Intrahepatic Bile Ducts
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Intrahepatic Bile Ducts (ICD‐O‐3 C22.1) Rules for Classification The staging system applies to intrahepatic cholangiocarcinoma, cholangio cellular carcinoma, and combined hepatocellular and cholangiocarcinoma (mixed hepatocellular/cholangiocellular carcinoma). 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
For right‐liver intrahepatic cholangiocarcinoma, the regional lymph nodes include the hilar (common bile duct, hepatic artery, portal vein, and cystic duct), periduodenal, and peripancreatic lymph nodes. For left‐liver intrahepatic cholangiocarcinoma, regional lymph nodes include hilar and gastrohepatic lymph nodes. For intrahepatic cholangiocarcinoma, spread to the coeliac and/or peri aortic and caval lymph nodes are distant metastases (M1).
TNM Clinical Classification T – Primary Tumour TX Primary tumour cannot be assessed T0 No evidence of primary tumour Tis Carcinoma in situ (intraductal tumour)
T1a Solitary tumour 5 cm or less in greatest dimension without vascular invasion T1b Solitary tumour more than 5 cm in greatest dimension without vas cular invasion T2 Solitary tumour with intrahepatic vascular invasion or multiple tumours, with or without vascular invasion T3 Tumour perforating the visceral peritoneum T4 Tumour involving local extrahepatic structures by direct hepatic invasion
Digestive System
Regional Lymph Nodes
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Digestive System Tumours
N – Regional Lymph Nodes NX Regional lymph nodes cannot be assessed N0 No regional lymph node metastasis N1 Regional lymph node metastasis
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 6 or more lymph nodes. If the regional lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.
Stage – Intrahepatic Bile Ducts Stage I Stage IA Stage IB Stage II Stage IIIA Stage IIIB Stage IV
T1 T1a T1b T2 T3 T4 Any T Any T
N0 N0 N0 N0 N0 N0 N1 Any N
M0 M0 M0 M0 M0 M0 M0 M1