Stages of perihilar bile duct cancer | Cancer Research UK
Cancer Research UK on Google+ Cancer Research UK on Facebook Cancer Research UK on Twitter

Stages of perihilar bile duct cancer

Landing page cancer type image

This page has detailed information about the staging systems for perihilar bile duct cancer. The bile duct cancer stages page has a simpler description.

There are separate pages about the staging for intrahepatic bile duct cancer and distal bile duct cancer.  On this page, you can find the following information

 

A quick guide to what's on this page

Perihilar bile duct tumours are cancers that start in the bile ducts just outside the liver and are also called Klatskin tumours. Bile duct cancer is also called cholangiocarcinoma.

What is staging

The stage of a cancer means how big it is, whether it has spread into the lymph nodes, or elsewhere in the body. The tests and scans you have to diagnose your cancer will give some information about the stage. But it may not be possible to be completely sure until you have had an operation.

Knowing the stage is important because your specialist uses this information to decide on the most suitable treatment for you.

Staging your cancer is an important part of preparation for surgery. If your cancer has spread to another part of your body your doctor needs to know where it has spread to. In this situation they may not need to know exactly what size the cancer in the bile duct is or whether the cancer has spread to any lymph nodes.

Different staging systems

Doctors most commonly use a staging system for perihilar cancers called Bismuth-Collette. This system looks at which bile ducts in the area have cancer in them and divides them up into 4 main types.  

Doctors may use 2 other staging systems – the TNM staging system and the number staging system.

TNM staging covers the size of the tumour (T), whether cancer cells have spread into the lymph nodes (N) and whether the tumour has spread anywhere else in the body (M).

The number staging system uses information from the TNM staging system to divide perihilar bile duct cancers into one of 4 groups – stages 1 to 4.
 

CR PDF Icon You can view and print the quick guides for all the pages in the treating bile duct cancer section.

 

 

What staging is

Perihilar bile duct tumours are cancers that start in the bile ducts just outside the liver and are also called Klatskin tumours. Bile duct cancer is also called cholangiocarcinoma. The stage means how far the cancer has grown or spread. This is important, because your specialist will often use this information to decide on the most suitable treatment for you. The tests and scans you have when diagnosing your cancer give your doctor some information about the stage.

The grade of a cancer is a guide to how fast it is likely to grow. A low grade tumour is generally slow growing and high grade tumours are generally faster growing.

 

The different staging systems

There are different ways of staging cancers. Doctors most commonly use the Bismuth-Collette staging system for perihilar bile duct cancers. They may also use the TNM system and number system.

The information you get about the stage of your cancer may sound a bit confusing. You will probably not be familiar with the terms your doctor uses. If you don't understand what stage your cancer is, and would like to know more, ask your doctor or nurse.

Staging your cancer is an important part of preparation for surgery. If your cancer has spread to another part of your body your doctor needs to know where it has spread to. In this situation they may not need to know exactly what size the cancer in the bile duct is or whether the cancer has spread to any lymph nodes.

Knowing the stage of your cancer may help you understand why your doctors have chosen a particular treatment for you. At the end of this section there is a list of questions for your doctor that may help. There is general information about staging cancers in the section on cancers in general.

 

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 stage 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 stage 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

T stages of perihilar bile duct cancer

  • Tis – the tumour is only within the top layers of cells lining the bile duct
  • T1– the tumour has grown deeper into the wall of the bile duct
  • T2a – the tumour has grown through the wall of the bile duct into the fatty tissue around it
  • T2b – the tumour has grown into the main part of the liver next to the bile duct
  • T3 – the tumour has grown into one of the main blood vessels of the liver (the portal vein or hepatic artery)
  • T4 – the tumour has grown into the right and left hepatic bile ducts. Or it has grown into more than one of the blood vessels. Or it has grown into a hepatic bile duct and more than one blood vessel

N stages of perihilar bile duct cancer

  • N0 – there are no cancer cells in the lymph nodes
  • N1 – there are cancer cells in nearby lymph nodes
  • N2 – there are cancer cells in lymph nodes further away, such as the chest

M stages of perihilar bile duct cancer

  • M0 – there is no sign of cancer spread
  • M1 – the cancer has spread to other parts of the body far away from the bile duct
 

Number stages of perihilar bile duct cancer

There are 4 main number stages of perihilar bile duct cancer.

Stage 1 means the tumour is contained within the bile duct

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

Stage 3 has 2 main groups

  • Stage 3a – the tumour has grown into one of the main blood vessels, either the portal vein or hepatic artery
  • Stage 3b – 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 has 2 main groups

  • Stage 4a – the tumour has grown into the right and left hepatic ducts. Or it has grown into more than one of the blood vessels. Or both of these. And there may be cancer cells in nearby lymph nodes
  • Stage 4b – there are cancer cells in lymph nodes further away, such as the chest. Or the cancer has spread to other parts of the body away from the bile duct
 

The different 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.

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

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

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

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 means how developed or mature a cell is. Cancer cells are not as mature as normal cells. So you may hear your doctor describe Grade 1 cancer cells as well differentiated. Grade 2 cancer cells are moderately differentiated. Grade 3 cancer cells are poorly differentiated. Grade 4 cancer cells are undifferentiated.

 

Rate this page:
Submit rating

 

Rated 5 out of 5 based on 3 votes
Rate this page
Rate this page for no comments box
Please enter feedback to continue submitting
Send feedback
Question about cancer? Contact our information nurse team

No Error

Updated: 20 January 2015