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Number stages

The stage of a cancer tells you how big it is and whether it has spread. It helps your doctor decide which treatment you need.

Most doctors use a system of stages called TNM, or a system of number stages.

There are four main stages in the number system, numbered 1 to 4. Some doctors also refer to stage 0.

Layers of the gallbladder

The diagram below shows the layers of the gallbladder. Knowing about the layers helps you understand the different stages.

Diagram showing the layers of the gallbladder

Stage 0 or carcinoma in situ (CIS)

Very, very early stage gallbladder cancer is called CIS or stage 0. There are cancer cells only in the layer of tissue lining your gallbladder.

Some doctors may not regard this as a true cancer because the cancer cells are just in the lining. So there is very little risk of the cancer having spread.

It is unusual for gallbladder cancer to be found this early, as there are few or no symptoms at this stage. Sometimes it can be picked up this early when someone has their gallbladder removed for gallstones.

Stage 1

This is the earliest stage of invasive cancer. It means that the cancer is only in the inner layers of the tissues lining the gallbladder. It has not spread to nearby tissues, lymph nodes or other organs. Stage 1 is the same as T1, N0, M0 in the TNM stages.

Stage 2

This means that cancer has grown through the muscle layer of the gallbladder wall and into the connective tissue underneath. It has not spread outside the gallbladder. Stage 2 in the TNM stages is the same as T2, N0, M0.

Stage 3

This stage is divided into 3A and 3B:

  • stage 3A means the cancer has grown through the gallbladder wall but has not spread to the lymph nodes (this is the same as TNM stages T3, N0, M0)
  • stage 3B means the cancer is within the gallbladder wall or has broken through the outer lining and spread to nearby lymph nodes (this is the same as T1, T2 or T3, N1 or M0)

Stage 4

This means that the cancer is advanced. It's divided into stage 4A and 4B. 

Stage 4A means the cancer has either grown into one of the main blood vessels leading into the liver, or into 2 or more organs outside of the liver. It might also have spread into nearby lymph nodes. This is the same as T4, N0 or N1, M0.

Stage 4B means the cancer is any size and:

  • has spread to lymph nodes further away from the gallbladder. But has not spread to distant organs in the body. This is also known as any T, N2, M0.

  • has spread to structures or organs far away from the gallbladder. This is also known as any T, any N, M1.

Treatment

The stage of your cancer helps your doctor to decide which treatment you need. Treatment also depends on:

  • your type of cancer (the type of cells the cancer started in)
  • where the cancer is 
  • other health conditions that you have

The stage of the cancer and these other factors can also give an idea of your outlook (prognosis).

Surgery is the main treatment for gallbladder cancer. The main type of surgery used is called a cholecystectomy, which means having your gallbladder removed. You might also need a second operation to remove any lymph nodes that contain cancer cells.

Radiotherapy can be used alongside other treatments. And you might have chemotherapy treatment for gallbladder cancer that has come back, or which can’t be treated with surgery. Chemotherapy can also be used to relieve your symptoms and slow the growth of your cancer.

Last reviewed: 
02 Jan 2020
  • AJCC Cancer Staging Manual (8th edition)
    American Joint Committee on cancer
    Springer, 2017

  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. 
    Valle J W et al (2016)
    Annals of Oncology (supplement 5): v28-v37

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