).

Almost of bile duct malignancies begin in the mucosa, the deepest layer of the bile duct wall. They can grow through the wall and exit the bile duct over time. If a tumor penetrates the bile duct wall, it has the potential to infiltrate (grow into) adjacent blood vessels, organs, and other tissues.

Staging describes where the cancer is present, whether or not it has spread, and whether it impacts other regions of the body.

Doctors employ diagnostic tests to determine the stage of cancer, thus staging may not be complete until all of the tests are completed.

The TNM classification used to stage other types of cancers into stages I through IV (one through four) is medically complex for bile duct cancer. The headings listed below provide a simpler way to describe the stages of bile duct cancer. By classifying each cancer into 1 of these categories, the health care team can then plan the best treatment strategy.

  • Local. This type of bile duct cancer is located only within the bile duct and can be removed surgically. There is no evidence of spread to areas outside of the bile duct.
  • Locally advanced. This type is located only in the area around the bile duct, but it does affect nearby organs, arteries, or veins. There is no evidence of spread to distant parts of the body.
  • Metastatic. The tumour has spread beyond the area of the bile duct to reach distant parts of the body. It is unlikely that surgery can remove all of cancer.

Recurrent. Recurrent cancer is cancer that has come back after treatment. Cancer may need to be staged again (called re-staging) if there is a recurrence using the system above. It is very rare for recurrent.

Resectable versus unresectable

The TNM staging method offers clinicians an estimate of a person’s prognosis by providing a thorough description of how far the bile duct cancer has progressed (outlook). However, for therapeutic purposes, clinicians frequently employ a simplified method depending on whether or not cancer can be removed (resected) surgically:

  • Resectable cancers are those that doctors believe can be removed completely by surgery.
  • Unresectable cancers have spread too far or are in too difficult a place to be removed entirely by surgery.

In general, most stage 0, I, and II cancers, as well as perhaps some stage III cancers, are resectable, but most stage III and IV tumors are not. However, this is dependent on several other circumstances, including the size and location of the tumor, as well as whether the patient is in good enough condition to undergo surgery.

Staging of Intrahepatic Bile Duct Cancers

When a person is diagnosed with intrahepatic bile duct cancer, doctors will try to determine whether the disease has spread and, if so, how far it has spread. This is referred to as staging. Cancer’s stage reflects how much cancer is present in the body. It aids in determining the severity of cancer and how best to treat it. When discussing survival rates, doctors also refer to cancer’s stage.

Stage 0 intrahepatic bile duct tumors are the most severe (also called carcinoma in situ, or CIS). The stages are then classified as I (1) through IV (4). The lower the number, the less likely cancer has spread. A higher number, such as stage IV, indicates that cancer has progressed farther. And an earlier letter inside a stage denotes a lower stage.

How is the stage determined?

The staging system most often used for intrahepatic bile duct cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The extent (size) of the main tumour (T): How large has cancer grown? Has cancer reached nearby structures or organs?
  • The spread to nearby lymph nodes (N): Has cancer spread to nearby lymph nodes?
  • The spread (metastasis) to distant sites (M): Has cancer spread to distant lymph nodes or distant organs such as the bones, lungs, or peritoneum (the lining of the abdomen [belly])?

The system described below is the most recent AJCC system, effective January 2018. It’s used only for intrahepatic bile duct cancers (those starting within the liver). Staging systems for cancers starting in other parts of the bile ducts are described in:

  • Perihilar Bile Duct Cancer Stages (for cancers starting in the hilum, just outside the liver)
  • Distal Bile Duct Cancer Stages (for cancers starting farther down the bile duct)

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.

Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. For more on this, see Cancer Staging.

Intrahepatic bile duct cancer is typically based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Bile Duct Cancer). If surgery is done, the pathologic stage (also called the surgical stage) is determined by examining the tissue removed during the operation. 

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

Staging of Perihilar Bile Duct Cancers

Bile Duct Cancer

Doctors will try to determine if a person has perihilar (hilar) bile duct cancer and, if so, how far it has gone. This is referred to as staging. Cancer’s stage reflects how much cancer is present in the body. It aids in determining the severity of cancer and how best to treat it. When discussing survival rates, doctors also refer to cancer’s stageThe earliest stage perihilar bile duct cancers are stage 0, also called carcinoma in situ (CIS) or high-grade biliary intraepithelial neoplasia. Stages then range from stages I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more. And within a stage, an earlier letter means a lower stage.

Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in much the same way.

How is the stage determined?

The staging system most often used for perihilar bile duct cancer is the American Joint Committee on Cancer (AJCC) TNM system, which is based on 3 key pieces of information:

  • The extent (size) of the main tumor (T): Has the cancer grown through the bile duct or reached nearby structures or organs?
  • The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?
  • The spread (metastasis) to distant sites (M): Has the cancer spread to distant lymph nodes or distant organs such as the bones, lungs, or peritoneum (the lining of the abdomen [belly])?

The system described below is the most recent AJCC system, effective January 2018. It’s used only for perihilar bile duct cancers (those starting in the hilum, just outside the liver). Staging systems for cancers starting in other parts of the bile ducts are described in: 

  • Intrahepatic Bile Duct Cancer Stages (for cancers starting in bile ducts within the liver)
  • Distal Bile Duct Cancer Stages (for cancers starting farther down the bile duct)

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced.

Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. Perihilar bile duct cancer is typically given a clinical-stage based on the results of a physical exam, biopsy, and imaging tests (described in Tests for Bile Duct Cancer). If surgery is done, the pathologic stage (also called the surgical stage) is determined by examining the tissue removed during the operation. 

Cancer staging can be complex, so ask your doctor to explain it to you in a way you understand.

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