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.
Types of bile duct cancer
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
- perihilar bile duct cancer starts in the bile ducts just outside the liver
- distal bile duct cancer starts in the bile ducts closer to the
pancreas 
and small bowel
Doctors stage the different types of bile duct cancer in different ways. We have detailed information about the staging for each type here:
Number staging system
The number staging system divides bile duct cancers into 4 main stages. These are numbered 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. They may have spread into the bile duct walls. But they have not spread outside the walls.
Stage 2 means the cancer is larger. There might be one or more cancers in the bile duct. It may have grown into the surrounding tissues, and there may be cancer cells in the nearby lymph nodes.
Stage 3 means the cancer has spread to nearby:
-
tissues
-
blood vessels
-
organs that are close to the bile ducts like the gallbladder and pancreas
-
lymph nodes
Stage 4 means the cancer has spread to other parts of the body further away from the bile ducts. Common places include the liver and lungs.
You may hear this called advanced cancer, secondary bile duct cancer or metastatic bile duct cancer.
TNM stages
TNM stands for Tumour (T), Node (N) and Metastasis (M). The staging is different depending on the type of bile duct cancer you have.
The information below is an overview of the TNM staging for all types of bile duct cancer.
- T describes the size of the tumour (cancer)
- N describes whether there are any cancer cells in the nearby lymph nodes
- M describes whether the cancer has spread to parts of the body further away from the bile ducts
The doctor gives each factor (T, N and M) a number. The number depends on how far the cancer has grown or spread.
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 nearby lymph nodes and to another part of the body may be T3 N1 M1.
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 tells your doctor how abnormal the 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 grow faster and be 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.
