TNM 7 classification







TNM 6 classification



1. Rules for Classification


The classification applies to carcinomas of extrahepatic bile ducts and those
of choledochal cysts. There should be histological confirmation of the disease.


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

2. Regional Lymph Nodes


The regional lymph nodes are the cystic duct, pericholedochal, hilar, peripancreatic
(head only), periduodenal, periportal, coeliac, and superior mesenteric nodes.

3. TNM Clinical Classification


3.1. T - Primary Tumour


TX. Primary tumour cannot be assessed

T0. No evidence of primary tumour

Tis. Carcinoma in situ

T1. Tumour confined to the bile duct

T2. Tumour invades beyond the wall of the bile duct

T3. Tumour invades the liver, gallbladder, pancreas, and/or unilateral tributaries
of the portal vein (right or left) or hepatic artery (right or left)

T4. Tumour invades any of the following: main portal vein or its tributaries
bilaterally, common hepatic artery, or other adjacent structures, e.g., colon,
stomach, duodenum, abdominal wall


3.2. N - Regional Lymph Nodes


NX. Regional lymph nodes cannot be assessed

N0. No regional lymph node metastasis

N1. Regional lymph node metastasis


3.3. M - Distant Metastasis


MX. Distant metastasis cannot be assessed

M0. No distant metastasis

M1. Distant metastasis


4. pTNM Pathological Classification


The pT, pN, and pM categories correspond to the T, N, and M categories.


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

5. G Histopathological Grading


GX. Grade of differentiation cannot be assessed

G1. Well differentiated

G2. Moderately differentiated

G3. Poorly differentiated

G4. Undifferentiated


6. Stage Grouping




















































Stage 0
 Tis
 N0
 M0
Stage IA
 T1
 N0
 M0
Stage IB
 T2
 N0
 M0
Stage IIA
 T3
 N0
 M0
Stage IIB
 T1, T2, T3
 N1
 M0
Stage III
 T4
 Any N
 M0
Stage IV
 Any T
 Any N
 M1





7. Summary

































Extrahepatic Bile Ducts
T1
 Ductal wall
T2
 Beyond ductal wall
T3
 Liver, gallbladder, pancreas, or unilateral vessels
T4
 Other adjacent organs, or main or bilateral vessels
N1
 Regional