About bile duct cancer stages and grades

Staging means how big the cancer is and whether it has spread. Grading means how abnormal the cancer cells look under a microscope. This is important because your doctor uses this information to decide which treatment you need.

There are different ways of staging bile duct cancer. In the UK, doctors usually use the number staging system and the TNM system. TNM stands for Tumour, Node, Metastasis.

They may also use the Bismuth-Corlette staging system to stage a type of bile duct cancer called perihilar. 

The staging systems are different depending on where the bile duct cancer started. There are 3 types of bile duct cancer depending on where they start:

• intrahepatic bile duct cancer
• perihilar bile duct cancer
• distal extrahepatic bile duct cancer

We have detailed information about the number and TNM staging of the different types of bile duct cancer:

• intrahepatic bile duct cancer stages
• perihilar bile duct cancer stages
• distal extrahepatic bile duct cancer stages

Number staging system

The number staging system divides bile duct cancers into 4 main stages, from 1 to 4. The staging is different depending on the type of bile duct cancer you have. The information below is an overview of the number staging for all types of bile duct cancer.

Stage 1 means the cancer is small. The cancer cells are in the bile duct and have not started to spread into the surrounding tissue. Or they have grown into the bile duct wall.

Stage 2 means that the cancer is larger. There might be one or more tumours. It may have grown into the surrounding tissues, and there may be cancer cells in the lymph nodes nearby.

Find out about lymph nodes and the lymphatic system

Stage 3 means that the cancer has spread to nearby:

• tissues
• blood vessels
• organs such as the gallbladder and pancreas
• lymph nodes

Stage 4 means that the cancer has spread to other parts of the body. Common places where bile duct cancer can spread include the liver and lungs.

You may hear this called advanced cancer, secondary bile duct cancer or metastatic bile duct cancer.

TNM stages

The TNM staging system stands for Tumour, Node, Metastasis.

• T describes the size of the tumour (cancer)
• N describes whether there are any cancer cells in the lymph nodes
• M describes whether the cancer has spread to a different part of the body

The doctor gives each factor (T, N and M) a number, depending on how far the cancer has grown.

So, a very small cancer which hasn't spread to the lymph nodes or elsewhere in the body may be T1 N0 M0.

A larger cancer that has spread into the lymph nodes and to another part of the body may be T3 N1 M1.

Grades of bile duct cancer

The grade of a cancer is a way of measuring how abnormal cancer cells are compared to healthy cells. It also gives an idea of how quickly a cancer may grow and whether it is likely to spread.

Low grade cancers are usually slower growing and less likely to spread. High grade cancers tend to be faster growing and more likely to spread.

There are 3 grades of bile duct cancer – grade 1 to grade 3:

Grade 1

Grade 1 cancer means the cancer cells look similar to normal bile duct cells. This is called low grade cancer.

Grade 2

Grade 2 cancer means the cancer cells look a bit abnormal. This is called intermediate grade cancer.

Grade 3

Grade 3 cancer means the cancer cells look very abnormal and unlike normal bile duct cells. This is called high grade cancer.