Canadian Cancer Society logo

Gallbladder cancer

You are here: 

Stages of gallbladder cancer

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

TNM stands for tumour, nodes, metastasis. TNM staging describes:

  • how far the primary tumour has grown into the gallbladder wall and whether or not it has spread into nearby organs or tissues
  • the number and location of any regional lymph nodes that have cancer cells in them
  • whether the cancer has spread or metastasized to another organ or part of the body

Primary tumour (T)

TX

Primary tumour cannot be assessed.

T0

No evidence of primary tumour.

Tis

Carcinoma in situ – Cancer cells are found only in the inner (mucosal) layer of the gallbladder.

T1

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.

T2

Tumour has grown into the perimuscular connective tissue. The cancer has not spread beyond the serosa or into the liver.

T3

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).

T4

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 (N)

NX

Regional lymph nodes cannot be assessed.

N0

No regional lymph node metastasis.

N1

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.

Distant metastasis (M)

M0

No distant metastasis.

M1

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.

Stage grouping for gallbladder cancer

The UICC further groups the TNM data into the stages listed in the table below.

UICC staging – gallbladder cancer
UICCTNMExplanation

stage 0

Tis

N0

M0

Carcinoma in situ – Cancer is found only on the innermost surface of the gallbladder, without growing into the wall.

stage I

T1

N0

M0

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.

stage II

T2

N0

M0

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.

stage IIIA

T3

N0

M0

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.

stage IIIB

T1–3

N1

M0

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.

stage IVA

T4

any N

M0

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.

stage IVB

any T

any N

M1

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.

Resectable and unresectable

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).

  • resectable
    • Resectable tumours can be completely removed by surgery.
    • Early stage or localized gallbladder tumours are more likely to be completely removed by surgery.
  • unresectable
    • Gallbladder cancer is often considered unresectable if it cannot be completely removed by surgery because it has spread either:
      • through the gallbladder wall to lymph nodes, tissues or organs around the gallbladder
      • throughout the abdominal cavity

Recurrent gallbladder cancer

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).

Stories

Rebecca and James Hamm It was very important that the fundraiser be in honour of my uncle, because it’s a great way to show our support for him.

Read the Hamm's story

How can you stop cancer before it starts?

It's My Life! icon

Discover how your lifestyle choices can affect cancer risk and how you can take action with our interactive tool – It’s My Life!

Learn more