Σταδιοποίηση σε Ca Εξωηπατικών Χοληφόρων

 

Ca Περιφερικού Χοληδόχου Πόρου

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

IA

T1

N0

M0

IB

T2

N0

M0

IIA

T3

N0

M0

IIB

T1

N1

M0

T2

N1

M0

T3

N1

M0

III

T4

Any N

M0

IV

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ

T1

Tumor confined to the bile duct histologically

T2

Tumor invades beyond the wall of the bile duct

T3

Tumor invades the gallbladder, pancreas, duodenum, or other adjacent organs without involvement of the celiac axis or the superior mesenteric artery

T4

Tumor involves the celiac axis or the superior mesenteric artery

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis

(M) Distant Metastasis

M0

No distant metastasis

M1

Distant metastasis

Χαρακτηριστικά Επέκτασης

Contiguous spread

  • Predilection for longitudinal submucosal spread in duct wall
    • May have substantial extension of tumor beneath intact epithelial lining
      • Up to 2 cm proximally and 1 cm distally
  • Spread along periductal tissues
    • Neural & perineural involvement
  • Direct invasion of adjacent organs
    • Pancreas
    • Stomach, duodenum, or colon
    • Omentum & abdominal wall

Lymphatic spread

  • Regional lymph nodes
    • Common bile duct
    • Hepatic artery and celiac trunk
    • Posterior and anterior pancreaticoduodenal
    • Superior mesenteric vein
  • Right lateral wall of superior mesenteric artery
  • Sentinel nodes → porta hepatis
  • Spread 1st to pericholedochal nodes in hepatoduodenal ligament → posterior pancreaticoduodenal nodes → periportal nodes → common hepatic nodes
  • Peripancreatic lymph nodes along body & tail are considered distant metastases
  • Ideally, resection specimen should include histologic examination of at least 12 lymph nodes
    • Fewer than 12 lymph nodes resected and all negative → assign pN0

Hematogenous spread

  • Uncommon, occurs late in disease
  • Liver and lungs

Peritoneal seeding

  • 10-20% have peritoneal involvement

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Carcinoma in situ
  • Adenocarcinoma (most common)
    • Intestinal type
    • Mucinous
    • Clear cell
  • Signet ring cell
  • Squamous cell
  • Adenosquamous
  • Small cell (oat cell)
  • Undifferentiated
  • Papillary carcinoma, noninvasive
  • Papillary carcinoma, invasive
  • Carcinoma, not otherwise specified