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.
Your care team will use a variety of diagnostic tests to evaluate gallbladder cancer. If you’ve been recently diagnosed, the care team will 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.
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.
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.
Stage 1 is still localized within the gallbladder, but the tumor has begun to penetrate into the lamina propria and the muscle layer.
Stage 2 has two subcategories.
Stage 3 has two subcategories.
Stage 4 has two subcategories.
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.