The gallbladder is a small pouch that sits just under the liver. The gallbladder stores bile produced by the liver. After meals, the gallbladder is empty and flat, like a deflated balloon. Before a meal, the gallbladder may be full of bile and about the size of a small pear.
Gallbladder cancer is a disease that begins in the gallbladder. Gallbladder cancer is rare and typically strikes older people (age 70 and above). It usually responds well to treatment when diagnosed early. However, many people are diagnosed at a later stage.
It is not clear what causes gallbladder cancer. Certain factors make a person more likely to develop the disease. Gallbladder cancer usually affects older people (age 70 and above). Women are also much more likely than men to develop the disease. Gallbladder cancer is more common among Mexican Americans, southwestern Native Americans, and people from certain South American countries, particularly Chile.
Some other risk factors for gallbladder cancer include:
Gallstones and Inflammation
Gallstones are hard, rocklike formations similar to kidney stones. Gallstones are made of cholesterol and other substances in the gallbladder. Up to 90 percent of people diagnosed with gallbladder cancer also have gallstones and longstanding inflammation of the gallbladder. These conditions are more common in women. That’s why women are more likely to develop gallbladder cancer. It is important to remember that gallstones are quite common, and most people with gallstones never develop gallbladder cancer.
Porcelain Gallbladder
Porcelain gallbladder is a condition in which the gallbladder becomes covered in calcium deposits, resembling porcelain ceramic. This condition can occur when the gallbladder becomes inflamed. It is thought that excessive gallstones bring on porcelain gallbladder, but the exact cause is not clear.
Gallbladder Polyps
Gallbladder polyps are growths that extend from the gallbladder’s mucous membrane. Some polyps are precancerous and can progress to cancer. Our surgeons will usually remove polyps that are 1 centimeter or larger, appear to be growing, or have a broad base.
Typhoid
People who have been repeatedly infected with salmonella (the bacteria that causes typhoid) are six times more likely to develop gallbladder cancer.
Obesity
Many people who develop gallbladder cancer are overweight or obese. They often have a high-carbohydrate or low-fiber diet.
Family History
A family history of gallbladder cancer seems to increase a person’s chances of developing the disease, although the risk is still low.
Gallbladder cancer doesn’t usually cause many symptoms until it reaches an advanced stage, when it has spread to other organs and tissues. Occasionally, symptoms appear at an early stage, when treatment is more effective.
The following signs and symptoms may be caused by gallbladder cancer or another condition. Check with your doctor if you experience any of them.
Jaundice
Jaundice is a condition in which the skin and the whites of the eyes become yellow, urine darkens, and the color of stool is lighter than normal. This can occur because a gallbladder tumor has grown large enough to block the bile duct.
Weight Loss
The loss of a significant amount of weight without trying can be a sign of many cancers, including gallbladder cancer.
Fever
An increase in body temperature without another explanation can be an early sign of cancer, including gallbladder cancer.
Loss of Appetite
Gallbladder cancer may make it uncomfortable to eat or make you feel like you don’t want to eat at all.
Bloating or Pain in the Belly
The pain or bloating typically occurs in the upper right part of the belly.
Fatigue
Fatigue is a common symptom of many types of cancer, including gallbladder cancer.
Lumps in the Belly
Gallbladder cancer that blocks the bile ducts or has spread to the liver can sometimes be felt by doctors on the right side of the belly.
Most gallbladder cancers are a type called adenocarcinoma. Cancer cells in the gallbladder sometimes spread to nearby lymph nodes or organs.
The type of gallbladder cancer depends on the kind of cell where it began. Several varieties of cells in the gallbladder develop different gallbladder cancer types. Pathologists (doctors who specialize in diagnosing disease) can identify the type of gallbladder cancer by looking at tumor cells under a microscope.
Gallbladder Adenocarcinoma
Most common gallbladder cancer — about 90 percent — is adenocarcinoma. This growth begins in the gland like cells that line the insides of the gallbladder. There are three types of adenocarcinoma of the gallbladder:
- Non papillary adenocarcinoma
- Papillary adenocarcinoma
- Mucinous adenocarcinoma
Non papillary adenocarcinoma is the most common.
