About bile duct cancer stages and grades

Types of bile duct cancer

There are 3 types of bile duct cancer. The type depends on where in the bile ducts the cancer starts:

• intrahepatic bile duct cancer starts in the bile ducts in the liver

• perihilar bile duct cancer starts in the bile ducts just outside the liver

• distal bile duct cancer starts in the bile ducts closer to the ​pancreas​ and small bowel

In the UK, doctors usually use the number staging system and the TNM system to stage bile duct cancer. If you have perihilar bile duct cancer, your doctor might use the Bismuth-Corlette classification as well as the number or TNM staging system.

The TNM and number stages are different for each type of bile duct cancer. We have detailed information about the staging for each type here:

• Intrahepatic bile duct cancer

• Perihilar bile duct cancer

• Distal bile duct cancer

Number staging system for bile duct cancer

The number staging system divides bile duct cancers into 4 main stages. These are numbered from 1 to 4. The staging is different depending on the type of bile duct cancer you have.

The information below is an overview of the number staging for all types of bile duct cancer.

Stage 1

This means the cancer is small. The cancer cells are in the bile duct and they may have spread into the bile duct walls. But they have not spread outside the walls.

Stage 2

This means the cancer is larger. There might be one or more cancers in the bile duct. It may have grown into the surrounding tissues, and there may be cancer cells in the nearby lymph nodes.

Find out about lymph nodes and cancer

Stage 3

This means the cancer has spread to nearby:

• tissues

• blood vessels

• organs that are close to the bile ducts like the gallbladder and pancreas

• lymph nodes

Stage 4

This means the cancer has spread to other parts of the body further away from the bile ducts. Common places include the liver and lungs.

You may hear this called advanced bile duct cancer, secondary bile duct cancer or metastatic bile duct cancer.

Read about advanced bile duct cancer

TNM staging for bile duct cancer

TNM stands for Tumour (T), Node (N) and Metastasis (M). The staging is different depending on the type of cancer you have.

The information below is an overview of the TNM staging for all types of cancer.

• T describes the size of the tumour (cancer)

• N describes whether there are any cancer cells in the nearby lymph nodes

• M describes whether the cancer has spread to parts of the body further away from where the cancer started

The doctor gives each factor (T, N and M) a number. The number depends on how far the cancer has grown or spread.

So, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1 N0 M0.

A larger cancer that has spread into the nearby lymph nodes and to another part of the body may be T3 N1 M1.

Grades of bile duct cancer

The grade of a cancer tells your doctor how abnormal the 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 grow faster and be more likely to spread.

There are 3 grades of 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 a bit abnormal. 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.

Read more about cancer grades

How you might feel

Bile duct cancer stages and grades can be difficult to understand. You might feel frightened or overwhelmed after being told you have cancer. So you might not be able to take in everything your doctor tells you.

It might help to have a family or friend with you when you see your doctor. They can:

• support you

• ask questions

• take notes for you

You might also want to talk with your specialist nurse about the cancer stage and grade. But you may want to wait until you’ve had a chance to take in what your doctor has said. Your specialist nurse can also arrange for you to see your doctor again if necessary.

Find out about coping with bile duct cancer