Distal cholangiocarcinoma (staging)

Radiopaedia • CC-by-nc-sa 3.0 • de

Distal cholangiocarcinoma staging is defined according to the TNM staging classification of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC). As of 2018, the staging criteria are in their 8 edition and reflected below . These criteria apply to cancers of the distal (extrahepatic) bile ducts, while cancers of the intrahepatic and perihilar bile ducts are staged differently.

Primary tumor (T)

  • TX: primary tumor cannot be assessed 
  • Tis: carcinoma in situ/high-grade dysplasia
  • T1: tumor invades the bile duct wall with depth <5 mm
  • T2: tumor invades the bile duct wall with depth 5–12 mm
  • T3: tumor invades the bile duct wall with depth >12 mm
  • T4: tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery

Regional lymph node (N)

  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: 1-3 positive regional lymph nodes
  • N2: 4 or more positive regional lymph nodes

Distant metastases (M)

  • cM0: no evidence of metastases
  • cM1: distant metastasis
  • pM1: distant metastasis, microscopically confirmed

Stage groups

  • stage 0
    • ​Tis, N0, M0
  • stage I
    • T1, N0, M0
  • stage IIA
    • T1, N1, M0
    • T2, N0, M0
  • stage IIB
    • ​T2, N1, M0
    • T3, [N0, N1], M0
  • stage IIIA
    • ​[T1, T2, T3], N2, M0
  • stage IIIB
    • T4, [N0, N1, N2], M0
  • stage IV
    • [Any T], [Any N], M1