Cholangiocarcinoma (staging)

Cholangiocarcinoma staging is dependent on whether the tumor is primarily intrahepatic (ICC), hilar/perihilar (Klatskin), or extrahepatic.

Tumor resection is currently the most optimal treatment and the ability of the tumor to infiltrate longitudinally and radially along the biliary tree necessitates aggressive resection strategies such as ipsilateral hepatectomy.

Intrahepatic cholangiocarcinoma (ICC) staging

ICC staging follows the more traditional "TNM" staging model for epithelial tumors 1. Lymph node metastases and extrahepatic metastases are much more likely than with hepatocellular carcinoma.

Current staging classifications include:

Variables used in these systems include

  • tumor size (>2 cm)
  • multiple tumors
  • bilaterality of tumors
  • vascular invasion (micro and/or macro)
Perihilar/hilar cholangiocarcinoma staging

The problem with traditional TNM staging for hilar cholangiocarcinoma is that a small, badly place tumor markedly worsens prognosis, and T staging was inadequate. Traditionally, the Bismuth-Corlette classification (developed in 1975) was an anatomic description used to assess resectability of hilar/perihilar cholangiocarcinoma 2. This classification is useful but has been modified over time.

Current staging classifications include:

Important features common to both assessments include: 

  • hepatic duct involvement (unilateral vs. bilateral)
  • portal vein involvement (ipsilateral vs contralateral vs. main)

Other variables include:

  • ipsilateral hepatic hemiatrophy
  • tumor extension into second order biliary radicles
  • tumor extension into surrounding adipose tissue or hepatic parenchyma
  • hepatic artery involvement (ipsilateral vs contralateral vs. common hepatic artery)
  • regional lymph node metastases
Exrahepatic cholangiocarcinoma staging

content pending

Pathology

Poorer prognosis has also been associated with: 3,4

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Article information

rID: 34374
Section: Staging
Synonyms or Alternate Spellings:
  • CCA staging

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