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Bile Duct Cancer Stages

This page describes the stages of bile duct cancer (cholangiocarcinoma) for adults. The stage describes the extent of cancer in the body. Knowing the stage helps the doctor plan the best treatment. Bile duct cancer stages are described using the TNM staging system. To learn more about TNM and how cancer stages are described, see Cancer Staging. 

To learn about the tests and procedures used to diagnose and stage bile duct cancer, see Bile Duct Cancer Diagnosis. 

Intrahepatic bile duct cancer

  • Stage 0: In stage 0 intrahepatic bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the intrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
  • Stage I: Stage I intrahepatic bile duct cancer is divided into stages IA and IB.  
    • In stage IA, cancer has formed in an intrahepatic bile duct and the tumor is 5 centimeters or smaller. 
    • In stage IB, cancer has formed in an intrahepatic bile duct and the tumor is larger than 5 centimeters.
    EnlargeDrawing shows different sizes of a tumor in centimeters (cm) compared to the size of a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm). Also shown is a 10-cm ruler and a 4-inch ruler.
    Tumor sizes are often measured in centimeters (cm) or inches. Common food items that can be used to show tumor size in cm include: a pea (1 cm), a peanut (2 cm), a grape (3 cm), a walnut (4 cm), a lime (5 cm or 2 inches), an egg (6 cm), a peach (7 cm), and a grapefruit (10 cm or 4 inches).
  • Stage II: In stage II intrahepatic bile duct cancer, either of the following is found: 
    • the tumor has spread through the wall of an intrahepatic bile duct and into a blood vessel; or 
    • more than one tumor has formed in the intrahepatic bile duct and may have spread into a blood vessel.
  • Stage III: Stage III intrahepatic bile duct cancer is divided into stages IIIA and IIIB. 
    • In stage IIIA, the tumor has spread through the capsule (outer lining) of the liver. 
    • In stage IIIB, cancer has spread to organs or tissues near the liver, such as the duodenum, colon, stomach, common bile duct, abdominal wall, diaphragm, or the part of the vena cava behind the liver, or the cancer has spread to nearby lymph nodes.  
  • Stage IV: In stage IV intrahepatic bile duct cancer, cancer has spread to other parts of the body, such as the bone, lungs, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen.

Perihilar bile duct cancer

  • Stage 0: In stage 0 perihilar bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia.
  • Stage I: In stage I perihilar bile duct cancer, cancer has formed in the innermost layer of tissue lining the perihilar bile duct and has spread into the muscle layer or fibrous tissue layer of the perihilar bile duct wall.
  • Stage II: In stage II perihilar bile duct cancer, cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to liver tissue. 
  • Stage III: Stage III perihilar bile duct cancer is divided into stages IIIA, IIIB, and IIIC. 
    • Stage IIIA: Cancer has spread to branches on one side of the hepatic artery or of the portal vein. 
    •  Stage IIIB: Cancer has spread to one or more of the following:  
      • the main part of the portal vein or its branches on both sides
      • the common hepatic artery
      • the right hepatic duct and the left branch of the hepatic artery or of the portal vein
      • the left hepatic duct and the right branch of the hepatic artery or of the portal vein
    •  Stage IIIC: Cancer has spread to 1 to 3 nearby lymph nodes.
  • Stage IV: Stage IV perihilar bile duct cancer is divided into stages IVA and IVB. 
    • Stage IVA: Cancer has spread to 4 or more nearby lymph nodes.
    •  Stage IVB: Cancer has spread to other parts of the body, such as the liver, lung, bone, brain, skin, distant lymph nodes, or tissue lining the wall of the abdomen and most organs in the abdomen. 

Distal bile duct cancer

  • Stage 0: In stage 0 distal bile duct cancer, abnormal cells are found in the innermost layer of tissue lining the distal bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ or high-grade dysplasia. 
    EnlargeMillimeters; drawing shows millimeters (mm) using everyday objects. A sharp pencil point shows 1 mm, a new crayon point shows 2 mm, and a new pencil-top eraser shows 5 mm.
    Millimeters (mm). A sharp pencil point is about 1 mm, a new crayon point is about 2 mm, and a new pencil eraser is about 5 mm.
  • Stage I: In stage I distal bile duct cancer, cancer has formed and spread fewer than 5 millimeters into the wall of the distal bile duct.
  • Stage II: Stage II distal bile duct cancer is divided into stages IIA and IIB. 
    • Stage IIA: Cancer has spread
      • fewer than 5 millimeters into the wall of the distal bile duct and has spread to 1 to 3 nearby lymph nodes; or 
      • 5 to 12 millimeters into the wall of the distal bile duct.
    • Stage IIB: Cancer has spread 5 millimeters or more into the wall of the distal bile duct. Cancer may have spread to 1 to 3 nearby lymph nodes.
  • Stage III: Stage III distal bile duct cancer is divided into stages IIIA and IIIB.
    • Stage IIIA: Cancer has spread into the wall of the distal bile duct and to 4 or more nearby lymph nodes.
    • Stage IIIB: Cancer has spread to the large vessels that carry blood to the organs in the abdomen. Cancer may have spread to 1 or more nearby lymph nodes.
  • Stage IV: In stage IV distal bile duct cancer, cancer has spread to other parts of the body, such as the liver, lungs, or tissue lining the wall of the abdomen and most organs in the abdomen.

For bile duct cancer, the following groups are used to plan treatment: 

Resectable (localized) bile duct cancer

The cancer is in an area, such as the lower part of the common bile duct or perihilar area, where it can be removed completely by surgery.

Unresectable (including metastatic and recurrent) bile duct cancer

Unresectable cancer cannot be removed completely by surgery. Most patients with bile duct cancer cannot have their cancer completely removed by surgery.

Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic bile duct cancer may have spread to the liver, other parts of the abdominal cavity, or to distant parts of the body. To learn more about metastatic cancer, see Metastatic Cancer: When Cancer Spreads.

Recurrent bile duct cancer is cancer that has come back after treatment. The cancer may come back in the bile ducts, liver, or gallbladder. Less often, it may come back in distant parts of the body.  To learn more about recurrent cancer, see Recurrent Cancer: When Cancer Comes Back. 

To learn about treatment options, see Bile Duct Cancer Treatment. 

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