If extrahepatic bile duct cancer is diagnosed, the doctor needs to know the stage
, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has spread, and if so, to what parts of the body.
The Spreading of Cancer
There are three ways that cancer spreads in the body:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary tumor and travel through the lymph or blood to other places in the body, another, or secondary tumor, may form. This process is called metastasis.
The secondary, or metastatic, tumor is the same type of cancer as the primary tumor. For example, if bile duct cancer spreads to the bones, the cancer cells in the bones are actually bile duct cancer cells. The disease is metastatic bile duct cancer
, not bone cancer.
The following stages are used for Extrahepatic Bile Duct cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the innermost layer of tissue lining the extrahepatic bile duct. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ
In stage I, cancer has formed. Stage I is divided into stage IA and stage IB.
- Stage IA - The cancer is found in the bile duct only
- Stage IB - The cancer has spread through the wall of the bile duct
Stage II is divided into stage IIA and stage IIB
- Stage IIA - Cancer has spread to the liver, gallbladder, pancreas and/or to either the right or left branch of the hepatic artery or to the right or left branch of the portal vein.
- Stage IIB - Cancer has spread to nearby lymph nodes and is found in the bile duct or through the wall of the bile duct or has spread to the liver, gallbladder, pancreas and/or to either the right or left branch of the hepatic artery or to the right or left branch of the portal vein.
In stage III, cancer has spread to the main portal vein or to both right and left branches of the portal vein; or to the hepatic artery or to other nearby organs or tissues, such as the colon, stomach, small intestine or abdominal wall. Cancer may have spread to nearby lymph nodes.
In stage IV, cancer has spread to lymph nodes and/or organs not near the extrahepatic bile duct. Extrahepatic bile duct cancer can also be grouped according to how the cancer may be treated. There are two treatment groups:
Localized (and Resectable)
The cancer is in an area where it can be removed completely by surgery.
Unresectable, Recurrent or Metastatic:
- Unresectable - The cancer cannot be removed completely by surgery. Most patients with extrahepatic bile duct cancer have unresectable cancer.
- Recurrent - The cancer is cancer that has recurred after it has been treated. Extrahepatic bile duct cancer may come back in the bile duct or in other parts of the body.
- Metastasis - This is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic extrahepatic bile duct cancer may have spread to nearby blood vessels, the liver, the common bile duct, nearby lymph nodes, other parts of the abdominal cavity or to distant parts of the body.
In all cases, treatment should be individualized for you. Although cancers are classified into particular stages, each person is unique.