Papillary adenocarcinoma is rare and less likely to spread to the liver and nearby lymph nodes. People with this type of gallbladder cancer have a better outlook than most people with a gallbladder adenocarcinoma.
Mucinous adenocarcinoma is even rarer. It begins in the cells that produce mucin, the primary ingredient of mucus.
Other Gallbladder Types
Other types of gallbladder cancer are quite rare. They include:
- adenosquamous carcinoma
- squamous cell carcinoma
- carcinosarcoma
These begin in different types of cells in the gallbladder. They are often more aggressive than adenocarcinoma of the gallbladder.
Gallbladder cancer is hard to find early. The gallbladder lies deep inside the body and cannot be felt during routine physical exams. The disease is often diagnosed unexpectedly when the gallbladder is removed to treat gallstones or another condition.
If you have symptoms that suggest you may have gallbladder cancer, it’s vital that your doctor has a clear and complete understanding of what’s causing them. When making a diagnosis, our experts take the time to learn about your medical history and understand your overall health. We conduct a thorough physical examination. In addition, you may have some of the following tests.
Blood Tests
Diagnosing gallbladder cancer may begin with a test to measure the amount of bilirubin in the blood. Bilirubin is a chemical that comes from the breakdown of red blood cells and gives bile its yellow color. A high bilirubin level can mean that the gallbladder or liver is not functioning properly. Other blood tests measure levels of liver enzymes (such as alkaline phosphatase, AST, ALT, and GGT) and can identify abnormal amounts of other substances (such as the proteins CEA and CA 19-9). Finding any of these substances in the blood can indicate the presence of gallbladder cancer.
Imaging
We use the latest imaging techniques to pinpoint the exact size and location of newly diagnosed gallbladder tumors. These details help us determine whether a tumor can be removed by surgery. They also help predict a tumor’s response to other treatments. Imaging helps guide our surgeons and interventional radiologists during various treatments.
The imaging techniques we use include:
- CT Scans
CT scans take cross-sectional pictures of the body, helping doctors determine if the cancer cells are only in the gallbladder or if they have spread to other areas. We use triphasic CT scans. These take images of the gallbladder, liver, bile ducts, and nearby lymph nodes during three phases of blood flow through the liver. - Ultrasound
Ultrasound is useful for detecting the location and number of tumors and whether the tumor involves the main blood vessels. Ultrasound can distinguish whether a mass is cancer or a benign (noncancerous) gallstone disease. Unlike CT, ultrasound does not use radiation. - magnetic resonance cholangiopancreatography
This technique uses magnetic resonance imaging (MRI) to show how much a tumor has grown within the gallbladder. It helps doctors determine if the tumor can be removed by surgery. More detailed MRI may be needed to see if the tumor has spread to the liver or other organs.
- Positron Emission Tomography
PET scans can detect whether cancer has spread from the gallbladder to other tissues or organs. PET and CT scans are sometimes used together (PET-CT) to pinpoint the exact location of tumors.
Other Diagnostic Techniques
We may do other tests to learn more about the extent of the tumor and the types of cells involved. These are often performed in an outpatient setting.
- Biopsy
During a biopsy, a doctor removes a small amount of tissue from the area where the cancer is suspected. At
KIMS
, we use an image-guided technique called fine needle aspiration to get this sample of gallbladder cancer. This procedure is usually performed by an interventional radiologist (a doctor who specializes in minimally invasive techniques). - Endoscopy
This technique involves inserting an endoscope (a long, narrow tube attached to a camera and light) through the mouth and down the throat to examine the gallbladder. - Laparoscopy
In this procedure, a doctor inserts a laparoscope (a thin lighted tube with a camera on its tip) through a small incision (cut) in the abdominal wall to look at the organs in the belly or pelvis. The doctor can then see the size of the cancer and if it has spread to other organs and lymph nodes. This evaluation is also called staging. Tissue samples may be removed for a biopsy during a laparoscopy as well. - Surgery
Sometimes a gallbladder tumor is too small to do a biopsy. If cancer is suspected, surgery to remove the tumor may be necessary to confirm the diagnosis.
