Gallbladder & extrahepatic bile ducts


Staging-distal bile duct

Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Last author update: 10 December 2020
Last staff update: 13 May 2021

Copyright: 2003-2024,, Inc.

PubMed Search: Staging of distal bile duct tumors "loattrfree full text"[sb]

Raul S. Gonzalez, M.D.
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Cite this page: Gonzalez RS. Staging-distal bile duct. website. Accessed May 19th, 2024.
Definition / general
  • All carcinomas of the distal common bile duct (with an epicenter between the cystic duct / common hepatic duct confluence and the ampulla of Vater), including poorly differentiated neuroendocrine carcinomas, are covered by this staging system
  • Cystic duct lesions are staged using the gallbladder template and common hepatic duct lesions are staged using the perihilar template
Essential features
  • AJCC, 7th Edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the AJCC, 8th Edition, 2018 is mandatory
  • These lesions are generally referred to as adenocarcinoma, rather than cholangiocarcinoma
ICD coding
  • C24.0: malignant neoplasm of extrahepatic bile duct
Primary tumor (pT)
  • TX: primary tumor cannot be assessed
  • T0: no evidence of primary tumor
  • Tis: carcinoma in situ / high grade dysplasia
  • T1: tumor invades the bile duct wall with a depth less than 5 mm
  • T2: tumor invades the bile duct wall with a depth of 5 - 12 mm
  • T3: tumor invades the bile duct wall with a depth greater than 12 mm
  • T4: tumor invades the celiac axis, superior mesenteric artery or common hepatic artery
  • Notes: careful perpendicular or longitudinal sections of the bile duct wall must be taken in order for accurate measurements of invasion to be made
Regional lymph nodes (pN)
  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: metastasis in one to three regional lymph nodes
  • N2: metastasis in four or more regional lymph nodes
  • Notes: regional lymph nodes include the common bile duct, hepatic artery, anterior and posterior pancreaticoduodenal and right lateral superior mesenteric artery nodes
Distant metastasis (pM)
  • M0: no distant metastasis
  • M1: distant metastasis
Stage grouping
  • Stage 0:Tis N0 M0
  • Stage I:T1 N0 M0
  • Stage IIA:T1 N1 M0
  •  T2 N0 M0
  • Stage IIB:T2 N1 M0
  •  T3 N0 - 1 M0
  • Stage IIIA:T1 - 3 N2 M0
  • Stage IIIB:T4 N0 - 2 M0
  • Stage IVB:any T any N M1

Registry data collection variables
  • Tumor location: cystic duct, perihilar bile ducts or distal bile duct
  • CEA
  • CA19-9
Histologic grade
  • GX: grade cannot be assessed
  • G1: well differentiated
  • G2: moderately differentiated
  • G3: poorly differentiated
Histopathologic type
  • Adenocarcinoma, biliary type
  • Adenocarcinoma, intestinal type
  • Adenocarcinoma, gastric foveolar type
  • Mucinous adenocarcinoma
  • Clear cell adenocarcinoma
  • Signet ring cell carcinoma
  • Squamous cell carcinoma
  • Adenosquamous carcinoma
  • Undifferentiated carcinoma
  • Neuroendocrine carcinoma
  • Small cell neuroendocrine carcinoma
  • Large cell neuroendocrine carcinoma
  • Mixed adenoneuroendocrine carcinoma
  • Intraductal papillary neoplasm with an associated invasive component
  • Mucinous cystic neoplasm with an associated invasive component
Residual tumor
  • R0: complete resection with grossly and microscopically negative margins of resection
  • R1: grossly negative but microscopically positive margins of resection
  • R2: grossly and microscopically positive margins of resection
Board review style question #1
Bile duct adenocarcinoma arising in the pancreas and invading 10 mm into the bile duct wall, focally involving the pancreas but no other local structures, would be staged as which of the following using AJCC 8th edition criteria?

  1. pT1
  2. pT2
  3. pT3
  4. pT4
Board review style answer #1
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