Gallbladder and extrahepatic bile ducts
Miscellaneous
TNM staging of carcinomas of the gallbladder and cystic duct (AJCC 8th edition)

Author: Raul S. Gonzalez, M.D.
Deputy Editor in Chief: Debra Zynger, M.D.

Revised: 10 July 2018, last major update June 2018

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: TNM staging for carcinoma of gallbladder and cystic duct

Cite this page: Gonzalez, R. S. TNM staging of carcinomas of the gallbladder and cystic duct. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladderstaging.html. Accessed December 12th, 2018.
Pathologic TNM staging of carcinomas of the gallbladder and cystic duct, AJCC 8th edition
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


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    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
Distant metastasis (pM)
  • M0: no distant metastasis
  • M1: distant metastasis
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 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?

  1. pT1
  2. pT2
  3. pT3
  4. pT4
Board review answer #1
B. pT2