Liver & intrahepatic bile ducts
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Staging-cholangiocarcinoma
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TNM staging[TIAB] intrahepatic bile duct tumors
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Cite this page: Gonzalez RS. Staging-cholangiocarcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/livertumortnmintrahepatic.html. Accessed May 30th, 2023.
Pathologic TNM staging of intrahepatic bile duct carcinomas, AJCC 8th edition
Definition / general
- All intrahepatic bile duct carcinomas, including combined hepatocellular cholangiocarcinomas and poorly differentiated neuroendocrine carcinomas, are covered by this staging system
- Not covered by this staging system are carcinomas of the perihilar or distal bile ducts
ICD coding
- C22.1: Intrahepatic bile duct carcinoma
Primary tumor (pT)
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ (intraductal tumor)
- T1: Solitary tumor without vascular invasion
- T1a: Solitary tumor ≤ 5 cm without vascular invasion
- T1b: Solitary tumor > 5 cm without vascular invasion
- T2: Solitary tumor with intrahepatic vascular invasion or multiple tumors, with or without vascular invasion
- T3: Tumor perforating the visceral peritoneum
- T4: Tumor involving local extrahepatic structures by direct invasion
Note:
- Tumor growth patterns (mass forming versus periductal) are no longer part of staging criteria but should still be reported
Regional lymph nodes (pN)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis
Notes:
- Regional lymph nodes depend on tumor site
- For left sided lesions, regional nodes include inferior phrenic, hilar and gastrohepatic lymph nodes
- For right sided lesions, regional nodes include hilar, periduodenal and peripancreatic lymph nodes
Prefixes
- y: Preoperative radiotherapy or chemotherapy
- r: Recurrent tumor stage
Stage grouping
| Stage 0: | Tis | N0 | M0
|
| Stage IA: | T1a | N0 | M0
|
| Stage IB: | T1b | N0 | M0
|
| Stage IIA: | T2 | N0 | M0
|
| Stage IIIA: | T3 | N0 | M0
|
| Stage IIIB: | T4 | N0 | M0
|
| | any T | N1 | M0
|
| Stage IV: | any T | any N | M1
|
Registry data collection variables
- Presence of nontumoral hepatic parenchymal fibrosis / cirrhosis
- Primary sclerosing cholangitis
- Serum CA 19-9 level
- Tumor growth pattern
Histologic grade
- GX: Grade cannot be assessed
- G1: Well differentiated
- G2: Moderately differentiated
- G3: Poorly differentiated
Histopathologic type
- Intrahepatic cholangiocarcinoma
- Combined hepatocellar cholangiocarcinoma
- Carcinosarcoma
- Intraductal papillary neoplasm with an associated invasive carcinoma
- Mucinous cystic neoplasm with an associated invasive carcinoma
- Bile duct cystadenocarcinoma
- Neuroendocrine carcinoma, NOS
- Large cell neuroendocrine carcinoma
- Small cell neuroendocrine carcinoma
Board review style question #1
Which of the following is true regarding AJCC 8th edition staging of intrahepatic bile duct carcinomas?
- Combined hepatocellular cholangiocarcinomas are staged using different criteria
- Periductal invasion automatically characterizes a tumor as pT4
- Regional lymph nodes are different for left sided and right sided tumors
- Size cutoff of 5 cm is used to distinguish pT1 from pT2 tumors
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