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Perihilar stages and grades

Perihilar bile duct cancer develops just outside the liver. Find out about how doctors stage and grade this type of bile duct cancer. 

Diagram showing the position of the perihilar bile ducts

The stage of a cancer tells you how far it has grown or spread. The grade describes how abnormal the cancer cells are compared to healthy cells. 

The stage and grade are important because your specialist uses this information to decide which treatment is most suitable for you.

Your scans and tests will give some information about the stage and grade of your cancer. 

Bile duct cancer is also known as cholangiocarcinoma. There are different ways of staging the different types of bile duct cancer. For perihilar bile duct cancer doctors use the:

  • Bismuth-Collette staging system
  • TNM system
  • number staging system

Bismuth-Collette staging

The Bismuth-Collette staging system divides perihilar cancers into 4 main types. The type you have depends on where the cancer is in the perihilar area.

Type 1 – the cancer is in the hepatic duct. 

Diagram showing type 1 perihilar bile duct cancer

Type 2 – the cancer is in the hepatic duct and the junction where the left and right hepatic bile ducts meet. 

Diagram showing type 2 perihilar bile duct cancer

Type 3A – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the right hepatic duct. 

Diagram showing type 3A perihilar bile duct cancer

Type 3B – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in the left hepatic duct. 

Diagram showing type 3B perihilar bile duct cancer

Type 4 – the cancer is in the hepatic duct, the junction where the left and right bile ducts meet, and in both left and right hepatic ducts. Or the cancer has started in a number of places in the bile duct. 

Diagram showing type 4 perihilar bile duct cancer

TNM staging system

TNM stands for Tumour, Node and Metastasis. The system describes: 

  • how far the primary tumour has grown (T)
  • whether the cancer has spread to the lymph nodes (N)
  • whether the cancer has spread to a different part of the body (M)

T stages

T describes how far the cancer (tumour) has grown. There are 5 main T stages for perihilar bile duct cancer – Tis to T4:

Tis means the tumour is only within the top layers of cells lining the bile duct.

T1 means the tumour has grown deeper into the wall of the bile duct.

T2 is split into 2 groups - T2A and T2B. T2A means the tumour has grown through the wall of the bile duct into the fatty tissue around it. T2B means tthe tumour has grown into the main part of the liver next to the bile duct.

T3 means the tumour has grown into one of the main blood vessels of the liver (the portal vein or hepatic artery).

T4  means the tumour has grown into one of the following:

  • the right and left hepatic bile ducts
  • more than one of the blood vessels
  • a hepatic bile duct and more than one blood vessel

N stages

N describes whether the cancer has spread to the lymph nodes. There are 3 stages - N0, N1 and N2. 

N0 means there are no cancer cells in the lymph nodes.

N1 means there are cancer cells in nearby lymph nodes.

N2 means there are cancer cells in lymph nodes further away, such as the chest.

M stages

M describes whether the cancer has spread (metastasised) to another part of the body. There are 2 stages - M0 and M1:

M0 means there is no sign of cancer spread.

M1 means the cancer has spread to other parts of the body away from the bile duct.

Number stages

There are 4 main number stages of perihilar bile duct cancer - stage 1 to stage 4:

Stage 1

Stage 1 means the tumour is contained within the bile duct.

Stage 2

Stage 2 means the tumour has grown into the fatty tissue around the bile duct and may have grown into the liver.

Stage 3

Stage 3 has 2 main groups - stage 3a and 3b:

Stage 3a means the tumour has grown into one of the main blood vessels, either the portal vein or hepatic artery.

Stage 3b means the tumour is any size and may have grown into the fatty tissue or the liver and there are cancer cells in nearby lymph nodes.

Stage 4

Stage 4 has 2 main groups - stage 4a and 4b:

Stage 4a means there may be cancer cells in nearby lymph nodes and the tumour has grown into one or both of the following:

  • the right and left hepatic ducts
  • more than one of the blood vessels

Stage 4b means one of the following:

  • there are cancer cells in lymph nodes further away, such as the chest
  • the cancer has spread to other parts of the body away from the bile duct

Grades of perihilar bile duct cancer

The grade of a cancer is a way of measuring how abnormal cancer cells are compared to healthy cells. It also gives an idea of how quickly a cancer may grow and whether it is likely to spread.

Low grade cancers are usually slower growing and less likely to spread. High grade cancers tend to be faster growing and more likely to spread.

There are 4 grades of perihilar bile duct cancer - grade 1 to grade 4:

Grade 1

Grade 1 cancer means the cancer cells look very like normal bile duct cells. This is called low grade cancer.

Grade 2

Grade 2 cancer means the cancer cells look slightly different to normal bile duct cancers. This is called intermediate grade cancer.

Grade 3

Grade 3 cancer means the cancer cells look abnormal and unlike normal bile duct cells. This is called high grade cancer.

Grade 4

Grade 4 cancer means the cancer cells look very abnormal and nothing like normal bile duct cancer cells. This is also called high grade cancer.

Differentiation

Differentiation means how developed or mature a cell is. Cancer cells are not as mature as normal cells.

You may hear your doctor describe:

  • grade 1 cancer cells as well differentiated
  • grade 2 cancer cells as moderately differentiated
  • grade 3 cancer cells as poorly differentiated
  • grade 4 cancer cells as undifferentiated
Last reviewed: 
20 Jan 2015
  • AJCC Cancer Staging Manual (7th Edition)
    S Edge and others.
    Springer, 2011

  • Cholangiocarcinoma--current treatment options.
    ​S Friman 
    Scand J Surg. 2011, Volume 100, Issue1, Pages 30-4.

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