Gallbladder cancer (staging - AJCC 8th edition)

Last revised by Dr Joshua Yap on 29 Jul 2022

The AJCC (American Joint Committee on Cancer) 8th edition gallbladder cancer staging system was introduced in 2018.

TNM system

T: primary tumor

  • Tis: carcinoma in situ - tumor only within the epithelium (the inner layer of the gallbladder)
  • T1: tumor invades the lamina propria or muscularis
    • T1a: limited to lamina propria
    • T1b: invades muscularis
  • T2: tumor invades the perimuscular fibrous tissue
    • ​T2a: tumor invades the perimuscular fibrous tissue on the side of the peritoneum (the lining of the abdominal cavity)
    • T2b: tumor invades the perimuscular fibrous tissue on the side of the liver, but has not invaded the liver
  • T3: tumor invades the serosa (the outermost covering of the gallbladder) and/or directly invades the liver and/or one other adjacent structure (stomach, duodenum, colon, pancreas, omentum or extra-hepatic bile ducts)
  • T4: tumor invades the hepatic artery, main portal vein, or two or more extra-hepatic organs

N: regional lymph node involvement

  • N0: no regional lymph node metastasis
  • N1: metastasis in 1-3 regional lymph nodes
  • N2: metastasis in ≥4 regional lymph nodes 

M: distant metastasis

  • M0: no distant metastasis
  • M1: distant metastasis present
Stage groupings
  • stage 0: Tis, N0, M0
  • stage I: T1, N0, M0
  • stage II
    • ​stage IIa: T2a, N0, M0
    • stage IIb: T2b, N0, M0
  • stage III
    • ​stage IIIa: T3, N0, M0
    • stage IIIb: T1-T3, N1, M0
  • stage IV
    • stage IVa: T4, N0-N1, M0
    • stage IVb: any T, N2, M0 or any T, any N, M1

See also

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