Gallbladder cancer is classified according to the type and stage, from the earliest to the most advanced. The stages of gallbladder cancer are based on the location and size of the tumor and how far it has spread. Nearly all gallbladder cancer starts in the inner lining of the gallbladder. Over time it may grow through various layers toward the outside of the gallbladder.
Cancers at similar stages tend to have a similar outlook and are often treated in much the same way. When we know the stage of the cancer, our doctors can prepare a treatment plan that’s customized specifically to each person’s needs.
There are four main stages of gallbladder cancer. They are often written with the Roman numerals I, II, III, and IV.
Stage I Gallbladder Cancer
Stage I describes cancer that is confined to the inner layers of the gallbladder.
Stage II Gallbladder Cancer
Stage II describes cancer that has grown into the outer layers of the gallbladder.
Stage III Gallbladder Cancer
Stage III describes cancer that has spread to one or more nearby organs, such as the liver, small intestine, or stomach. The cancer may have spread to nearby lymph nodes.
Stage IV Gallbladder Cancer
Stage IV describes the most advanced form of gallbladder cancer. It includes large tumors that involve several nearby organs and tumors of any size that have spread (metastasized) to distant areas of the body.
Gallbladder Cancer Treatment Groups
The stages of gallbladder cancer are also generally grouped by how the cancer may be treated.
There are two treatment groups:
- localized (stage I)
- unresectable, recurrent, or metastatic (stage II, stage III, and stage IV)
Surgery, chemotherapy, radiation or a combination of these may be used treat gallbladder cancer. Depending on the stage of the disease, your
KIMS
care team will determine the most appropriate treatment plan for you.
Surgery
Surgery is the preferred treatment for gallbladder cancer and offers the best chance for a cure. For tumors that have not spread beyond the gallbladder, the most effective procedure is called a radical cholecystectomy. In this procedure, a surgeon removes the gallbladder, nearby lymph nodes, and some of the tissue surrounding the organs. More-extensive surgery may be done if the cancer has spread.
Symptom Relief
Some people with gallbladder cancer can’t have surgery because the tumor has spread or is in too difficult a place to be entirely removed by surgery. The tumor may be blocking bile from draining out of the gallbladder, causing discomfort. We can use minimally invasive, image-guided procedures to remove blockages and relieve symptoms.
Chemotherapy
Chemotherapy is a drug or combination of drugs that kills cancer cells wherever they are in the body. Several chemotherapy approaches have been shown to shrink gallbladder tumors and possibly improve survival.
Radiation Therapy
Radiation may be used for people with gallbladder tumors that cannot be removed by surgery. The radiation may be given alone or in combination with chemotherapy and other treatments.
Gallbladder Cancer Surgery
Surgery is the preferred treatment for gallbladder cancer and offers the best chance for a cure. The most common approach is radical cholecystectomy, which involves removing the entire gallbladder, usually along with nearby lymph nodes and surrounding tissue. (There is no evidence that removal of the gallbladder increases the risk of developing other cancers, despite this misconception.)
Cholecystectomy
Surgery to remove only the gallbladder is called a cholecystectomy (also called a simple cholecystectomy). This procedure is not done if gallbladder cancer is known or suspected. But gallbladder cancers are sometimes found by accident after a person has a cholecystectomy for another reason.
Radical Cholecystectomy
Radical cholecystectomy is also called extended cholecystectomy. In this procedure, a surgeon removes the gallbladder, nearby lymph nodes, and some of the tissue surrounding the gallbladder, usually a portion of the liver. It is the most effective treatment for gallbladder tumors that have not spread.
Symptom Relief for Gallbladder Cancer
Many people are not candidates for surgery by the time gallbladder cancer is diagnosed. However, minimally invasive, image-guided procedures can help improve quality of life by allowing bile to drain out of the gallbladder or a bile duct that is blocked by a tumor. Our surgeons, gastroenterologists, and experts in interventional radiology use tools such as catheters and needles, to relieve such symptoms as jaundice, itching, nausea, vomiting, and infection.
Stent Placement
A stent is a small drainage tube. It can relieve a blocked bile duct so bile can flow across a blockage to the small intestine. Usually, a stent is placed using an endoscope (a small tubelike instrument) inserted through the mouth. When that method is not possible, a stent can be placed with a needle inserted through the liver. Imaging is used to identify the blockage and place a stent or a drainage catheter (a thin, flexible tube) through the blockage. Some people may need to have a catheter for a while after getting a stent.
