Gallbladder cancer as the name suggests, begins in the gallbladder, an organ that stores a substance called bile. To read about gallbladder and gallbladder cancer, click here
How is gallbladder cancer staged?
Staging of gallbladder cancer helps the doctors figure out the on how much the cancer has spread in the body and determine its best treatment. Staging also helps calculate survival statistics too. The lower the number of the stage, the less is the cancer has spread, with early stages being 1 and the most advanced stage being 4. The staging system and the other factors taken into consideration to determine the stage of gallbladder cancer are as follows:
Cancer types that form tumours are staged using TNM system and the same method is used for gallbladder cancer too, TNM stands for stands for tumour, node and metastasis.
Tumour(T) generally is used to categorize the size of the primary tumour but in this case, it used to reflect the extent to which the cancer has spread to the walls of the gallbladder. The gallbladder has several layers listed below in the order of innermost to the outermost layers:
- The epithelium, a thin layer of cells that lines the interior wall of the gallbladder.
- The lamina propria, a layer of loose connective tissues.
- The muscularis, a layer of muscular tissue that helps the gallbladder contract to push the bile into the bile duct.
- The perimuscular, a layer lining the muscularis made up of fibrous tissue.
- The serosa which forms the outer covering of gallbladder and comes from the peritoneum (lining of the abdominal cavity).
The node describes whether the cancer has spread to the nearby lymph nodes or not. N0 represents no spreading of the cancer to the lymph nodes, N1 represents the spreading of cancer to nearby lymph nodes and N2 stands for spreading to distant lymph nodes.
This gives information about the cancer spreading to other parts of the body, M0 represents no metastasis while M1 stands for metastasized tumours.
Read more about the staging of gallbladder cancer here.
Stage II of gallbladder cancer:
Most cases of stage II gallbladder cancers are detected during surgeries to remove gallstones or because of inflammation in the gallbladder.
The stage grouping of gallbladder is as follows:
Stage IIA: The cancer has spread through the muscularis into the fibrous tissue on the side of the peritoneum but has not spread to nearby lymph nodes or distant organs and the grouping is (T2a, N0, M0).
Stage IIB: The cancer has spread through the muscularis into the fibrous tissue on the side of the liver but has not invaded the liver or spread to nearby lymph nodes or distant organs and the grouping is (T2b, N0, M0).
How is stage II gallbladder cancer treated?
Surgery is the best method for treating early gallbladder cancer, read more about it here. Stage II gallbladder cancer treatment may require extended cholecystectomy which could be followed by a round of radiation therapy or chemotherapy depending on the extent of spreading and the risk of recurrence.
In case there is a risk of the cancer coming back after a simple cholecystectomy, extended or radical cholecystectomy will be done and this prefered more often a simple cholecystectomy. This involves removal of the gallbladder, an 2 cm or more of the liver tissue next to the gallbladder and all the lymph nodes in the region, depending on the spread of the cancer and the patient’s health, more organs or parts may be removed too.
Chemotherapy uses drugs to kill cancer cells throughout the body and is used in treating stage II gallbladder cancer if there is a chance of recurrence. Capecitabine, a chemotherapy drug may be suggested for treating this cancer type. Read more about use of chemotherapy in gallbladder cancer treatment here
Radiotherapy involves killing cancer cells using high intensity radiation and is also used if the tumours are to be targeted unlike chemotherapy which kills cancer cells in all body parts, however due the risk associated with radiation, it is used only in case the cancer has locoregional spread or can recur. Read more about use of radiotherapy in gallbladder cancer treatment here