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The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Gallbladder cancer stages

At Cancer Treatment Centers of America® (CTCA), our doctors use a variety of diagnostic tests to evaluate gallbladder cancer. If you’ve been recently diagnosed, we’ll review your pathology to confirm you have received the correct diagnosis and staging information. If you have a recurrence, we will perform comprehensive testing. Either way, we will identify and develop a personalized treatment plan that’s tailored to your specific needs.

To best 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 (biopsy) is known as clinical staging.

TNM scores

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 with one another in a standardized way. Gallbladder cancer stages are based on three categories:

T (tumor) describes the size of the original tumor.

N (node) indicates whether the cancer is present in the lymph nodes.

M (metastasis) refers to whether cancer has spread to other parts of the body.

Staging gallbladder cancer guidelines

Once the TNM scores have been assigned, the cancer is staged. Gallbladder cancers are staged as 0, 1, 2A, 2B, 3A, 3B, 4A and 4B. 0 is the earliest stage and 4B is the most advanced. Below find the details for each, as well as the TNM characteristics, according to the American Cancer Society.

Stage 0, also called carcinoma in situ, has abnormal cells in the epithelium. It hasn’t spread to the lymph nodes or other places in the body.

  • TNM characteristics: Tis, N0, M0

Stage 1 is still localized within the gallbladder, but the tumor has begun to penetrate into the lamina propria and the muscle layer.

  • TNM characteristics: T1, N0, M0

Stage 2 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.
    • TNM characteristics: T2A, N0, M0
  • 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.
    • TNM characteristics: T2B, N0, M0

Stage 3 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.
    • TNM characteristics: T3, N0, M0
  • Stage 3B: This stage shares stage 3A characteristics, but cancer may also be found in one to three lymph nodes.
    • TNM characteristics: T1-3, N1, M0

Stage 4 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.
    • TNM characteristics: T4, N0 or N1, M0
  • 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.
    • TNM characteristics: Any T, N2, M0 or any T, any N, M1

How stage affects treatment

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.

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