Biliary Bypass
A biliary bypass connects the gallbladder or bile duct directly to the small intestine. This creates a new way for bile to get around a tumor that is blocking the flow from the gallbladder.
Neurolytic Celiac Plexus Block
People with advanced gallbladder cancer often have pain. The pain may be caused by cancer cells that have invaded a cluster of nerves near the liver known as the celiac plexus. People who don’t get enough pain relief with conventional pain-relieving drugs may benefit from a procedure called neurolytic celiac plexus block (NCPB). This involves injecting a local anesthetic into the celiac plexus to disrupt the body’s pain signals. It can be performed with a laparoscope while examining the gallbladder to diagnose and stage the cancer.
Ablation
Ablation destroys cancer cells by delivering heat or cold through a needle placed into a gallbladder tumor. It requires no incisions (cuts) and is effective for some people with isolated tumors who are not candidates for surgery.
Chemotherapy is a drug or a combination of drugs that kills cancer cells wherever they are in the body. Doctors may give chemotherapy before surgery to shrink a gallbladder tumor. This is called neoadjuvant therapy. Chemotherapy given after surgery to destroy any cancer cells that may remain is called adjuvant therapy.
The standard chemotherapy drugs for gallbladder cancer are gemcitabine (Gemzar®) and cisplatin. Other drugs sometimes used include fluorouracil (also called 5-FU), oxaliplatin (Eloxatin®), and capecitabine (Xeloda®). Our doctors will carefully tailor treatment to make sure that it’s as effective as possible while helping maintain quality of life.
If gallbladder cancer has spread, chemotherapy may be given as the main treatment if surgery is not an option. Chemotherapy is also given to relieve symptoms due to cancer, such as a tumor that is pressing on a nerve and causing pain.
RADIATION THERAPY FOR GALLBLADDER CANCER
Radiation therapy uses precisely focused high-energy beams to kill cancer cells. To treat gallbladder cancer, our doctors may give radiation alone or in combination with chemotherapy or other treatments. We deliver radiation therapy in a variety of forms. The kind of radiation we recommend depends on the type of gallbladder cancer, the location of the tumor, and whether it has spread.
External-beam radiation therapy is the most common type of radiation therapy used to treat gallbladder cancer. The radiation may be given alone or in combination with a radiosensitizer. This is a drug that makes the body more sensitive to radiation.
You may have heard of CyberKnife. This is a brand name for a type of radiation therapy called stereotactic body radiation therapy. This method destroys tumors with very intense doses of radiation in fewer sessions than standard radiation therapy.
Minimizing Radiation Side Effects
Our doctors use highly sophisticated computer software and 3-D computer images from CT scans to develop individualized plans for each person we care for. This makes it possible to deliver high doses of radiation to a gallbladder tumor while sparing surrounding organs and reducing the risk to healthy tissue.
Our doctors use radiation therapy to treat gallbladder cancer in several ways:
Before or After Surgery
Radiation is occasionally given before surgery to shrink a tumor so it is possible to remove it.
After the gallbladder has been removed, radiation may be given to the area where the organ once was or to the nearby lymph nodes. This is done to destroy any cancer cells that may remain following surgery.
As the Main Cancer Treatment
Radiation therapy may be used as the main treatment in people with gallbladder cancer that has spread throughout the body and cannot be removed by surgery. The radiation will not cure the cancer, but it may help people with advanced gallbladder cancer live longer.
As Palliative Therapy
Radiation is sometimes given to people with advanced gallbladder cancer to address physical symptoms. This may include shrinking a tumor that is causing discomfort by blocking blood vessels or bile ducts or pressing on nerves
LIVING BEYOND GALLBLADDER CANCER
we know that even after you’ve finished gallbladder cancer treatments, you may still need our help. We’re committed to supporting you in every way we can — physically, emotionally, spiritually, and otherwise — for as long as you need us.
We’ve built a program designed for cancer survivors and their families. Our Survivorship Center has many services for you and your loved ones, including support groups, follow-up programs, educational resources, and more.