Distal extrahepatic bile duct cancer stages

Bile duct cancer is also known as cholangiocarcinoma. There are different types of bile duct cancer depending on where it starts. Distal extrahepatic bile duct cancer starts in the bile ducts near the bowel. 

Diagram showing the position of the distal bile ducts

There are different ways of staging distal bile duct cancer. In the UK, doctors use the:

  • number staging system
  • TNM system

The stage of a cancer tells you how big the cancer is and whether it has spread. This is important because your doctor uses this information to decide which treatment you need. Your doctor looks at your tests results to work out the stage.

The number staging system

The number staging system divides distal bile duct cancer into 4 main stages, from 1 to 4.

Stage 1

Stage 1 means the tumour has grown less than 5mm into the bile duct wall. This is the same as T1, N0, M0 in the TNM staging system.

Stage 2

Stage 2 is split into 2 groups:

Stage 2A means the tumour has grown less than 5mm into the bile duct wall and there are cancer cells in 1 to 3 of the nearby lymph nodes. This is the same as T1, N1, M0.

Or the tumour has grown 5 to 12mm into the bile duct wall and has not spread to the lymph nodes nearby. This is the same as T2, N0, M0.

Stage 2B means the tumour has grown between 5 and 12mm into the bile duct wall and has spread to 3 or less lymph nodes. This is the same as T2, N1, M0.

Or the tumour has grown more than 12mm into the bile duct wall and may have spread to 3 lymph nodes or less. This is the same as T3, N0 or N1, M0.

Stage 3

Stage 3 is split into 2 groups:

Stage 3A means the tumour has grown up to 12mm or more into the bile duct wall. And it has spread to 4 or more nearby lymph nodes. This is the same as T1, 2 or 3, N2, M0.

Stage 3B means the tumour has grown into the main blood vessels and there may or may not be cancer cells in the lymph nodes nearby. This is the same as T4, N0, 1 or 2, M0.

Stage 4

Stage 4 means the cancer has spread to other parts of the body such as the lungs. This is the same as Any T, Any N, M1 in the TNM staging system.

The TNM staging system

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

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

Tumour (T) stages

There are 4 main T stages for distal bile duct cancer, from T1 to T4.

T1 means the tumour is inside the bile duct and has grown less than 5mm into the bile duct wall.

T2 means the tumour has grown between 5 and 12 mm into the wall of the bile duct.

T3 means the tumour has grown more than 12mm into the wall of the bile duct.

T4 means the tumour is growing into nearby main blood vessels. This includes the celiac artery, superior mesenteric artery, or the common hepatic artery.

Node (N) stages

There are 3 stages:

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

N1 means there are cancer cells in 1 to 3 of the nearby lymph nodes.

N2 means there are cancer cells in 4 or more of the nearby lymph nodes

Metastasis (M) stages

There are two M stages:

M0 means there is no sign of cancer spread.

M1 means the cancer has spread to other parts of the body such as the lungs.

Last reviewed: 
25 Jan 2022
Next review due: 
25 Jan 2022
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017.

  • Cancer: Principles and Practice of Oncology (11th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2019

  • Guidelines for the management and treatment of cholangiocarcinoma: an update
    SA Khan and others  
    Gut, 2012. Vol 61, issue 12.

  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up
    JW Valle and others
    Annals of oncology, 2016. Vol 27, Supplement 5. Pages 28-37

  • Cholangiocarcinoma 2020: the next horizon in mechanisms and managements
    JM Banales and others
    Nature reviews gastroenterology & hepatology, 2020. Vol 17, Pages 557-588

Related links