Clinical T

This input is used for staging


**Note 1:** Perihilar bile duct tumors arise at the confluence of the right and left hepatic ducts in the hilar area of the liver. **Note 2:** The biliary radicals are the ducts or tubes that drain bile into the intestine as part of the digestive process. The second-order biliary radicals are the next largest branches or ducts of the biliary system which join to form or empty into the main hepatic bile duct. **Note 3:** T3 and T4 are defined strictly in terms of invasion into specific large blood vessels and the biliary radicals within the liver. Assign T4 when the specified vessels and/or the biliary radical within the liver plus other named organs are involved. **Note 4:** Involvement within the porta hepatis is coded according to the structures involved: portal vein, common hepatic artery, and common hepatic duct.


Clinical T Clinical T Display Description Registrar Notes
cX cTX Primary tumor cannot be assessed Clinical classification criteria met, evaluation done:
Physician unable to assess T
Extension cannot be determined
Physician assigns cTX, no other information available to determine T
c0 cT0 No evidence of primary tumor
pIS pTis Carcinoma in situ Intraepithelial, noninvasive

Stated as Tis
c1 cT1 Tumor confined to the bile duct, with extension up to the muscle layer or fibrous tissue Invasive tumor of perihilar (proximal) bile duct(s) confined to:
Fibromuscular layer (tunic muscularis)
Lamina propria
Mucosa, NOS
Muscularis propria
Submucosa (superficial invasion)
Subepithelial connective tissue (tunica mucosa)

Localized, NOS

Stated as T1
c2 cT2 Not defined by UICC*# Note: T2 has subcategories of T2a and T2b. Assign T2 only when there is no information available to assign one of the subcategories.

Invasion beyond wall of the bile duct or invasion of hepatic parenchyma

Stated as T2[NOS]
c2A cT2a Tumor invades beyond the wall of the bile duct to surrounding adipose tissue Beyond wall of bile duct
Periductal/fibromuscular connective tissue

Stated as T2a
c2B cT2b Tumor invades adjacent hepatic parenchyma Adjacent hepatic parenchyma
Liver extension, NOS
Liver, NOS

Stated as T2b
c3 cT3 Tumor invades unilateral branches of the portal vein or hepatic artery Unilateral branches of portal vein (right or left)
Unilateral branches of hepatic artery (right or left)

Stated as T3
c4 cT4 Tumor invades the main portal vein or it's 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
Main portal vein or its branches bilaterally
Common hepatic artery
Hepatic artery, NOS
Portal vein, NOS

Stated as T4
88 88 Not applicable Primary site/histology not TNM defined
Death certificate only (DCO) case
<BLANK> BLANK See Registrar Notes Clinical classification criteria not met
Clinical classification criteria met, evaluation done:
No information about diagnostic workup
Results not documented in record
Clinical evaluation of primary tumor not done or unknown if done
Tumor first detected on surgical resection (no clinical workup)
Evidence of metastatic disease [(cM1) or (pM1)], no other workup
Only Clinical Stage Group documented (no T, N, or M information available)
\* T2 [NOS] is not defined by UICC in the 7th edition. Approval has been provided by UICC to use "Invasion beyond wall of the bile duct or invasion of hepatic parenchyma" for T2 [NOS]. \# T2 [NOS] is not defined in AJCC 7th edition.