Stages of Gallbladder Cancer

Tests and procedures to stage gallbladder cancer are usually done at the same time as diagnosis.

See the General Information section for a description of tests and procedures used to detect, diagnose, and stage gallbladder cancer.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if gallbladder cancer spreads to the liver, the cancer cells in the liver are actually gallbladder cancer cells. The disease is metastatic gallbladder cancer, not liver cancer.

The following stages are used for gallbladder cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the mucosa (innermost layer) of the gallbladder wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle layer of the gallbladder wall.

Stage II

Stage II is divided into stages IIA and IIB, depending on where the cancer has spread in the gallbladder.

• In stage IIA, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the side of the gallbladder that is not near the liver.
• In stage IIB, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the same side as the liver. Cancer has not spread to the liver.

Stage III

Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.

• In stage IIIA, cancer has spread through the connective tissue layer of the gallbladder wall and one or more of the following is true:
  • Cancer has spread to the serosa (layer of tissue that covers the gallbladder).
  • Cancer has spread to the liver.
  • Cancer has spread to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver).
• In stage IIIB, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle, connective tissue, or serosa (layer of tissue that covers the gallbladder) and may have also spread to the liver or to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver). Cancer has spread to one to three nearby lymph nodes.

Stage IV

Stage IV is divided into stages IVA and IVB.

• In stage IVA, cancer has spread to the portal vein or hepatic artery or to two or more organs or structures other than the liver. Cancer may have spread to one to three nearby lymph nodes.
• In stage IVB, cancer may have spread to nearby organs or structures. Cancer has spread:
  • to four or more nearby lymph nodes; or
  • to other parts of the body, such as the peritoneum and liver.

For gallbladder cancer, stages are also grouped according to how the cancer may be treated. There are two treatment groups:

Localized (Stage I)

Cancer is found in the wall of the gallbladder and can be completely removed by surgery.

Unresectable, recurrent, or metastatic (Stage II, Stage III, and Stage IV)

Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer have unresectable cancer.

Recurrent cancer is cancer that has recurred (come back) after it has been treated. Gallbladder cancer may come back in the gallbladder or in other parts of the body.

Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic gallbladder cancer may spread to surrounding tissues, organs, throughout the abdominal cavity, or to distant parts of the body.