Radiation Oncology/Bile duct/Staging

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Extrahepatic bile ducts[edit]

Current staging[edit]

AJCC 7th Edition (2009)
For the 7th Edition staging, there are now separate staging classifications for perihilar (proximal) and distal bile duct tumors

Perihilar Bile Ducts
Primary Tumor:

  • Tis - carcinoma in situ
  • T1 - confined to the bile duct, with extension up to the muscle layer or fibrous tissue
  • T2
    • T2a - invades beyond the wall of the bile duct to surrounding adipose tissue
    • T2b - invades adjacent hepatic parencyma
  • T3 - invades unilateral branches of the portal vein or hepatic artery
  • T4 - invades main portal vein or its braches bilaterally; common hepatic artery; second-order biliary radicals bilaterally; or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement

Regional Lymph Nodes:

  • N0 - no
  • N1 - regional lymph node metastasis (along the cystic duct, common bile duct, hepatic artery, and portal vein)
  • N2 - metastasis to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes

Distant Metastases:

  • M0 - no
  • M1 - yes

Stage Grouping:

  • I - T1 N0
  • II - T2a-b N0
  • IIIA - T3 N0
  • IIIB - T1-3 N1
  • IVA - T4 N0-1
  • IVB - N2 or M1


Distal Bile Duct
Primary Tumor:

  • Tis - carcinoma in situ
  • T1 - confined to the bile duct
  • T2 - invades beyond the wall of the bile duct
  • T3 - invades the gallbladder, pancreas, duodenum, or other adjacent organs without involvement of the celiac axis or the superior mesenteric artery
  • T4 - involves the celiac axis or the superior mesenteric artery

Regional Lymph Nodes:

  • N0 - no
  • N1 - regional lymph node metastasis

Distant Metastases:

  • M0 - no
  • M1 - yes

Stage Grouping:

  • IA - T1 N0
  • IB - T2 N0
  • IIA - T3 N0
  • IIB - T1-3 N1
  • III - T4
  • IV - M1

Prognostic factors : serum CEA, CA19.9

Changes from 6th Edition:

  • Now separate staging classifications for perihilar and distal extrahepatic bile duct tumors

Previous editions[edit]

AJCC 6th Edition (2002)
For the 6th edition - all extrahepatic bile duct tumors (perihilar or distal) are included in one classification

Primary Tumor:

  • Tis - carcinoma in situ
  • T1 - confined to the bile duct
  • T2 - invades beyond the wall of the bile duct
  • T3 - invades liver, gallbladder, pancreas, and/or unilateral branches of the portal vein or hepatic artery
  • T4 - invades main portal vein or its braches bilaterally, common hepatic artery, or other adjacent structures such as the colon, stomach, duodenum, or abdominal wall (unresectable)

Regional Lymph Nodes:

  • N0 - no
  • N1 - yes

Distant Metastases:

  • M0 - no
  • M1 - yes

Stage Grouping:

  • IA - T1 N0
  • IB - T2 N0
  • IIA - T3 N0
  • IIB - N1
  • III - T4
  • IV - M1


AJCC 5th edition (1997)
Primary Tumor:

  • T1
    T1a - invades subepithelial connective tissue
    T1b - invades fibromuscular layer
  • T2 - invades perifibromuscular connective tissue
  • T3 - invades adjacent structures (liver, pancreas, duodenum, gallbladder, colon, stomach)

Regional Lymph Nodes:

  • N1 - metastasis in cystic duct, pericholedochal and/or hilar lymph nodes (i.e in the hepatoduodenal ligament)
  • N2 - metastasis in peripancreatic (head only), periduodenal, periportal, celiac, and/or superior mesenteric and/or posterior pancreatic duodenal lymph nodes

Stage grouping:

  • I - T1 N0
  • II - T2 N0
  • III - T1-2 N1-2
  • IVA - T3 Any N
  • IVB - M1

Intrahepatic bile ducts[edit]

AJCC 7th Edition (2009)
Note: New staging category beginning with the 7th edition. In prior editions, staging for intrahepatic bile ducts was grouped in with Liver staging.

Primary tumor:

  • Tis - carcinoma in situ (intraductal tumor)
  • T1 - solitary tumor without vascular invasion
  • T2
    • T2a - solitary tumor with vascular invasion
    • T2b - multiple tumors, with or without vascular invasion
  • T3 - tumor penetrating the visceral peritoneum or involving the local extrahepatic structures by direct invasion
  • T4 - tumor with periductal invasion

Regional Lymph Nodes:

Regional nodes:
Right liver (segments 5-8) - hilar (common bile duct, hepatic artery, portal vein, and cystic duct), periduodenal, peripancreatic, inferior phrenic
Left liver (segments 2-4) - hilar, gastrohepatic, inferior phrenic
Distant nodes (M1) - celiac, periaortic, pericaval
  • N0 - no
  • N1 - yes

Distant Metastases:

  • M0 - none
  • M1 - yes

Stage Grouping:

  • I - T1 N0
  • II - T2 N0
  • III - T3 N0
  • IVA - T4 N0, Any N1
  • IVB - M1