Σταδιοποίηση σε Ca Περιπυλαίων Χοληφόρων

Ca Περιπυλαίου Χοληδόχου Πόρου

AJCC Stages

Stages

T

N

M

0

Tis

N0

M0

I

T1

N0

M0

II

T2a, T2b

N0

M0

IIIA

T3

N0

M0

IIIB

T1, T2, T3

N1

M0

IVA

T4

N0, N1

M0

IVB

Any T

N2

M0

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, with extension up to the muscle layer or fibrous tissue

T2a

Tumor invades beyond the wall of the bile duct to surrounding adipose tissue

T2b

Tumor invades adjacent hepatic parenchyma

T3

Tumor invades unilateral branches of the portal vein or hepatic artery

T4

Tumor invades main portal vein or its branches bilaterally; or the common hepatic artery; or the second-order biliary radicals bilaterally; or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement

(N) Regional Lymph Nodes

NX

Regional lymph nodes cannot be assessed

N0

No regional lymph node metastasis

N1

Regional lymph node metastasis (including nodes along the cystic duct, common bile duct, hepatic artery, and portal vein)

N2

Metastasis to periaortic, pericaval, superior mesenteric artery, &/or celiac artery lymph nodes

(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
  • Perihilar tumor tends to infiltrate into intrahepatic ducts
• Spread along periductal tissues
  • Neural and perineural involvement
• Direct invasion of adjacent structures
  • Invasion of hepatic parenchyma in 85%
  • Invasion of vasculature
    • Portal vein is common
    • Hepatic artery
  • Invasion of adjacent organs
    • Pancreas
    • Stomach, duodenum, or colon
    • Omentum and abdominal wall

Lymphatic spread

• Prevalence of 30-53%
• ↑ prevalence of lymph node metastases with ↑ in primary tumor stage

• Most commonly involves hepatoduodenal nodes
  • Hilar nodes
  • Pericholedochal nodes
• N1 regional nodes
  • Cystic duct
  • Common bile duct
  • Hepatic artery
  • Portal vein
• N2 regional nodes
  • Periaortic
  • Pericaval
  • Superior mesenteric artery
  • Celiac artery
• Incidence of N2 nodal metastases is 14-50% in patients with lymphatic spread

Hematogenous spread

• 10-20% have distant metastases at presentation
• 50% have metastatic disease at autopsy
• Liver is common site of metastases
• Spread to other organs, especially extraabdominal, uncommon

Peritoneal spread

• 10-20% have peritoneal involvement

Κατηγοριοποίηση (Ιστολογικοί Τύποι)

• Adenocarcinoma
• Adenocarcinoma, intestinal type
• Clear cell adenocarcinoma
• Mucinous carcinoma
• Signet ring cell carcinoma
• Squamous cell carcinoma
• Adenosquamous carcinoma

• Small cell (oat cell) carcinoma
• Undifferentiated carcinoma
• Papillomatosis
• Papillary carcinoma, noninvasive
• Papillary carcinoma, invasive
• Carcinoma, not otherwise specified (NOS)