Intrahepatic Bile Ducts
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Intrahepatic Bile Ducts (ICD‐O‐3 C22.1) Rules for Classification The staging system applies to intrahepatic cholangiocarcinoma, cholangio cellular carcinoma, and combined hepatocellular and cholangiocarcinoma (mixed hepatocellular/cholangiocellular carcinoma). The following are the procedures for assessing T, N, and M categories. T categories Physical examination, imaging, and/or surgical exploration N categories Physical examination, imaging, and/or surgical exploration M categories Physical examination, imaging, and/or surgical exploration
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 peri aortic 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 T1b Solitary tumour more than 5 cm in greatest dimension without vas cular invasion T2 Solitary tumour with intrahepatic vascular invasion or multiple tumours, with or without vascular invasion T3 Tumour perforating the visceral peritoneum T4 Tumour involving local extrahepatic structures by direct hepatic invasion
Digestive System
Regional Lymph Nodes