Gallbladder Cancer: Stages 

What does stage of cancer mean?

The stage of a cancer is how much and how far the cancer has spread in your body. Your healthcare provider uses exams and tests to find out the size of the cancer and where it is. Your provider can also see if the cancer has grown into nearby areas, and if it has spread to other parts of your body. The stage of a cancer is one of the most important things to know when deciding how to treat the cancer. 

The place where cancer starts is called the primary site. Gallbladder cancer can spread from the primary site to other parts of your body. Cancer that has spread is called metastatic cancer. When a cancer spreads, it’s said to have metastasized.

Gallbladder cancer starts in the inner layer of the gallbladder. As the cancer grows, it can spread deeper through the outer layers. Then, like all cancers, it can spread (metastasize) to other parts of the body.

The TNM system of staging

The most commonly used system to stage gallbladder cancer is the TNM system from the American Joint Committee on Cancer.

The first step in staging is to find the value for each part of the TNM system. Here's what the letters stand for in the TNM system:

• T tells how far the main tumor has spread into the lining of your gallbladder and nearby tissue.

• N tells if the lymph nodes in the area of the original tumor have cancer in them.

• M tells if the cancer has spread (metastasized) to distant organs in the body, such as the liver or lungs.

Numbers or letters after T, N, and M provide more details about each of these factors. There are also 2 other values that can be assigned:

• X means the provider does not have enough information to tell the extent of the main tumor (TX), or if the lymph nodes have cancer cells in them (NX).

• 0 means no sign of cancer, such as no sign of lymph node spread (N0).

What are the stage groupings of gall bladder cancer?

Stage groupings are determined by combining the T, N, and M values from the TNM system. These groupings give an overall description of your cancer. A stage grouping can have a value of 0 or of Roman numeral I through IV (1 through 4). The higher the number, the more advanced the cancer is. Letters and numbers can be used after the Roman numeral to give more details.

These are the stage groupings of gallbladder cancer and what they mean:

Stage 0. Cancer cells are found only in the inside layer of the gallbladder. This stage is also called carcinoma in situ.

Stage I. The cancer is growing into the wall of the gallbladder and has reached the muscle layer. It hasn't spread to nearby lymph nodes or distant parts of the body.

Stage II. The cancer hasn't spread to nearby lymph nodes or distant parts of the body. It's divided into one of these groups:

• Stage IIA. It has grown through the muscle layer and into the connective tissue layer of the gallbladder wall that is not near the liver.

• Stage IIB. It has grown through the muscle layer and into the connective tissue layer of the gallbladder wall on the same side as the liver but has not spread to the liver.

Stage III. The cancer hasn't spread to distant parts of the body. It's divided into one of these groups depending on where the cancer has spread:

• Stage IIIA. It has grown through the outside covering of the gallbladder and into the liver, and into one nearby organ or structure (such as the stomach, small intestine, colon, bile ducts or pancreas). It has not spread to nearby lymph nodes.

• Stage IIIB. Cancer formed in the innermost layer of the gallbladder may have spread to the outer layer of the gallbladder, muscle, connective tissue, liver or a nearby organ or structure. Cancer has also spread to 1 to 3 nearby lymph nodes.

Stage IV. The cancer is divided into one of these groups:

• Stage IVA. It has grown into 1 of the main blood vessels that goes to the liver, or it has grown into at least 2 other organs or structures, but not the liver. It may or may not have spread to 1 to 3 nearby lymph nodes. It hasn't spread to distant parts of the body.

• Stage IVB. This stage is either of these:

  • The main tumor may or may not have grown through the outside of the gallbladder, but it has spread to 4 or more nearby lymph nodes. It hasn't spread to distant parts of the body.

  • The main tumor may or may not have grown through the outside of the gallbladder, and it may or may not have spread to nearby lymph nodes. It has spread to distant parts of the body, like the lungs, liver, or peritoneum.

Talking with your healthcare provider

Once your cancer is staged, talk with your healthcare provider about what the stage means for you. Make sure to ask questions and talk about your concerns.