This page was reviewed under our medical and editorial policy by
Maurie Markman, MD, President, Medicine & Science
This page was updated on June 3, 2022.
Following a gallbladder cancer diagnosis, the care team will review the patient's pathology to confirm the diagnosis and determine the stage of disease. Staging cancer is one of the most important factors in developing a personalized gallbladder cancer treatment plan that’s tailored to the patient's specific needs.
To understand the staging of this cancer, it’s important to know about the layers of tissue that make up the gallbladder. The innermost layer of the gallbladder is a thin sheet of tissue called the epithelium. The next layers are connective tissue called the lamina propria and muscularis, which are surrounded by another layer of connective tissue (perimuscular fibrous tissue). The outermost layer is the serosa.
Gallbladder cancer is rare and doesn’t usually cause symptoms in its earliest stage. Identifying the stage of gallbladder cancer is a way to learn how far it’s spread. Staging the cancer may include ordering imaging studies and blood tests, as well as looking at a sample of the cancer cells under a microscope.
If the gallbladder is removed during surgery as part of staging, it’s called pathological or surgical staging. Staging done without removing the gallbladder (through a biopsy) is known as clinical staging.
Guidelines developed by the American Joint Committee on Cancer are often used to stage the disease and allow doctors to communicate important information about the cancer in a standardized way. Gallbladder cancer stages are based on three categories, listed below:
T (tumor): This describes the size of the original tumor.
N (node): This indicates whether the cancer is present in the lymph nodes.
M (metastasis): This refers to whether cancer has spread (metastasized) to other parts of the body.
Once the individual T, N and M scores have been established, an overall stage is assigned.
Gallbladder cancers are staged as 0, 1, 2A, 2B, 3A, 3B, 4A and 4B. The earliest stage is 0, and 4B is the most advanced. Below find the details for each, as well as the TNM characteristics, according to the American Cancer Society.
Also called carcinoma in situ, stage 0 gallbladder cancer is diagnosed when abnormal cells are present in the epithelium. The cancer hasn’t spread to the lymph nodes or other places in the body.
In this stage, the cancer is still localized within the gallbladder, but the tumor has begun to penetrate into the lamina propria and the muscle layer.
This stage has two subcategories.
Stage 2A: Cancer cells have spread through the muscle to the next layer of connective tissue, but not on the side that sits under the liver.
Stage 2B: The cancer cells are in the connective tissue on the outside of the gallbladder on the same side as the liver, but they haven’t affected the liver.
This stage has two subcategories.
Stage 3A: The cancer has spread through the outer layer of connective tissue to the serosa and/or to the liver or to a nearby organ or structure in the abdomen.
Stage 3B: This stage shares stage 3A characteristics, but cancer may also be found in one to three lymph nodes.
This stage has two subcategories.
Stage 4A: The cancer has spread to the main artery or vein of the liver or to two or more abdominal organs or structures beyond the liver. Cancer cells may have reached nearby lymph nodes, but they haven’t reached distant organs.
Stage 4B: Cancers at this stage are the most advanced. Cancer cells have either spread to lymph nodes farther away from the gallbladder, or they have spread to distant organs.
When it comes to treatment for gallbladder cancer, the stages may be arranged in two groups — resectable and unresectable cancers. Resectable or localized cancers haven’t spread outside the gallbladder, so they may be completely removed surgically.
Many people with gallbladder cancer are in the unresectable group. They may still undergo surgery, but the cancer isn’t completely removed. This means other treatments may be needed to control the cancer. These may include radiation, chemotherapy, targeted chemotherapy and immunotherapy.
Identifying the stage of cancer not only helps the care team determine a treatment plan, it also helps predict a potential prognosis. This is achieved by calculating the percentage of people with gallbladder cancer who survive at least five years after diagnosis compared to people who don’t have that type of cancer. It’s important to remember that this is only a statistic based on all people with gallbladder cancer several years in the past, so individual patient experiences may vary.
The American Cancer Society (ACS) shares gallbladder cancer survival rates from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. The survival rate for gallbladder cancer is based on where the cancer started and how far the cancer has spread, as indicated below.
Localized: The cancer has not spread outside the gallbladder. The five-year relative survival rate for localized gallbladder cancer is about 69 percent.
Regional: The cancer has spread to nearby tissues or lymph nodes. The five-year relative survival rate for regional gallbladder cancer is about 28 percent.
Distant: The cancer has spread to farther reaches of the body. The five-year relative survival rate for distant gallbladder cancer is about 3 percent.
The overall five-year relative survival rate for gallbladder cancer is 20 percent, according to the ACS.
Keep in mind that the survival rate for gallbladder cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so always talk to the care team about the patient’s individual prognosis.