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Staging is a way of describing or classifying a cancer based on the extent of cancer in the body. The most common staging system for gallbladder cancer is the TNM system. The International Union Against Cancer (UICC) uses the TNM system to describe the extent of many solid tumour cancers.
The TNM staging below is used only for carcinomas of the gallbladder and the cystic duct.
TNM stands for tumour, nodes, metastasis. TNM staging describes:
Primary tumour cannot be assessed.
No evidence of primary tumour.
Carcinoma in situ – Cancer cells are found only in the inner (mucosal) layer of the gallbladder.
Tumour has grown into the lamina propria or the muscular layer of the gallbladder.
T1a – Tumour has spread to the lamina propria.
T1b – Tumour has spread to the muscular layer.
Tumour has grown into the perimuscular connective tissue. The cancer has not spread beyond the serosa or into the liver.
Tumour has grown through the serosa of the gallbladder or the cancer has spread to the liver or one other nearby organ or structure. Nearby organs include the stomach, duodenum (first part of the small intestine), colon, pancreas, omentumomentumA fold in the peritoneum (the membrane that lines the walls of the abdomen and pelvis) that covers and supports organs and blood vessels in the abdomen. or bile ducts outside the liver (extrahepatic bile ducts).
Tumour has grown into one of the main blood vessels leading into the liver (portal vein or hepatic artery) or the cancer has spread to 2 or more nearby organs other than the liver.
Regional lymph nodes cannot be assessed.
No regional lymph node metastasis.
Regional lymph node metastasis.
Note: Regional lymph nodes are the hepatic hilus nodes near the gallbladder, including those along the cystic duct, common bile duct, common hepatic artery and portal vein.
No distant metastasis.
Note: Distant metastasis means the cancer has spread to distant organs or lymph nodes farther from the gallbladder (extra-regional lymph nodes), such as the peripancreatic, celiac, periduodenal or superior mesenteric artery lymph nodes.
The UICC further groups the TNM data into the stages listed in the table below.
Carcinoma in situ – Cancer is found only on the innermost surface of the gallbladder, without growing into the wall.
The tumour has grown into the wall of the gallbladder (lamina propria or the muscular layer).
The cancer has not spread outside the gallbladder to the lymph nodes or other organs.
The tumour has grown into the perimuscular connective tissue.
The cancer has not spread outside the gallbladder, to the lymph nodes or to other organs.
The tumour has grown through the outer surface of the gallbladder (serosa) or has spread to the liver or one other nearby organ.
The cancer has not spread to the lymph nodes or to organs far away from the gallbladder.
The tumour has grown anywhere in the gallbladder.
The cancer has spread to nearby lymph nodes but has not spread to organs far away from the gallbladder.
The tumour has spread to a main blood vessel leading to the liver or to 2 or more nearby organs other than the liver.
The cancer may or may not have spread to nearby lymph nodes and has not spread to organs far away from the gallbladder.
The cancer has spread to lymph nodes farther away from the gallbladder (extra-regional lymph nodes).
The cancer has spread to organs far away from the gallbladder.
When planning treatment, doctors may put people with gallbladder cancer into 1 of 2 groups based on whether or not the cancer can be removed by surgery (is resectable).
Recurrent gallbladder cancer means that the cancer has come back after it has been treated. It may recur in the same location as the original cancer or it may recur in another part of the body (metastatic gallbladder cancer).