Staging Diagram & Classification Criteria (TNM)  

Investigations for Staging

It is essential to determine the extent of involvement of the bile duct. An ultrasound exam will usually demonstrate duct dilatation. A CT scan may identify tumour mass in the region of the duct. The proximal extent of involvement must be determined either by ERCP or transhepatic cholangiography. Angiography is helpful in determining the presence or absence of vascular encasement. FDG PET scan has about a 90% sensitivity and 90% specificity for identifying cholangiocarcinoma; false negatives are associated with mucin producing tumours. PET scan may be useful for identifying metastatic disease preoperatively; this use remains investigational at this time.