The following statement(s) is/are true concerning the mode of spread of gallbladder cancer

b. Lymphatic drainage of the gallbladder can extend from the cystic duct lymph node to periportal lymph nodes and the celiac and superior mesenteric lymph nodes

d. Direct extension to the liver, particularly liver segments IV and V, is the most common mode of spread for gallbladder cancer

The mode of spread of gallbladder cancer can be predicted by the lymphatic and venous drainage of the gallbladder. Venous drainage is into the venules that drain directly into the adjacent liver. The most common spread of gallbladder cancer is through direct extension into the liver, particularly liver segments IV and V. The lymphatic drainage of the gallbladder is to the cystic duct lymph node, to periportal lymph nodes, and then to celiac and superior mesenteric lymph nodes. These tumors can also spread into and around the cystic duct and may extend into the common bile duct, causing biliary obstruction. Besides direct extension and lymphatic spread of the tumor, distant metastases is possible but is less commonly seen. A staging system has been developed which takes into consideration lymphatic and venous drainage of the gallbladder. The most advanced stage, stage V, includes distant spread, either into the liver or adjacent organs, which unfortunately is the case at the time of presentation for most patients.