Extrahepatic bile ducts
TNM staging of distal bile duct tumors

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 9 February 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging of distal bile duct tumors

Cite this page: Gulwani, H. TNM staging of distal bile duct tumors. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladderstagingextrahepaticdistal.html. Accessed March 23rd, 2018.
Definition / general
  • Classification excludes sarcomas and carcinoid tumors
  • Divided into perihilar (proximal) and distal bile duct tumors
  • Bile duct wall is more precisely defined as occurring between the mucosa and the outermost boundary of dense fibromuscular tissue, without consideration of the presence or absence of blood vessels and nerve fibers (Am J Surg Pathol 2006;30:744)
  • Primary tumor / vessel tumor / nodal tumor classification is better instead of current TNM classification for extrahepatic bile duct carcinoma (Hum Pathol 2008;39:37)
Primary tumor (T) - distal bile duct tumors
  • TX: Primary tumor cannot be assessed
  • T0: No evidence of primary tumor
  • Tis: Carcinoma in situ
  • T1: Tumor confined to the bile duct histologically
  • T2: Tumor invades beyond the wall of the bile duct
  • T3: Tumor invades the gallbladder, pancreas, duodenum or other adjacent organs without involvement of the celiac axis or the superior mesenteric artery
  • T4: Tumor invades the celiac axis or the superior mesenteric artery

pT2 and pT3
  • Extrahepatic biliary tree histology varies along its length, with little smooth muscle in wall of proximal ducts compared to distal bile duct, rendering assessment of depth of tumor invasion difficult
  • Inflammatory changes in bile ducts and desmoplastic stromal response to tumor may also cause distortion
  • To overcome these difficulties, recommended by some (but not widely adopted) to measure depth of tumor invasion from basal lamina of normal epithelium to the point of deepest tumor invasion
  • Current pT3 stage of distal EBD carcinomas can be subdivided into superficial (pT3a) and deep pancreatic invasion (pT3b, Mod Pathol 2005;18:969)
Regional lymph nodes (N) - distal bile duct tumors
  • NX: Regional lymph nodes cannot be assessed
  • N0: No regional lymph node metastasis
  • N1: Regional lymph node metastasis

  • Proposed to classify as N1 (metastasis in 1 - 4 regional lymph nodes) or N2 (metastasis in 5+ regional lymph nodes, Am J Surg Pathol 2005;29:1177)
Distant metastasis (M) - distal bile duct tumors
  • M0: No distant metastasis
  • M1: Distant metastasis
Stage grouping - distal bile duct tumors
  • 0: Tis N0 M0
  • IA: T1 N0 M0
  • IB: T2 N0 M0
  • IIA: T3 N0 M0
  • IIB: T1 - 3 N1 M0
  • III: T4 any N M0
  • IV: any T any N M1
Diagrams / tables

Images hosted on other servers:

Table - stage groupings

Various images