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Cancer Staging Systems

Staging of gall bladder cancer

TNM definition

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Carcinoma in situ
• T1: Tumor invades lamina propria or muscle layer
  • T1a: Tumor invades lamina propria
  • T1b: Tumor invades the muscle layer
• T2: Tumor invades the perimuscular connective tissue; no extension beyond the serosa or into the liver
• T3: Tumor perforates the serosa (visceral peritoneum) or directly invades one adjacent organ, or both (extension 2 cm or less into the liver)
• T4: Tumor extends more than 2 cm into the liver, and/or into two or more adjacent organs (stomach, duodenum, colon, pancreas, omentum, extrahepatic bile ducts, any involvement of the liver)

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed
• N0: No regional lymph node metastasis
• N1: Metastasis in cystic duct, pericholedochal, and/or hilar lymph nodes (i.e., in the hepatoduodenal ligament)
• N2: Metastasis in peripancreatic (head only), periduodenal, periportal, celiac, and/or superior mesenteric lymph nodes

Distant metastasis (M)

• MX: Distant metastasis cannot be assessed
• M0: No distant metastasis
• M1: Distant metastasis

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Stage grouping

Stage 0

• Tis, N0, M0

Stage I

• T1, N0, M0

Stage II

• T2, N0, M0

Stage III

• T1, N1, M0
• T2, N1, M0
• T3, N0, M0
• T3, N1, M0

Stage IVA

• T4, N0, M0
• T4, N1, M0

Stage IVB

• Any T, N2, M0
• Any T, any N, M1

References

1. Gallbladder. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 5th ed. Philadelphia, Pa: Lippincott-Raven Publishers, 1997, pp 103-108. 

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