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Gallbladder Cancer Treatment (PDQ®)

  • Last Modified: 07/31/2014

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Stage Information for Gallbladder Cancer

Definitions of TNM



Definitions of TNM

The American Joint Committee on Cancer has designated staging by the TNM classification to define gallbladder cancer.[1]

Table 1. Primary Tumor (T)a
aReprinted with permission from AJCC: Gallbladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 211-7.
TXPrimary tumor cannot be assessed.
T0No evidence of primary tumor.
TisCarcinoma in situ.
T1Tumor invades lamina propria or muscular layer.
T1aTumor invades lamina propria.
T1bTumor invades muscular layer.
T2Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver.
T3Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.
T4Tumor invades main portal vein or hepatic artery or invades at least two extrahepatic organs or structures.

Table 2. Regional Lymph Nodes (N)a
aReprinted with permission from AJCC: Gallbladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 211-7.
NXRegional lymph nodes cannot be assessed.
N0No regional lymph node metastasis.
N1Metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein.
N2Metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes.

Table 3. Distant Metastasis (M)a
aReprinted with permission from AJCC: Gallbladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 211-7.
M0No distant metastasis.
M1Distant metastasis.

Table 4. Anatomic Stage/Prognostic Groups
Stage T N M 
aReprinted with permission from AJCC: Gallbladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 211-7.
0TisN0M0
IT1N0M0
IIT2N0M0
IIIAT3N0M0
IIIBT1–3N1M0
IVAT4N0–1M0
IVBAny TN2M0
Any TAny NM1

Localized (Stage I)

These types of patients have cancer confined to the gallbladder wall that can be completely resected. They represent a minority of cases of gallbladder cancer. Patients with cancers confined to the mucosa have 5-year survival rates of nearly 100%.[2] Patients with muscular invasion or beyond have a survival of less than 15%. Regional lymphatics and lymph nodes should be removed along with the gallbladder in such patients.

Unresectable (Stage II–IV)

With the exception of some patients with focal stage IIA disease, these types of patients have cancer that cannot be completely resected. They represent the majority of cases of gallbladder cancer. Often the cancer invades directly into adjacent liver or biliary lymph nodes or has disseminated throughout the peritoneal cavity. Spread to distant parts of the body is not uncommon. At this stage, standard therapy is directed at palliation. Because of its rarity, no specific clinical trials exist; however, such patients can be included in trials aimed at improving local control by combining radiation therapy with radiosensitizer drugs.

References
  1. Gallbladder. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 211-7. 

  2. Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992.  [PUBMED Abstract]