Intrahepatic cholangiocarcinoma (staging)

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Intrahepatic cholangiocarcinoma staging is conducted most commonly in accordance with the TNM staging classification of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC). As of 2018, the staging criteria are in their 8 edition and reflected below . The rare mixed hepatocholangiocarcinoma (combined hepatocellular and cholangiocarcinoma) is also staged according to the intrahepatic bile duct classification . However, cancers of the perihilar and distal bile ducts are staged differently.

Primary tumor (T)

  • 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

Regional lymph node (N)

  • NX: regional lymph nodes cannot be assessed
  • N0: no regional lymph node metastasis
  • N1: regional lymph node metastasis present

Distant metastases (M)

  • cM0: no evidence of metastases
  • cM1: distant metastasis
  • pM1: distant metastasis, microscopically confirmed

Stage groups

  • stage 0
    • ​Tis, N0, M0
  • stage IA
    • T1a, N0, M0
  • stage IB
    • T1b, N0, M0
  • stage II
    • T2, N0, M0
  • stage IIIA
    • T3, N0, M0 
  • stage IIIB
    • T4, N0, M0
    • [Any T], N1, M0
  • stage IV
    • [Any T], [Any N], M1

Prognosis

The 5-year survival for each stage of intrahepatic cholangiocarcinoma in the AJCC 8 edition is as follows :

  • stage IA: 58%
  • stage IB: 45%
  • stage II: 31%
  • stage IIIA: 24%
  • stage IIIB: 12%
  • stage IV: 9%