T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side)
Two labels for a gallbladder cancer that has grown through the muscle layer but is still inside the gallbladder. T2a sits on the free side facing the abdominal cavity; T2b sits on the side pressed against the liver, spreads to nodes and vessels more often and roughly doubles the risk of dying, so the surgeon removes more liver for it.
Overview
The AJCC and UICC 8th edition (2017) split T2 by tumour location: T2a invades the perimuscular connective tissue on the peritoneal side without reaching the serosa, T2b on the hepatic side without liver invasion (CRUK stages and grades). The split rests on an international series of 437 resected patients: among 252 with T2 disease, hepatic-side tumours (99) had more vascular invasion (51 versus 19 percent), neural invasion (33 versus 8 percent) and nodal metastasis (40 versus 17 percent) than peritoneal-side tumours (153), and tumour location predicted recurrence pattern and survival (Shindoh 2015). A 2022 meta-analysis of 15 studies and 2,531 patients (1,332 T2a, 199 T2b classified) found overall survival significantly worse in T2b (hazard ratio 2.18) with more recurrence, and liver resection appeared to improve survival in T2b (Alrawashdeh 2022). Validation studies are mixed: a Korean series found T1b and T2a, and T2b and T3, hard to separate and suggested dropping the subcategories (Sung 2020), and the National Cancer Database validation called for prospective confirmation (Giannis 2021). In practice T2b is the stage at which a formal liver resection (segments IVb and V) is most argued for.
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- Gallbladder
- Nodes: peripancreatic
- Nodes: hepatic hilar
- Nodes: coeliac and superior mesenteric
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)Neuroendocrine carcinoma of the gallbladder (small cell and large cell; under 5 percent)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- GallbladderGallbladder adenocarcinoma (about 90 percent; biliary, intestinal, mucinous and other patterns) · Papillary carcinoma of the gallbladder, and its precursor the intracholecystic papillary neoplasm · Mucinous carcinoma of the gallbladder (about 2.5 percent) · Adenosquamous and squamous carcinoma of the gallbladder (about 5 percent) · Neuroendocrine carcinoma of the gallbladder (small cell and large cell; under 5 percent) · Incidental gallbladder cancer found in the cholecystectomy specimen · Carcinoma in situ and dysplasia of the gallbladder (biliary intraepithelial neoplasia; stage 0) · Cystic duct carcinoma (staged with gallbladder cancer)
- peripancreatic
- hepatic hilar
- coeliac and superior mesenteric
Same organ: Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder adenocarcinoma, Papillary carcinoma of the gallbladder, Mucinous carcinoma of the gallbladder, Adenosquamous and squamous carcinoma of the gallbladder, Neuroendocrine carcinoma of the gallbladder, Incidental gallbladder cancer (found after cholecystectomy), Carcinoma in situ and dysplasia of the gallbladder, Cystic duct carcinoma, Ampullary cancer (ampulla of Vater), Resectable pancreatic ductal adenocarcinoma, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma
Showing the organ this term concerns: Gallbladder cancer.
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