Gallbladder Cancer Staging

Primary Tumor Classification

The American Joint Committee on Cancer (AJCC) classifies the primary tumor based on the depth of tumor invasion, with stages ranging from Tis (carcinoma in situ) to T4 (tumor invades the main portal vein or hepatic artery, or invades two or more extrahepatic organs or structures) 1, 2, 3
The T1a stage is characterized by tumor invasion of the lamina propria only, while the T1b stage involves invasion of the muscular layer 1, 2, 3
The T2 stage is defined by tumor invasion of perimuscular connective tissue with no extension beyond the serosa or into the liver 1, 2, 3
The T3 stage involves tumor perforation of the serosa and/or direct invasion of the liver and/or one other adjacent organ or structure 1, 2, 3

The N stage categorizes lymph node involvement, with N0 indicating no regional lymph node metastasis, N1 indicating metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein, and N2 indicating metastases to periaortic, pericaval, superior mesenteric artery, and/or celiac artery lymph nodes 1, 2, 3

Lymph node involvement is present in 50% of all patients at presentation and is associated with poor surgical outcomes, according to Praxis Medical Insights 4
Peritoneal and distant metastases are present in 10-20% of all patients at presentation, representing stage IVB disease, as reported by Praxis Medical Insights 4, 5

Complete staging must include a complete history and physical examination, blood counts and liver function tests, chest X-ray, abdominal imaging with sonography and CT scan or MRI, endoscopic retrograde or percutaneous transhepatic cholangiography, and endoscopic ultrasonography, cholangioscopy, and laparoscopy when indicated, as recommended by the Annals of Oncology 1, 2, 3
Laparoscopy may be used to determine the presence of peritoneal or superficial liver metastases, according to Praxis Medical Insights 4