Staging of Your Cancer

Your cancer’s stage refers to the extent of your cancer — whether it remains confined to the original disease site or has spread to nearby tissues, lymph nodes or organs or to distant locations in the body.

Gallbladder Cancer Staging

  • Stage 0 (Carcinoma in Situ): Abnormal cells are found only in the inner (mucosal) layer of the gallbladder.
  • Stage I:  Cancer has spread beyond the inner (mucosal) layer to a layer of tissue with blood vessels or to the muscle layer.
  • Stage II:  Cancer has spread beyond the muscle layer to the connective tissue around the muscle.
  • Stage IIIA:  Cancer has spread through the thin tissue layer that covers the gallbladder and/or to the liver and/or to one nearby organ, such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver.
  • Stage IIIB: Cancer has spread to nearby lymph nodes and:
    • beyond the inner layer of the gallbladder to a layer of tissue with blood vessels or to the muscle layer; or
    • beyond the muscle layer to the connective tissue around the muscle; or
    • through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).
  • Stage IVA: Cancer has spread to a main blood vessel of the liver or to two or more nearby organs or areas other than the liver, and may have spread to nearby lymph nodes.
  • Stage IVB: Cancer has spread to either:
    • lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone; or
    • to distant areas or organs

Bile Duct Cancer Staging

Bile duct cancer uses two different staging systems depending on the location where the cancer first began.

  • Perihilar or proximal bile duct tumors: form in the upper bile duct where the bile leaves the liver.
  • Distal bile duct tumors: form in the lower bile duct where the bile enters the small intestine.

Stages of Perihilar Bile Duct Cancer

  • Stage 0 (Carcinoma in Situ): Abnormal cells are found in the innermost layer of tissue lining the perihilar bile duct.
  • Stage I: Cancer has formed in the innermost layer of the wall of the perihilar bile duct and has spread into the muscle and fibrous tissue of the wall. 
  • Stage II: Cancer has spread through the wall of the perihilar bile duct to nearby fatty tissue or to the liver.
  • Stage IIIA: Tumor has spread to one branch of the hepatic artery or of the portal vein (vessels that carry blood to and from the liver).
  • Stage IIIB: Tumor has spread to nearby lymph nodes and into the perihilar bile duct wall, and may have spread through the wall to nearby fatty tissue, the liver, or to one branch of the hepatic artery or of the portal vein (vessels that carry blood to and from the liver).
  • Stage IVA: Tumor may have spread to nearby lymph nodes and one or more of the following:
    • main part of the portal vein (a vessel that carries blood away from the liver) or both branches of the portal vein;
    • hepatic artery (a vessel that carries blood to the liver);
    • right and left hepatic ducts;
    • right hepatic duct and the left branch of the hepatic artery or of the portal vein;
    • left hepatic duct and the right branch of the hepatic artery or of the portal vein
  • Stage IVB: Tumor has spread to other parts of the body, such as the liver.

Stages of Distal Bile Duct Cancer

  • Stage 0 (Carcinoma in Situ): Abnormal cells are found in the innermost layer of tissue lining the distal bile duct.
  • Stage IA: Cancer is found in the distal bile duct only.
  • Stage IB: Cancer has spread through the wall of the distal bile duct.
  • Stage IIA: Cancer has spread to the gallbladder, pancreas, small intestine, or other nearby organs.
  • Stage IIB: Cancer has spread to nearby lymph nodes, and may have spread through the distal bile duct wall to the gallbladder, pancreas, small intestine, or other nearby organs.
  • Stage III: Cancer has spread to the large vessels that carry blood to the organs in the abdomen and may have spread to nearby lymph nodes.
  • Stage IV: Cancer has spread to other parts of the body, such as the liver or lungs.

Both gallbladder and bile duct cancers are evaluated in additional terms, which help to guide treatment choices:

  • Localized (and resectable) cancer: This indicates that the cancer can be removed entirely by surgery.
  • Unresectable: This indicates the cancer cannot be removed entirely by surgery.
  • Recurrent cancer: Refers to cancer that has recurred or come back after it was treated previously. Cancer may recur in the same area or other body locations.
  • Metastatic: Refers to cancer that has spread to other areas of the body such as nearby blood vessels, liver, lymph nodes, other parts of the abdominal cavity or more distant locations.