Cholangiocarcinoma (staging)

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

Tumour resection is currently the most optimal treatment and the ability of the tumour 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 tumours ¹. Lymph node metastases and extrahepatic metastases are much more likely than with hepatocellular carcinoma.

Current staging classifications include:

• AJCC/UICC system (8^th edition) for staging cholangiocarcinoma
• Okabayashi system
• AJCC system (7^th edition) for staging cholangiocarcinoma

Variables used in these systems include

• tumour size (>2;5 cm)
• multiple tumours
• bilaterality of tumours
• 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 tumour 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:

• MSKCC system for staging cholangiocarcinoma
• AJCC system (7^th edition) for staging cholangiocarcinoma

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
• tumour extension into second order biliary radicles
• tumour 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

• worse histological grade of the tumour
• increased tumour markers
  • CA-19-9
  • CEA