Intrahepatic 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. Intrahepatic bile duct cancer starts in the bile ducts in the liver.

Diagram showing the position of the intrahepatic bile ducts

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

number staging system
TNM 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.

The number staging system

The number staging system divides intrahepatic bile duct cancer into 4 main stages, 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 divided 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 can mean 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 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 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 the 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 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.