Stage IV gallbladder cancer is divided into stages IVA and IVB. In stage IVA, cancer has spread to a main blood vessel of the liver or to 2 or more nearby organs or areas other than the liver. Cancer may have spread to nearby lymph nodes. In stage IVB, cancer has spread to either (1) lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone; or (2) to organs or areas far away from the gallbladder.