Σταδιοποίηση σε Ca Ενδοηπατικών Χοληφόρων

 

Ca Ενδοηπατικών Χοληφόρων

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

IVA

T4

N0

M0

Any T

N1

M0

IVB

Any T

Any N

M1

(T) Primary Tumor

TX

Primary tumor cannot be assessed

T0

No evidence of primary tumor

Tis

Carcinoma in situ (intraductal tumor)

T1

Solitary tumor without vascular invasion

T2a

Solitary tumor with vascular invasion

T2b

Multiple tumors, with or without vascular invasion

T3

Tumor perforating the visceral peritoneum or involving the local extrahepatic structures by direct invasion

T4

Tumor with periductal invasion

(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

  • Intrahepatic tumor tends to grow centrally
  • Peripheral intrahepatic tumors can invade portal vein with tumor thrombus
  • Tendency toward perineural spread

Lymphatic spread

  • 30-50% have nodal metastases at presentation
  • More common than with hepatoma
  • Reactive adenopathy is common in primary sclerosing cholangitis (PSC) and should be confirmed with histology
  • Intrahepatic lymphatic drainage has laterality
    • Segments 2-3 → drain along lesser curvature of stomach → celiac nodal basin
    • Segments 5-8 → hilar nodes → caval & paraaortic nodes
  • Regional lymph nodes
    • Tumors in segments 2-4 (left lobe)
      • Hilar
      • Gastrohepatic
      • Inferior phrenic
  • Tumors in segments 5-8 (right lobe)
    • Hilar: Nodes along common bile duct, hepatic artery, portal vein, cystic duct
    • Periduodenal
    • Peripancreatic
    • Inferior phrenic
  • Distant metastases
    • Celiac
    • Paraaortic
    • Caval

Hematogenous spread

  • 10-20% have distant metastases at presentation
  • 50% have metastatic disease at autopsy
  • Liver, lung, bones, adrenal glands
  • Rare reported cases of metastases to
    • Central nervous system
    • Breast
    • Skeletal muscle

Peritoneal seeding

  • 10-20% at presentation

Κατηγοριοποίηση (Ιστολογικοί Τύποι)
  • Cholangiocarcinoma (CCA)
    • Tumor growth pattern
      • Mass-forming
  • Periductal infiltrating
  • Mixed
  • Combined hepatocellular cholangiocarcinoma