Perihilar bile duct cancer stages

Bile duct cancer is also known as cholangiocarcinoma. There are different types of bile duct cancer depending on where it starts. Perihilar bile duct cancer starts in the bile ducts just outside the liver.

Diagram showing the position of the perihilar bile ducts

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

Bismuth-Corlette staging system
TNM system
number staging system

The stage of a cancer tells you how big the cancer is and whether it has spread. This is important because your doctor uses this information to decide which treatment you need. Your doctor looks at your test results to work out the stage.

Bismuth-Corlette staging

The Bismuth-Corlette staging system divides perihilar cancers into 4 main types. The type you have depends on where the cancer is in the perihilar area.

Type 1 means that the cancer is in the common hepatic duct.

Diagram showing type 1 perihilar bile duct cancer

Type 2 means that the cancer is in the common hepatic duct and the junction where the left and right hepatic bile ducts meet.

Diagram showing type 2 perihilar bile duct cancer

Type 3 is split into two groups.

Type 3A means that the cancer is in the common hepatic duct, the junction where the left and right bile ducts meet, and in the right hepatic duct.

Diagram showing type 3A perihilar bile duct cancer

Type 3B means that the cancer is in the common hepatic duct, the junction where the left and right bile ducts meet, and in the left hepatic duct.

Diagram showing type 3B perihilar bile duct cancer

Type 4 means that the cancer is in the common hepatic duct, the junction where the left and right bile ducts meet, and in both left and right hepatic ducts.

Diagram showing type 4 perihilar bile duct cancer

The number staging system

The number staging system divides perihilar bile duct cancer into 4 main stages, from 1 to 4.

Stage 1

Stage 1 means the tumour is within the bile duct and has not spread anywhere else. It is the same as T1, N0, M0 in the TNM staging system.

Stage 2

Stage 2 means the tumour has grown either into the fatty tissue around the bile duct or the liver. It is the same as T2, N0, M0.

Stage 3

Stage 3 is divided into 3 groups:

Stage 3A means the tumour has grown into a branch on one side of the portal vein or hepatic artery. These are main blood vessels that carry blood to the liver. It is the same as T3, N0, M0.

Stage 3B means the tumour has grown into one of the following:

both sides of the portal vein or hepatic artery
a hepatic bile duct on one side and one of the main blood vessels on the other side

This is the same as T4, N0, M0.

Stage 3C means the cancer is any size and has spread to between 1 and 3 lymph nodes nearby. This is the same as Any T, N1 and M0.

Stage 4

Stage 4 is split into 2 groups:

Stage 4A means that the cancer is any size and has spread to 4 or more nearby lymph nodes. It is the same as Any T, N2, M0.

Stage 4B means that the cancer has spread to another part of the body such as the lungs. It 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 the lymph nodes (N)
whether the cancer has spread to another part of the body (M)

Tumour (T) stages

There are 4 main T stages for perihilar bile duct cancer, from T1 to T4.

T1 means the tumour is within the bile duct.

T2 is split into 2 groups:

T2a means the tumour has grown through the wall of the bile duct and into the fatty tissue around it.
T2b means the tumour has grown into the liver next to the bile duct.

T3 means the tumour has grown into the branches on one side of the portal vein or hepatic artery.

T4 means the tumour has grown into one of the following:

the main portal vein or its branches on both sides
the common hepatic artery or its branches on both sides
a hepatic bile duct on one side and one of the main blood vessels on the other side

Diagram showing the two lobes of the liver and its blood supply and hepatic ducts

Node (N) stages

There are 3 stages:

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

N1 means there are cancer cells in 1 to 3 nearby lymph nodes.

N2 means there are cancer cells in 4 or more nearby lymph nodes.

Metastasis (M) stages

There are two M stages:

M0 means there is no sign of cancer spread.

M1 means the cancer has spread to other parts of the body such as the lungs.

Treatment options for perihilar bile duct cancer

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

where your cancer is
your general health and level of fitness

Depending on where the cancer is, you might have surgery. When deciding who can have surgery, doctors usually look at the Bismuth-Corlette stage. For example, if you have a type 3 perihilar bile duct cancer you might have surgery to remove:

the extrahepatic bile duct
gallbladder
lymph nodes nearby
part of the liver

These are major operations. Your doctor will make sure that you are well enough to have it.

Your doctor might also suggest other treatments to reduce your symptoms and help you feel better. This includes chemotherapy and putting a small tube (stent) to open up a blockage caused by the cancer.