Julie - In response to your staging statement:
"We weren't given the staging, although when I asked the oncologist last Wednesday what my Dad's staging is now given his recurrence, he said Stage III or IV which seems quite an aggressive staging to me after looking at the NCCN guidelines."
The accepted reference for cancer staging in the United States and elsewhere is the American Joint Cancer Committee Cancer Staging Manual, 7th edition which replaced the 6th edition and became effective 1/1/2010. I believe some doctors still use a previous version of the manual for staging, which may be the situation in your father's case. For example, many people report that they have IHCC (intrahepatic cholangiocarcinoma), Stage IV, but there is no Stage IV for IHCC in the 7th edition, only a Stage IVA and a Stage IVB, and there is a big difference between the two of them.
From your discripitons of your father's situation, he was initally T1N0M0 and Stage I. T1 is a solitary tumor without vascular invasion, N0 is no regional lymph node metastases, and M0 is no distant metastases. Usually, a patient is not restaged when his cancer recurs, but if they did restage your father, he would br T2bN0M0 and Stage II. T2b is multiple tumors, with or without vascular invasion.
In order to be stage III, the tumors would have to perforate the visceral peritoneum OR involve local hepatic structures by direct invasion.
To reach stage IVA, a tumor would have periductal invasion OR regional lymph node metastases would be present. My wife had a positive regional lymph node and was stage IVA, but she was resectable. Stage IVB results when distant metastases is present and usually that results in no resection.
Also, the above is just the case for IHCC. Different stagings are used for Perihilar CC (aka Hilar CC or Klatskin) and Extrahepatic CC (aka Distal or Distal Extrahepatic). Whereas the stages for IHCC are 0, I, II, III, IVA, and IVB, the stages for perihilar are 0, I, II, IIIA, IIIB, IVA, and IVB; and the stages for Extrahepatic are 0, 1A, 1B, IIA, IIB, III, and IV.
An example of how staging depends on the type of cc a patient has is illustrated by the impact of a single positive regional lymph node on staging. A positive node can cause a patient with IHCC to be stage IVA, a patient with perihilar cc to be stage IIIB, and a patient with extrahepatic cc to be stage IIB.
Please be advised that any advice or information in my posts is my personal opinion only and is not intended nor implied to be a substitute for professional medical advice. ALWAYS seek the advice of your physician or other qualified health care provider.