Decorative image

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 its size and whether it has spread. Your doctor looks at your scans and x-rays to work out the stage. This helps them to decide what treatment you need.

The grade describes how abnormal the cancer cells are compared to healthy cells. A specialist doctor (pathologist) works out the grade by looking at a sample of cells under the microscope.

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-Corlette staging system
  • TNM system
  • number staging system

Bismuth-Corlette staging

The Bismuth-Corlette 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.

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 4 main T stages for perihilar bile duct cancer – T1 to T4:

T1 means the tumour is within 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 and into the fatty tissue around it. 

T2b means the tumour has grown into the liver next to the bile duct.

T3 means the tumour has grown into the branches on one side of 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 main portal vein or its branches on both sides
  • the common hepatic artery or its branches on both sides
  • a hepatic bile duct on one side and one of the main blood vessels on the other side
Diagram showing the two lobes of the liver, its blood supply and the hepatic ducts

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 1 to 3 nearby lymph nodes.

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

M stages

M describes whether the cancer has spread to another part of the body (metastases). 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 such as the lungs.

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 within the bile duct and has not spread anywhere else. It is the same as T1, N0, M0 in the TNM staging system.

Stage 2

Stage 2 means the tumour has grown either into the fatty tissue around the bile duct or the liver. It is the same as T2, N0, M0

Stage 3

Stage 3 is divided into 3 groups - stage 3A, 3B and 3C:

Stage 3A means the tumour has grown into the branches on one side of one of the main blood vessels. It is the same as T3, N0, M0.

Stage 3B means the tumour has grown into one of the following:

  • the main blood vessels of the liver or their branches on both sides
  • a hepatic bile duct on one side and one of the main blood vessels on the other side

This is the same as T4, N0, M0.

Stage 3C means that the cancer is any size and between 1 and 3 lymph nodes have cancer cells in them. This is the same as Any T, N1 and M0.

Stage 4

Stage 4 is split into 2 groups - stage 4A and 4B:

Stage 4A means that the cancer is any size and has spread to 4 or more nearby lymph nodes. It is the same as Any T, N2, M0. 

Stage 4B means that the cancer has spread to another part of the body such as the lungs.

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 3 grades of perihilar bile duct cancer - grade 1 to grade 3

Grade 1

Grade 1 cancer means the cancer cells look similar to 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 very abnormal and unlike normal bile duct cells. This is 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
Last reviewed: 
26 Mar 2018
  • AJCC Cancer Staging Manual (8th Edition)
    M Amin and S Edge.
    Springer, 2017.

Information and help