About staging of bile duct cancer

The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage of the cancer helps doctors decide on the best treatment for you.

The most commonly used staging systems for bile duct cancer are the number and TNM staging systems. Staging for bile duct cancer is different depending on where the cancer in the bile ducts began.

The bile ducts

We have more information about staging for:

  • intrahepatic bile duct cancer – (bile ducts inside the liver)
  • perihilar bile duct cancer – (bile ducts just outside the liver)
  • distal bile duct cancer – (bile ducts closest to the bowel).

Number staging

There are four stages of bile duct cancer:

  • Stage 1 – the cancer is small and only in one area of the bile ducts (localised cancer).
  • Stages 2 and 3 – the cancer is larger and may have grown into part of the body close to the bile ducts. There may also be cancer cells in nearby lymph nodes (locally advanced cancer).
  • Stage 4 – the cancer has spread to a part of the body far from the bile ducts (secondary or metastatic cancer).

TNM staging

  • T describes the size of the tumour.
  • N describes whether the cancer has spread to the lymph nodes.
  • M describes whether the cancer has spread to another part of the body (this is called metastatic or secondary cancer).

This system gives detailed information about the tumour stage.

Staging for intrahepatic bile duct cancer

Intrahepatic bile duct cancer starts in the bile ducts in the liver.

TNM staging

Tumour (T)

Tis – the tumour is only in the first layer of the bile duct. It has not grown into deeper layers of the bile duct. This stage is also called intramucosal carcinoma or carcinoma in situ.

T1 – there is one tumour. It has grown into deeper layers of the bile duct wall, but it is contained in the bile duct.

T2 – there is more than one tumour, or a tumour has grown into a blood vessel, or both.

T3 – the tumour has grown into the tissue (peritoneum) that covers organs such as the liver.

T4 – the tumour has grown into nearby structures outside of the liver.

Nodes (N)

N0 – the cancer has not spread to nearby lymph nodes.

N1 – the cancer has spread to nearby lymph nodes.

Metastases (M)

M0 – the cancer has not spread to other parts of the body far away from the bile duct.

M1 – the cancer has spread to other parts of the body far away from the bile duct.

Number staging

There are five main stages of intrahepatic bile duct cancer.

Stage 0

The tumour is only in the top layer of the bile duct and has not grown into deeper layers of the bile duct.

Stage 1

There is one tumour. It has grown into deeper layers of the bile duct wall, but it is contained in the bile duct.

Stage 2

The tumour has grown into a blood vessel, or there is more than one tumour.

Stage 3

The tumour:

  • has grown into the peritoneum (the tissue lining the organs in the abdomen)
  • has grown into nearby structures outside of the liver
  • is any size and has spread to nearby lymph nodes.

Stage 4

The cancer has spread to a part of the body far from the liver, such as the lungs or bones.

Staging for perihilar bile duct cancer

Perihilar bile duct cancer starts in the bile ducts just outside the liver.

TNM staging

Tumour (T)

  • Tis – the tumour is only in the first layer of the bile duct.
  • T1 – the tumour has grown into deeper layers of the bile duct wall.
  • T2 – the tumour has grown through the bile duct wall and into nearby fatty tissue or liver tissue.
  • T3 – the tumour has grown into large blood vessels leading to the portal vein or hepatic artery.
  • T4 – the tumour has grown into a blood vessel that is joined to one of the main blood vessels of the liver (the portal vein and the hepatic artery).

Nodes (N)

  • N0 – the cancer has not spread to nearby lymph nodes.
  • N1 – the cancer has spread to 1 to 3 nearby lymph nodes.
  • N2 – the cancer has spread to four or more nearby lymph nodes.

Metastases (M)

  • M0 – the cancer has not spread to parts of the body that are far away from the bile duct.
  • M1 – the cancer has spread to parts of the body that are far away from the bile duct. For example, it has spread to the bones, lungs or distant parts of the liver.

Number staging

There are five main stages of perihilar bile duct cancer.

