Types of Cancer :: Gallbladder Cancer - Part V

How is gallbladder cancer staged?

The American Joint Committee on Cancer uses the TNM system to stage gallbladder cancer as follows: (Adapted from AJCC 6 th edition, 2002)

Primary tumor (T)

• TX - Primary tumor cannot be assessed
  
• T0 - No evidence of primary tumor
  
• Tis - Carcinoma in situ
  
• T1 - Tumor invades mucosa or muscle layer
  
• T2 - Tumor invades perimuscular connective tissue
  
• T3 - Tumor invades/perforates the serosa and/or directly invades the liver and/or one other adjacent organ or structure
  
• T4 - Tumor invades main portal vein or hepatic artery or adjacent organs

Regional lymph node (N)

• NX - Regional lymph nodes cannot be assessed
  
• N0 - No metastases in regional lymph nodes
  
• N1 – Regional lymph node metastases

Metastases (M)

• MX - Presence of metastases cannot be assessed
  
• M0 - No distant metastases
  
• M1 - Distant metastases

TNM Groupings by Stage

Stage	T	N	M
Stage IA	T1	N0	M0
Stage IB	T2	N0	M0
Stage IIA	T3	N0	M0
Stage IIB	T1 T2 T3	N1 N1 N1	M0 M0 M0
Stage III	T4	Any N	M0
Stage IV	Any T	Any N	M1

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Gallbladder Cancer: A Medical Dictionary, Bibliography, And Annotated Research Guide To Internet References

Types of Cancer :: Gallbladder Cancer - Part IV

How is gallbladder cancer diagnosed?

First and foremost, a HCP should always perform a thorough history and physical examination. Laboratory work should include metabolic chemistry and liver function panels to look for abnormal levels of various substances in the blood that are suggestive of general hepatobiliary disease. A urinalysis is usually done to evaluate urinary levels of some of these substances as well.

*The role of tumor markers, [carbohydrate antigen 19-9 (CA 19-9), cancer antigen 125 (CA125), and carcinoembryonic antigen (CEA)] has not been established in gallbladder cancer.

Ultrasonography (US) is the standard study done first in patients presenting with right upper quadrant pain. It allows HCPs to make a diagnosis of gallbladder cancer in about half of patients, and can also detect disease spread into the liver or bile ducts.

Computed tomography (CT) scans can also be helpful in patients with upper abdominal pain. They are better than US for detecting tumor invasion out of the gallbladder and disease spread to other sites in the abdomen or pelvis. About 70-80% of cases will have some degree of liver invasion, and so the combination of CT and US provides more accurate information.

Magnetic resonance imaging (MRI) has been useful in examining this region for disease spread into the liver or other tissues. This technology is particularly good for planning surgery, by evaluating surrounding blood vessels [magnetic resonance angiogram (MRA)] and bile duct passages [magnetic resonance cholangiogram (MRC)].

Cholangiography, either through the skin or the stomach, is a technique that allows HCPs to not only establish a diagnosis, but to locate the blockage and place a stent through the blockage to help alleviate the blockage.

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