Gastrointestinal Cancers

Gallbladder Cancer

Background

The gallbladder is a small, sac-like organ on the right side of the abdomen, just beneath the liver. The gallbladder stores bile, a digestive fluid produced by the liver.

Gallbladder cancer is uncommon. When gallbladder cancer is discovered at its earliest stages, the possibility of curing it is very good. However, gallbladder cancer is difficult to diagnose because it often has no signs or symptoms. Unfortunately, most gallbladder cancers are discovered at a late stage, when the prognosis is often poor.

Symptoms

Gallbladder cancer signs and symptoms may include:

  • Abdominal pain, particularly in the upper right portion of the abdomen
  • Abdominal bloating
  • Anorexia/loss of appetite
  • Itchiness
  • Fever
  • Weight loss (non-intentional)
  • Nausea
  • Yellowing of the skin and whites of the eyes (jaundice)

Risk Factors

Factors that can increase the risk of gallbladder cancer include:

  • Gallbladder cancer is more common in women than men.
  • The risk of gallbladder cancer increases with age.
  • Gallbladder cancer is most common in people who've had gallstones in the past. Just because a person has a history of gallstones, however, does not mean he or she will develop cancer, as the incidence of gallbladder cancer is rare.
  • Other gallbladder conditions that can increase the risk of gallbladder cancer include: porcelain gallbladder, choledochal cyst, and chronic gallbladder infection.

Staging

Determining the extent of gallbladder cancer
Once a doctor diagnoses gallbladder cancer, he or she will determine the extent (stage) of the cancer. Understanding its stage helps determine your prognosis and treatment options.

Tests and procedures used to stage gallbladder cancer include:

  • Imaging tests that can create pictures of the gallbladder, including ultrasound; or
  • computerized tomography (CT); or
  • magnetic resonance imaging (MRI).

Exploratory surgery
Your doctor may recommend surgery to look inside your abdomen for signs that gallbladder cancer has spread. During this procedure, called laparoscopy, the surgeon makes a small incision in the abdomen and inserts a tiny camera. The camera allows the surgeon to examine organs surrounding the gallbladder for signs that the cancer has spread to surrounding organs and tissues.

Tests to examine the bile ducts
Your doctor may recommend procedures to inject dye into the bile ducts. This is followed by an imaging test that records where the dye goes. These tests can show blockages in the bile ducts and may include:

  • endoscopic retrograde cholangiopancreatography; or
  • magnetic resonance cholangiography; or
  • percutaneous transhepatic cholangiography.

Stages of gallbladder cancer

Stage I: Cancer is confined to the inner layers of the gallbladder.

Stage II: Cancer has grown to invade the outer layer of the gallbladder and may protrude into nearby organs, such as the liver, stomach, intestines, or pancreas. This stage of cancer may also include less extensive tumors that have spread to nearby lymph nodes.

Stage III: Cancer has grown to invade more than one of the nearby organs, or it may invade the portal vein or hepatic artery.

Stage IV: Cancer includes tumors of any size that have spread to distant areas of the body.

Treatment

Treatment options will depend on the stage of cancer, your overall health and preferences. The initial goal of treatment is to remove the gallbladder cancer, but when that isn't possible, other therapies may help control the spread of the disease and keep you as comfortable as possible.

Surgery to remove the gallbladder
Early gallbladder cancer that is confined to the gallbladder is most often treated with an operation to remove the gallbladder (cholecystectomy).

Surgery to remove the gallbladder and a portion of the liver
Gallbladder cancer that extends beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as a portion of the liver and bile ducts that surround it. Whether additional treatments after a successful surgery will lessen the chance of the cancer returning is unclear. Some studies found that additional treatments lessen the chance, so your doctor may recommend chemotherapy, radiation therapy or a combination of both following surgery. Additional treatments are still controversial because so few studies have been done to evaluate the effectiveness of additional treatments.

Treatments for late-stage gallbladder cancer
Surgery can't cure gallbladder cancer that has spread beyond the gallbladder. Instead, doctors use treatments that may relieve signs and symptoms of cancer to make you as comfortable as possible. Options may include:

  • Chemotherapy, a drug treatment that uses chemicals to kill cancer cells
  • Radiation therapy, which uses high-powered beams of energy, such as X-rays, to kill cancer cells

Procedures to relieve blocked bile ducts
Advanced gallbladder cancer can cause blockages in the bile ducts, causing further complications. Procedures can relieve the blockage. For instance, surgeons can place a hollow metal tube (stent) in a duct to hold it open or surgically reroute bile ducts around the blockage (biliary bypass).

References
National Cancer Institute, Mayo Clinic, Cancer Treatment Centers of America.