Cancer Health Center

After extrahepatic bile duct cancer has been diagnosed, tests are done to find out if cancer cells have spread within the bile duct or to other parts of the body.

The process used to find out if cancer has spread within the extrahepatic bile duct or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

Extrahepatic bile duct cancer is usually staged following a laparotomy. A surgicalincision is made in the wall of the abdomen to check the inside of the abdomen for signs of disease and to remove tissue and fluid for examination under a microscope. The results of the diagnosticimaging tests, laparotomy, and biopsy are viewed together to determine the stage of the cancer. Sometimes, a laparoscopy will be done before the laparotomy to see if the cancer has spread. If the cancer has spread and cannot be removed by surgery, the surgeon may decide not to do a laparotomy.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

• 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 (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for extrahepatic bile duct cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormalcells 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.

Stage I

In stage I, cancer has formed. Stage I is divided into stage IA and stage IB.

• Stage IA: Cancer is found in the bile duct only.
• Stage IB: Cancer has spread through the wall of the bile duct.

Stage II

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
  • has spread through the wall of the bile duct; or
  • has spread to the liver, gallbladder, pancreas, and/or the right or left branches of the hepatic artery or portal vein.