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Bile Duct Cancer Diagnosis

Because bile ducts are deep within the body, they typically don’t cause any visible signs or symptoms until the disease is well advanced.  Only a very small number of bile duct cancers are diagnosed before they have spread to other areas of the body.

Tools for diagnosing bile duct cancer may include:

  • Blood tests to determine liver and gallbladder function
  • Imaging tests, including CT scan, X-ray, MRI, and abdominal ultrasound
  • Endoscopy (ERCP)
  • Biopsy
  • Tumor markers: CEA, CA 19-9

Bile Duct Cancer Staging

The staging system for bile duct cancer is the TNM system, developed by the American Joint Committee on Cancer (AJCC).

Each type of bile duct cancer has its own staging system, based on where the tumor starts.

Perihilar Bile Duct Cancer Stages

(source: American Joint Committee on Cancer)

T categories

  • TX: No description of the tumor’s extent is possible because of incomplete information.
  • T0: There is no evidence of a primary tumor.
  • Tis: Cancer cells are only in the mucosa (the innermost layer of the bile duct) and have not invaded deeper layers of the bile duct. This stage is also known as intramucosal carcinoma and was previously called carcinoma in situ.
  • T1: The cancer has grown into deeper layers of the bile duct wall, such as the muscle layer or the fibrous tissue layer.
  • T2: The tumor has grown through the wall of the bile duct and into nearby tissue.
    • T2a: The tumor has grown through the wall of the bile duct and into surrounding fat.   
    • T2b: The tumor has grown through the wall of the bile duct and into nearby liver tissue.
  • T3: The cancer is growing into branches of the main blood vessels of the liver (the portal vein and/or the hepatic artery) on one side (left or right).
  • T4: The cancer is growing into the main blood vessels of the liver (the portal vein and/or the common hepatic artery) or into branches of these vessels on both sides (left and right), OR the cancer is growing directly into other bile ducts while part of the tumor is growing into one of the main blood vessels.

N categories

  • NX: Nearby (regional) lymph nodes cannot be assessed.
  • N0: The cancer has not spread to nearby lymph nodes.
  • N1: The cancer has spread to nearby lymph nodes, such as those along the cystic duct, the common bile duct, the hepatic artery, and the portal vein.
  • N2: The cancer has spread to lymph nodes farther away from the tumor, such as those around the major blood vessels of the abdomen (the aorta, the vena cava, the celiac artery, and the superior mesenteric artery).

M categories

  • M0: The cancer has not spread to tissues or organs far away from the bile duct.
  • M1: The cancer has spread to tissues or organs far away from the bile duct.

Stage Grouping

Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping.  

Stage 0 (Tis, N0, M0): Cancer cells are only in the innermost layer of the bile duct and have not grown into deeper layers (Tis). Cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage I (T1, N0, M0): The cancer has grown into deeper layers of the bile duct wall, such as the muscle layer or the fibrous tissue layer (T1). It has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage II (T2, N0, M0): The tumor has grown through the wall of the bile duct and into surrounding fat (T2a) or liver tissue (T2b). Cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).

Stage III: Has 2 substages:  

Stage IIIA (T3, N0, M0): The cancer is growing into branches of the main blood vessels of the liver (the portal vein and/or the hepatic artery) on one side (T3). Cancer has not spread to nearby lymph nodes (N0) or distant sites (M0).   

Stage IIIB (T1 to T3, N1, M0): The cancer has grown into deeper layers of the bile duct wall (T1) and may have grown through the wall and into nearby fat or liver tissue (T2). The cancer may be growing into branches of the main blood vessels of the liver on one side (T3). Cancer cells are found in nearby lymph nodes (N1), but the cancer has not spread to distant sites (M0).

Stage IV: Has 2 substages:

Stage IVA (T4, N0-1, M0): The cancer is growing into the main blood vessels of the liver (the portal vein and/or the common hepatic artery), is growing into branches of these vessels on both sides, or part of the cancer is growing directly into other bile ducts while another part of the tumor is growing into one of the main blood vessels (T4). The cancer may have spread to nearby lymph nodes (N0 or N1), but it has not spread to distant sites (M0).   

Stage IVB (Any T, N2, M0) or (Any T, any N, M1): The cancer has either spread to lymph nodes away from the tumor (N2) or it has spread to distant sites (tissues or organs away from the bile duct) such as the lungs or bones (M1).

 

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