LIVER – INTRAHEPATIC BILE DUCTS (ICD‐O‐3 C22.1)

Rules for Classification

The staging system applies only to intrahepatic cholangiocarcinoma, cholangiocellular carcinoma, and combined hepatocellular and cholangiocarcinoma (mixed hepatocellular/ cholangiocellular carcinoma)

Regional Lymph Nodes

For right liver intrahepatic cholangiocarcinoma, the regional lymph nodes include the hilar (common bile duct, hepatic artery, portal vein and cystic duct), periduodenal and peripancreatic lymph nodes.

For left liver intrahepatic cholangiocarcinoma, regional lymph nodes include hilar and gastrohepatic lymph nodes.

For intrahepatic cholangiocarcinoma, spread to the coeliac and/or periaortic and caval lymph nodes are distant metastases (M1).

TNM Clinical Classification

T – Primary Tumour

TX	Primary tumour cannot be assessed
T0	No evidence of primary tumour
Tis	Carcinoma in situ (intraductal tumour)
T1a	Solitary tumour 5 cm or less in greatest dimension without vascular invasion (Fig. 207)
T1b	Solitary tumour more than 5 cm in greatest dimension without vascular invasion (Fig. 207)
T2	Solitary tumour with intrahepatic vascular invasion or multiple tumours, with or without vascular invasion (Figs. 208, 209)
T3	Tumour perforating the visceral peritoneum (Fig. 210)
T4	Tumour involving local extrahepatic structures by hepatic invasion (Fig. 210)

Schematic illustration of Solitary tumour 5 cm or less in greatest dimension without vascular
invasion. — **Fig. 207**

Schematic illustration of Solitary tumour with intrahepatic vascular invasion or multiple tumours, with or without vascular invasion. — **Fig. 208**

Schematic illustration of tumour perforating the visceral peritoneum. — **Fig. 210**

Schematic illustration of Regional lymph node metastasis. — **Fig. 211**

N – Regional Lymph Nodes

NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Regional lymph node metastasis (Fig. 211)

M – Distant Metastasis

M0	No distant metastasis
M1	Distant metastasis

TNM Pathological Classification

The pT and pN categories correspond to the T and N categories.

pM1	Distant metastasis microscopically confirmed

Note

pM0 and pMX are not valid categories.

pN0

Histological examination of a regional lymphadenectomy specimen will ordinarily include 3 or more lymph nodes. If the regional lymph nodes are negative, but the number ordinarily examined is not met, classify as pN0.