Distal Extrahepatic Bile Duct
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Distal Extrahepatic Bile Duct (ICD‐O‐3 C24.0) Rules for Classification The classification applies to carcinomas of the extrahepatic bile ducts distal to the insertion of the cystic duct. Cystic duct carcinoma is included under gallbladder. The following are the procedures for assessing T, N, and M categories. T categories Physical examination, imaging, and/or surgical exploration N categories Physical examination, imaging, and/or surgical exploration M categories Physical examination, imaging, and/or surgical exploration
Regional Lymph Nodes
TNM Clinical Classification T – Primary Tumour TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis Carcinoma in situ
T1 T2 T3 T4
Tumour invades bile duct wall to a depth less than 5 mm Tumour invades bile duct wall to a depth of 5 mm up to 12 mm Tumour invades bile duct wall to a depth of more than 12 mm Tumour involves the coeliac axis, the superior mesenteric artery and/ or the common hepatic artery
N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N1 Metastases to 1–3 regional nodes N2 Metastasis to 4 or more regional nodes
Digestive System
The regional lymph nodes are along the common bile duct, hepatic artery, back towards the coeliac trunk, posterior and anterior pancreaticoduodenal nodes, and nodes along the superior mesenteric artery.
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Digestive System Tumours
M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8. pN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 12 or more lymph nodes. If the regional lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.
Stage – Distal Extrahepatic Bile Duct Stage 0 Stage I Stage IIA Stage IIB Stage IIIA Stage IIIB Stage IV
Tis T1 T1 T2 T2 T3 T1, T2, T3 T4 Any T
N0 N0 N1 N0 N1 N0, N1 N2 Any N Any N
M0 M0 M0 M0 M0 M0 M0 M0 M1
Prognostic Factor Grid – Biliary Tract and Gallbladder Cancers Prognostic risk factors in biliary tract carcinoma Prognostic factors
Tumour related
Host related
Environment related
Essential
Resectable
ECOG status
Residual disease (R0, R1, R2)
Additional
Lymph node metastases
New and promising
FGFR2 mutations
Source: UICC Manual of Clinical Oncology, Ninth Edition. Edited by Brian O’Sullivan, James D. Brierley, Anil K. D’Cruz, Martin F. Fey, Raphael Pollock, Jan B. Vermorken and Shao Hui Huang. © 2015 UICC. Published 2015 by John Wiley & Sons, Ltd.