Stage 0

The tumour is only in the first layer of the bile duct. It has not grown into deeper layers.

Stage 1

There is only one tumour and it is only in the bile duct.

Stage 2

The tumour has grown through the bile duct wall and into nearby fatty tissue or liver tissue.

Stage 3

The tumour has grown into one or more of the blood vessels that are joined to one of the main blood vessels of the liver.

Or the tumour has grown into one of the main blood vessels of the liver (the portal vein or hepatic artery). It may also have grown into more bile ducts. Or it might have grown into all three places.

Stage 3 could also mean that the cancer has spread to 1 to 3 nearby lymph nodes.

Stage 4

The cancer has grown into four or more lymph nodes. Or it has spread to parts of the body that are far away from the bile duct. For example, it has spread to the bones, lungs or distant parts of the liver.

Staging for distal bile duct cancer

Distal bile duct cancer starts in the bile ducts below the gallbladder.

TNM staging

Tumour (T)

  • Tis – the tumour is only in the first layer of the bile duct.
  • T1 – the tumour has grown up to 5mm into the bile duct wall.
  • T2 – the tumour has grown between 5 and 12mm into the bile duct wall.
  • T3 – the tumour has grown more than 12mm into the bile duct wall.
  • T4 – the tumour has grown into one or more of the main blood vessels nearby.

Nodes (N)

  • N0 – the cancer has not spread to nearby lymph nodes.
  • N1 – the cancer has spread to 1 to 3 nearby lymph nodes.
  • N2 – the cancer has spread to four or more nearby lymph nodes.

Metastases (M)

  • M0 – the cancer has not spread to parts of the body that are far away from the bile duct.
  • M1 – the cancer has spread to parts of the body that are far away from the bile duct. For example, it has spread to the liver, lungs, or peritoneum (the tissue covering organs in the abdomen).

Number staging

There are five main stages of distal bile duct cancer.

Stage 0

The tumour is only in the first layer of the bile duct. It has not grown into deeper layers.

Stage 1

The tumour has grown up to 5mm into the bile duct, but is not anywhere else.

Stage 2

The tumour has grown 5mm or more into the bile duct wall, or there is cancer in 1 to 3 nearby lymph nodes, or both.

Stage 3

The tumour has grown into a main blood vessel nearby, or the cancer is in four or more nearby lymph nodes, or both.

Stage 4

The cancer has spread to organs that are far away from the bile duct. For example, it has spread to the liver, lungs, or peritoneum (the tissue covering organs in the abdomen).

Resectable or unresectable tumours

When planning treatment for bile duct cancer, doctors use the terms resectable or unresectable. This describes whether it might be possible to remove (resect) the tumour with surgery:

  • Resectable tumours are ones that doctors think it may be possible to remove with surgery
  • Unresectable tumours cannot be removed with surgery. This might be because the cancer has spread to parts of the body far from the bile ducts. Or, it may be because the cancer is affecting important structures (such as large blood vessels) that cannot be removed.

Early stage cancers (stage 1 or 2) are often resectable. Some stage 3 cancers may also be resectable. When deciding whether a cancer is resectable, the doctor also needs to consider the position of the cancer and your general health.

Grading of bile duct cancer

Grading gives an idea of how quickly a cancer may develop. It is based on the way cancer cells look under a microscope:

  • In low-grade tumours, the cancer cells look very much like normal cells. They are usually slow-growing and are less likely to spread.
  • In high-grade tumours, the cells look very abnormal. They are more likely to grow more quickly and to spread.

About our information

  • References

    Below is a sample of the sources used in our bile duct cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Valle JW, Borbath I, Khan SA, et al. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2016; 27, suppl 5, v28-v37. Available from www.doi.org/10.1093/annonc/mdw324 (accessed October 2019).

    Rizvi S, Khan A, Hallemeier C, et al. Cholangiocarcinoma - evolving concepts and therapeutic strategies. Clinical Oncology, 2018; 15, 2, 95-111. Available from www.doi.org/10.1038/nrclinonc.2017.157 (accessed October 2019). 


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

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