TCM diagnostic criteria for gallbladder cancer

Patients with gallbladder cancer lack specific clinical manifestations. Most are misdiagnosed as cholecystitis or cholelithiasis. When these patients experience symptoms such as right upper abdominal pain, right upper abdominal mass or anemia, their condition is often already in the advanced stage. Generally, according to their main symptoms, they are classified into the categories of jaundice, flank pain, masses, asthenia, and masses. So, what are the diagnostic criteria for the staging of gallbladder cancer?

1. Classification

Gallbladder cancer is divided into two types: adenocarcinoma and squamous cell carcinoma. The former accounts for about 71% to 90%, while the latter is less than 10%. Adenocarcinoma is further divided into the following types:

1. Papillary adenocarcinoma may be caused by the malignant transformation of papillary or polyp. The tumor grows into the gallbladder cavity, affecting the emptying of the gallbladder. There are ulcers on the surface of the tumor, which is easy to cause infection. If the tumor blocks the gallbladder neck, it can cause the gallbladder to swell and the gallbladder wall to thin, similar to gallbladder abscess or effusion.

2. Invasive adenocarcinoma is more common, accounting for about 70% of adenocarcinomas, and can cause the gallbladder to shrink and the gallbladder wall to become hard and thick.

3. Sclerosing adenocarcinoma may be accompanied by bile duct sclerosis, leading to obstruction in any part of the bile duct.

4. Mucinous adenocarcinoma tumors are soft and easily ruptured, leading to gallbladder perforation.

2. Clinical staging

(Nevein and Maron's classification based on the depth and extent of invasion of the gallbladder wall, 1976)

Stage I: Cancerous tissue is limited to the mucosa, that is, carcinoma in situ.

Stage II: invasion into the muscular layer.

Stage III: Cancerous tissue invades the entire thickness of the gallbladder wall.

Stage IV: invasion of the entire gallbladder wall with metastasis to surrounding lymph nodes

Stage V: Direct invasion of the liver or metastasis to other organs or distant metastasis.

TNM staging

T1: The tumor has invaded the gallbladder wall.

T1a: The tumor invades the mucosa.

T1b: The tumor has invaded muscle tissue.

T2: The tumor invades the muscular layer and surrounding tissues.

T3: Serosa and/or 1 organ are involved (liver infiltration ≤ 2 cm).

T4: 2 or more organs are involved, or the liver mass is > 2 cm.

N1a: bile duct and duodenal ligament lymph node metastasis.

N1b: Metastasis to other regional lymph nodes.

M0: No distant metastasis.

M1: There is distant metastasis.

4. Metastasis and dissemination

Gallbladder cancer develops and grows rapidly, and is prone to early spread. There are three ways of metastasis: lymphatic metastasis, hematogenous metastasis, and direct infiltration. Some people have found through surgery that among patients with gallbladder cancer that have metastasized, about 25%-75% have metastasized via the lymphatic system; more than half of the cancers can directly infiltrate adjacent organs, and the order of metastasis is liver, bile duct, pancreas, stomach, duodenum, omentum, colon, and abdominal wall.

Gallbladder cancer is a common metastatic route through the lymph nodes and directly to the liver. When the cancer grows extensively beyond the mucosa, perineural and vascular metastasis may also occur.

Gallbladder cancer can extend downward and cause bile duct obstruction. About 25% of gallbladder cancers can penetrate and spread to adjacent organs, including the stomach, duodenum, colon, and peritoneum. Distant hematogenous metastases often involve the lungs, bones, and kidneys. Patients with gallbladder cancer often find enlarged Virchow nodes on the clavicle.