Intrahepatic bile duct cancer stages

Bile duct cancer is also known as cholangiocarcinoma. 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.  

Diagram showing the position of the intrahepatic bile ducts

The stage of a cancer tells you how big the cancer is and whether it has spread. Your doctor looks at your test results to work out the stage.

Knowing the stage of a cancer is important. This is because it helps your doctor decide which treatment is best for you.

There are different ways of staging intrahepatic bile duct cancer. In the UK doctors usually use the:

  • number staging system
  • TNM system

The number staging system

The number staging system divides intrahepatic bile duct cancer into 4 main stages. These are numbered from 1 to 4.

Stage 1

This means the cancer is only in the bile ducts. It hasn't spread into the nearby blood vessels or anywhere else. Stage 1 is split into two groups:

Stage 1A means there is only one cancer and it is 5cm or smaller. This is the same as T1a, N0, M0 in the TNM staging system.

Stage 1B means there is only one cancer and it is bigger than 5cm. This is the same as T1b, N0, M0.

Stage 2

This means there is either:

  • one cancer in the bile ducts and it has grown into nearby blood vessels
  • more than one cancer in the bile ducts and they might have grown into nearby blood vessels

Stage 2 intrahepatic bile duct cancer is the same as T2, N0, M0.

Stage 3

This is split into two groups:

Stage 3A means the cancer has spread from the bile ducts and through the layer of tissue covering the liver (the visceral peritoneum). This is the same as T3, N0, M0.

Stage 3B means the cancer has spread from the bile ducts to either:

  • nearby structures outside the liver like the bowel. This is the same as T4, N0, M0
  • nearby lymph nodes. This is the same as any T, N1, M0

Stage 4

This means that the cancer has spread further away from the bile ducts. The most common places for intrahepatic bile duct cancer to spread to include the bones and lungs.

Stage 4 intrahepatic bile duct cancer is the same as any T, any N, M1.

The TNM staging system

TNM stands for Tumour, Node and Metastasis. The system describes: 

  • the size of the primary tumour (T)
  • whether the cancer has spread to nearby lymph nodes (N)
  • whether the cancer has spread to another part of the body further away from the bile ducts (M)

Tumour (T) stages

There are 4 main T stages for intrahepatic bile duct cancer. These are numbered from T1 to T4.

T1 means there is only one tumour and it hasn't grown into nearby blood vessels. T1 is split into 2 groups: 

  • T1a means the tumour is 5cm or smaller
  • T1b means the tumour is bigger than 5cm

T2 means there is either:

  • one tumour that has grown into nearby blood vessels
  • more than one tumour and they might have grown into nearby blood vessels

T3 means the tumour has spread from the bile ducts and through the layer of tissue covering the liver (the visceral peritoneum).

T4 means the tumour has grown into nearby structures outside the liver, like the bowel.

Node (N) stages

There are two N stages for intrahepatic bile duct cancer:

N0 means there are no cancer cells in the nearby lymph nodes.

N1 means there are cancer cells in the nearby lymph nodes.

Metastasis (M) stages

There are two M stages for intrahepatic bile duct cancer:

M0 means there is no sign the cancer has spread to other parts of the body away from the bile ducts.

M1 means the cancer has spread to other parts of the body away from the bile ducts. This includes the bones, lungs and lymph nodes that are further away.

Treatment options for intrahepatic bile duct cancer

The stage of the cancer helps your doctor decide which treatment is best for you. Treatment also depends on:

  • where in the intrahepatic bile ducts the cancer is
  • how well your liver works
  • your general health and level of fitness
  • if there are any gene Open a glossary item changes in the cancer cells

You might have surgery if you have a stage 1 or 2 intrahepatic bile duct cancer. Usually, your surgeon removes part of the liver. This is a major operation. Your doctor will make sure that you are well enough to have it.

Unfortunately, most bile duct cancers are advanced by the time they are diagnosed. This means you might not be able to have surgery. Your doctor might suggest other treatments to reduce your symptoms and help you feel better. This may include chemotherapy and targeted cancer drugs.

  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on Cancer
    Springer, 2017

  • EASL - ILCA Clinical Practice Guidelines on the management of intrahepatic cholangiocarcinoma
    European Association for the Study of the Liver
    Journal of Hepatology, 2023. Volume 79, Pages 181-208

  • British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma
    SM Rushbrook and others
    Gut, 2024. Volume 73, Pages 16-46

  • Current Management of Intrahepatic Cholangiocarcinoma: From Resection to Palliative Treatment
    I Bartolini and others
    Radiology and Oncology, 2020. Volume 54, Issue 3, Pages 263-271

  • Biliary tract cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow up
    A Vogel and others
    Annals of Oncology, 2023. Volume 34, Issue 2, Pages 127–140

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.

Last reviewed: 
03 Jul 2024
Next review due: 
03 Jul 2027

Related links