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Gallbladder Cancer Treatment (PDQ®)

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Stage Information for Gallbladder Cancer

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.
TX Primary tumor cannot be assessed.
T0 No evidence of primary tumor.
Tis Carcinoma in situ.
T1 Tumor invades lamina propria or muscular layer.
T1a Tumor invades lamina propria.
T1b Tumor invades muscular layer.
T2 Tumor invades perimuscular connective tissue; no extension beyond serosa or into liver.
T3 Tumor 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.
T4 Tumor 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.
NX Regional lymph nodes cannot be assessed.
N0 No regional lymph node metastasis.
N1 Metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein.
N2 Metastases 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.
M0 No distant metastasis.
M1 Distant 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.
0 Tis N0 M0
I T1 N0 M0
II T2 N0 M0
IIIA T3 N0 M0
IIIB T1–3 N1 M0
IVA T4 N0–1 M0
IVB Any T N2 M0
Any T Any N M1

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]
  • Updated: February 6, 2015