Stage Information
TNM Definitions
AJCC Stage Groupings
The American Joint Committee on Cancer (AJCC) has designated staging by the TNM
classification as follows:[1]
TNM Definitions
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) and/or directly invades
the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, or pancreas, omentum or extrahepatic bile ducts
- T4: Tumor invades main portal vein or hepatic artery or invades multiple extrahepatic organs or structures
Regional lymph nodes (N)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Regional lymph node metastasis
Distant metastasis (M)
- MX: Distant metastasis cannot be assessed
- M0: No distant metastasis
- M1: Distant metastasis
AJCC Stage Groupings
Stage 0
Stage IA
Stage IB
Stage IIA
Stage IIB
- T1, N1, M0
- T2, N1, M0
- T3, N1, M0
Stage III
Stage IV
Localized (Stage I)
These types of patients have cancer confined to the gallbladder wall that can be
completely resected. They represent a minority of cases of gallbladder cancer.
Patients with cancers confined to the mucosa have 5-year survival rates of
nearly 100%.[2] Patients with muscular invasion or beyond have a survival of
less than 15%. Regional lymphatics and lymph nodes should be removed along
with the gallbladder in such patients.
Unresectable (Stage II–IV)
With the exception of some patients with focal stage IIA disease, these
types of patients have cancer that cannot be completely resected. They represent the
majority of cases of gallbladder cancer. Often the cancer invades directly
into adjacent liver or biliary lymph nodes or has disseminated throughout the
peritoneal cavity. Spread to distant parts of the body is not uncommon. At this
stage, standard therapy is directed at palliation. Because of its rarity, no
specific clinical trials exist; however, such patients can be included in
trials aimed at improving local control by combining radiation therapy with
radiosensitizer drugs.
References
-
Gallbladder. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 139-44.
-
Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992.
[PUBMED Abstract]
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