Key Points for This Section

After extrahepatic bile duct cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bile duct or to other parts of the body. The following stages are used for extrahepatic bile duct cancer: Stage 0 (Carcinoma in Situ) Stage I Stage II Stage III Stage IV Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups: Localized (and resectable) Unresectable

After extrahepatic bile duct cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bile duct or to other parts of the body.

The process used to find out if cancer has spread within the extrahepatic bile duct or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

Extrahepatic bile duct cancer is usually staged following a laparotomy. A surgical incision is made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope. The results of the diagnostic imaging tests, laparotomy, and biopsy are viewed together to determine the stage of the cancer. Sometimes, a laparoscopy will be done before the laparotomy to see if the cancer has spread. If the cancer has spread and cannot be removed by surgery, the surgeon may decide not to do a laparotomy.

The following stages are used for extrahepatic bile duct cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the innermost layer of tissue lining the extrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA and stage IB.

• Stage IA: Cancer is found in the bile duct only.
• Stage IB: Cancer has spread through the wall of the bile duct.

Stage II

Stage II is divided into stage IIA and stage IIB.

• Stage IIA: Cancer has spread to the liver, gallbladder, pancreas, and/or to either the right or left branches of the hepatic artery or to right or left branches of the portal vein.
• Stage IIB: Cancer has spread to nearby lymph nodes and:
  • is found in the bile duct; or
  • has spread through the wall of the bile duct; or
  • has spread to the liver, gallbladder, pancreas, and/or the right or left branches of the hepatic artery or portal vein.

Stage III

In stage III, cancer has spread:

• to the portal vein or to both right and left branches of the portal vein; or
• to the hepatic artery; or
• to other nearby organs or tissues, such as the colon, stomach, small intestine, or abdominal wall.

Cancer may have spread to nearby lymph nodes also.

Stage IV

In stage IV, cancer has spread to lymph nodes and/or organs far away from the extrahepatic bile duct.

Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:

Localized (and resectable)

The cancer is in an area where it can be removed completely by surgery.

Unresectable

The cancer cannot be removed completely by surgery. The cancer may have spread to nearby blood vessels, the liver, the common bile duct, nearby lymph nodes, or other parts of the abdominal cavity.

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