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)
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T1: tumor invades the lamina propria or muscularis
- T1a: limited to lamina propria
- T1b: invades muscularis
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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
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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
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