Stages and grades
Bile duct cancer is also known as cholangiocarcinoma. There are 3 types of bile duct cancer. Your type depends on where in the bile ducts the cancer starts.
This page is about the stages of intrahepatic bile duct cancer. This cancer starts in the bile ducts in the liver and is a type of liver cancer.
The other main types of bile duct cancer are:
perihilar bile duct cancer
distal bile duct cancer
The stages are different for each type of bile duct cancer.
Find out about the stages of perihilar and distal bile duct cancer
The stage of a cancer tells you how big the cancer is and whether it has spread. Your doctor looks at your test results to work out the stage.
Knowing the stage of a cancer is important. This is because it helps your doctor decide which treatment is best for you.
Read about tests for bile duct cancer
There are different ways of staging intrahepatic bile duct cancer. In the UK doctors usually use the:
TNM system
number 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 nearby lymph nodes (N)
whether the cancer has spread to another part of the body further away from the bile ducts (M)
There are 4 main T stages for intrahepatic bile duct cancer. These are numbered from T1 to T4.
T1 means there is only one tumour and it hasn't grown into nearby blood vessels. T1 is split into 2 groups:
T1a means the tumour is 5cm or smaller
T1b means the tumour is bigger than 5cm
T2 means there is either:
one tumour that has grown into nearby blood vessels
more than one tumour and they might have grown into nearby blood vessels
T3 means the tumour has spread from the bile ducts and through the layer of tissue covering the liver (the visceral peritoneum).
T4 means the tumour has grown into nearby structures outside the liver, like the bowel.
There are two N stages for intrahepatic bile duct cancer:
N0 means there are no cancer cells in the nearby lymph nodes.
N1 means there are cancer cells in the nearby lymph nodes.
There are two M stages for intrahepatic bile duct cancer:
M0 means there is no sign the cancer has spread to other parts of the body away from the bile ducts.
M1 means the cancer has spread to other parts of the body away from the bile ducts. This includes the bones, lungs and lymph nodes that are further away.
The number staging system divides intrahepatic bile duct cancer into 4 main stages. These are numbered from 1 to 4.
This means the cancer is only in the bile ducts. It hasn't spread into the nearby blood vessels or anywhere else. Stage 1 is split into two groups:
Stage 1A means there is only one cancer and it is 5cm or smaller. This is the same as T1a, N0, M0 in the TNM staging system.
Stage 1B means there is only one cancer and it is bigger than 5cm. This is the same as T1b, N0, M0.
This means there is either:
one cancer in the bile ducts and it has grown into nearby blood vessels
more than one cancer in the bile ducts and they might have grown into nearby blood vessels
Stage 2 intrahepatic bile duct cancer is the same as T2, N0, M0.
This is split into two groups:
Stage 3A means the cancer has spread from the bile ducts and through the layer of tissue covering the liver (the visceral peritoneum). This is the same as T3, N0, M0.
Stage 3B means the cancer has spread from the bile ducts to either:
nearby structures outside the liver like the bowel. This is the same as T4, N0, M0
nearby lymph nodes. This is the same as any T, N1, M0
Find out about lymph nodes and cancer
This means that the cancer has spread further away from the bile ducts. The most common places for intrahepatic bile duct cancer to spread to include the bones and lungs.
Stage 4 intrahepatic bile duct cancer is the same as any T, any N, M1.
The stage of the cancer helps your doctor decide which treatment is best for you. Treatment also depends on:
where in the intrahepatic bile ducts the cancer is
how well your liver works
your general health and level of fitness
if there are any changes in the cancer cells
Read more about gene changes and cancer treatment
You might have surgery if you have a stage 1 or 2 intrahepatic bile duct cancer. Usually, your surgeon removes part of the liver. This is a major operation. Your doctor will make sure that you are well enough to have it.
Unfortunately, most bile duct cancers are advanced by the time they are diagnosed. This means you might not be able to have surgery. Your doctor might suggest other treatments to reduce your symptoms and help you feel better. This may include chemotherapy and targeted cancer drugs.
Last reviewed: 03 Jul 2024
Next review due: 03 Jul 2027
Bile duct cancer is when abnormal cells in the bile ducts divide in an uncontrolled way. It is also called cholangiocarcinoma.
There are 3 main types of bile duct cancer. Intrahepatic bile duct cancer starts in the liver. Perihilar and distal bile duct cancers start in the bile ducts outside the liver.
Perihilar bile duct cancer starts just outside the liver. Doctors usually use the the Bismuth-Corlette classification and the number or TNM staging system to describe perihilar bile duct cancer.
Distal bile duct cancer starts in the bile ducts near the pancreas and small bowel. Doctors usually use the number or TNM staging systems to describe distal bile duct cancer.
Treatments for bile duct cancers include surgery, chemotherapy and treatments to control symptoms. The treatments you have depend on the stage of the cancer.
Bile duct cancer is also called cholangiocarcinoma. It is a rare type of cancer that develops in the small tubes that connect the liver and gallbladder to the small bowel.
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