Gallbladder & extrahepatic bile ducts
General
Staging-gallbladder and cystic duct carcinoma
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Last author update: 10 December 2020
Last staff update: 13 May 2021
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PubMed Search: TNM staging for carcinoma of gallbladder and cystic duct
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Cite this page: Gonzalez RS. Staging-gallbladder and cystic duct carcinoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/gallbladderstaging.html. Accessed December 11th, 2024.
Definition / general
- All carcinomas of the gallbladder and cystic duct, including poorly differentiated neuroendocrine carcinomas, are covered by this staging system
- Well differentiated neuroendocrine tumors at this location are extremely rare and have no AJCC staging system
Essential features
- AJCC 7th edition staging was sunset on December 31, 2017; as of January 1, 2018, use of the
8th edition is mandatory
ICD coding
- C23: Malignant neoplasm of gallbladder
Primary tumor (pT)
- TX: primary tumor cannot be assessed
- T0: no evidence of primary tumor
- Tis: carcinoma in situ
- T1: tumor invades lamina propria or muscular layer
- T1a: tumor invades lamina propria
- T1b: tumor invades muscular layer
- T2: tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum) or tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver
- T2a: tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum)
- T2b: tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver
- T3: tumor perforates the serosa (visceral peritoneum) or directly invades the liver or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum or extrahepatic bile ducts
- T4: tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures
Contributed by Dr. Eldon Shaffer
Regional lymph nodes (pN)
- NX: Regional lymph nodes cannot be assessed
- N0: No regional lymph node metastasis
- N1: Metastasis in 1 - 3 regional lymph nodes
- N2: Metastasis in 4 or more regional lymph nodes
Note:
- Regional lymph nodes include the common bile duct, hepatic artery, portal vein and cystic duct nodes
Stage grouping
| Stage 0: |
Tis |
N0 |
M0 |
|
| Stage I: |
T1 |
N0 |
M0 |
|
| Stage IIA: |
T2a |
N0 |
M0 |
|
| Stage IIB: |
T2b |
N0 |
M0 |
|
| Stage IIIA: |
T3 |
N0 |
M0 |
|
| Stage IIIB: |
T1-3 |
N1 |
M0 |
|
| Stage IVA: |
T4 |
N0-1 |
M0 |
|
| Stage IVB: |
any T |
N2 |
M0 |
|
|
any T |
any N |
M1 |
|
Registry data collection variables
- Specimen type
- Extent of liver resection
- Free peritoneal side versus hepatic side for T2 tumors
Histologic grade
- GX: grade cannot be assessed
- G1: well differentiated
- G2: moderately differentiated
- G3: poorly differentiated
Histopathologic type
- Adenocarcinoma, biliary type
- Adenocarcinoma, intestinal type
- Adenocarcinoma, gastric foveolar type
- Mucinous adenocarcinoma
- Clear cell adenocarcinoma
- Signet ring cell carcinoma
- Squamous cell carcinoma
- Adenosquamous carcinoma
- Undifferentiated carcinoma
- Neuroendocrine carcinoma
- Small cell neuroendocrine carcinoma
- Large cell neuroendocrine carcinoma
- Mixed adenoneuroendocrine carcinoma
- Intraductal papillary neoplasm with an associated invasive component
- Mucinous cystic neoplasm with an associated invasive component
Residual tumor
- R0: complete resection with grossly and microscopically negative margins of resection
- R1: grossly negative but microscopically positive margins of resection
- R2: grossly and microscopically positive margins of resection
Board review style question #1
Which of the following AJCC T-category staging options for gallbladder carcinoma is substaged depending on whether the tumor arises from the peritoneum facing or liver facing side of the gallbladder?
- pT1
- pT2
- pT3
- pT4
Board review style answer #1
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