Gallbladder Cancer

What is gallbladder cancer?
About 6,000 new cases of gallbladder cancer occur in the United States each year, according to the American Cancer Society. Gallbladder cancer starts in the innermost layer of the organ’s tissue and grows through the outer layers.

Most gallbladder cancers are adenocarcinomas, which include variants of adenosquamous carcinomas, squamous cell carcinomas, and small cell carcinomas.

Who is most likely to have gallbladder cancer?
Most gallbladder cancer experts believe chronic inflammation caused by gallstones is the major cause. About three of four people with gallbladder cancer have gallstones when they are diagnosed. Yet, most people with gallstones never develop gallbladder cancer.

Because females are more susceptible to gallstones and inflammation caused by them, they are more susceptible to gallbladder cancer. Gallbladder cancer is seen mainly in older people; the average age of diagnosis is 73. About three of four people with gallbladder cancer are age 65 or older at diagnosis.

Other risk factors include obesity, having Native American or Mexican American ethnicity, bile duct abnormalities, gallbladder polyps, exposure to chemicals in the rubber and textile industries, and typhoid infection. However, not all cases of gallbladder cancer have identifiable risk factors.

What characterizes gallbladder cancer?
Most gallbladder cancers are not found in early stages because this disease does not cause early symptoms. Many gallbladder cancers are discovered only after the gallbladder is removed due to gallstones or long-term inflammation. Other cancers are found after the patient has symptoms such as jaundice, pain above the stomach, fever, nausea and vomiting, gallbladder enlargement, bloating, and abdominal lumps.

How does the physician diagnose gallbladder cancer?
The physician reviews the results of a physical examination, blood tests and pictures of the gallbladder on imaging studies. During the physical exam, the doctor checks the abdomen for lumps, fluid build-up, or other abnormalities and the lymph nodes for abnormal swelling. The primary physician may order blood tests for abnormal enzymes and tumor markers. Other tests such as ultrasound, computed tomography (CT) scan, x-ray, magnetic resonance imaging (MRI), and angiography will provide images of abdominal area. Another procedure, called cholangiography or endoscopic retrograde cholangiopancreatography (ERCP), enables the  physician to view the bile ducts and the gallbladder by injecting a dye-like agent from the opening of the distal bile duct located in the small intestine. Signs of narrowing or blockage, which is often associated with cancer, can be observed by ERCP, and the physician can gather a sample of bile fluid to examine for cancer cells by a pathologist.

What does the pathologist look for?
The doctor usually needs to obtain a biopsy specimen–a sample of the tumor’s cells–for the pathologist to examine under a microscope and to make a definitive diagnosis of cancer before making treatment decisions. When there is a large tumor and a CT scan or ERCP has established a high suspicion of cancer, a surgeon will explore the abdomen to assess whether the disease is localized or has spread outside the gallbladder before making a decision on the most appropriate operation for the patient. Sometimes, to guide surgical decisions, a biopsy of the tumor may be performed in the operating room and sent to the pathologist for a quick diagnosis during the surgery.

What is meant by the stage and grade of the cancer?
The pathologist and primary care doctor determine the cancer’s stage to plan treatment. Stage I gallbladder cancers are small, confined to wall of the gallbladder, and can be completely removed with surgery. Stage IV cancers have spread beyond the original area into other parts of the body. Stage II and III describe conditions in between these two extremes.

The grade of the cancer, which is assessed by a pathologist, can also affect the patient’s prognosis. Rated on a scale of 1 to 4, grade 1 cancer cells resemble normal tissue and are less likely to spread outside the gallbladder than high-grade cancers, which look very different than normal cells.

The combination of both stage and the grade of cancer are assessed for the prediction of cancer behavior. Thus, a cancer of low stage and a low grade has better prognosis than that of advanced stage and high grade.

How do doctors determine what treatment will be necessary?
The recommended treatment will depend on the size and location of the tumor, the type and stage of the cancer, whether the cancer is newly diagnosed or has come back, whether the cancer is causing symptoms, and the patient’s age and general health. The primary care physician or specialist consults with the pathologist. Together, using their combined experience and knowledge, they determine treatment options most suited to the patient’s condition. It’s important to learn about treatment options and make the decision that’s right for you.

What kinds of treatments are available for gallbladder cancer?
Gallbladder cancer is treated with surgery, radiation therapy, and chemotherapy. Surgery and radiation therapy may be used individually or in combination. Chemotherapy may be used before or after surgery and along with radiation therapy.

Surgery is the only possible way to cure gallbladder cancer if the tumor is localized and can be completely removed. Surgery to remove the gallbladder is called cholecystectomy. In addition to removing the gallbladder, the surgeon may remove nearby lymph nodes and a portion of adjacent liver tissue. Depending on where the cancer is located and how far it might have spread, other organs and tissue in the abdominal area may be removed.

Radiation therapy uses pinpointed, high-energy beams to kill cancer cells. In some cases, a physician can deliver radiation therapy through needles, seeds, wires, or catheters that are placed directly into or near the cancer. The spheres destroy the blood supply to the tumor, which has extended to the liver.

Chemotherapy kills cancer cells with anti-cancer drugs. It may be used before or after surgery, or along with radiation therapy for advanced cancers. Because regular chemotherapy is not very effective against gallbladder cancer, physicians are studying ways to deliver anti-cancer drugs directly into the hepatic artery, which supplies the tumor.

In addition, people with gallbladder cancer may receive other treatments to control pain and other symptoms, relieve side effects, or to ease emotional problems. Gallbladder cancer patients must receive frequent check-ups after treatment because gallbladder cancer may come back. The type of follow-up evaluation can include physical exams, blood tests, and imaging tests. Patients must be vigilant about reporting any unusual symptoms.

Clinical trials of new treatments for may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental but may be an option for advanced cancers. To learn more about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.

For more information, go to www.cancer.gov (National Cancer Institute) or www.cancer.org (American Cancer Society). Type the keywords gallbladder cancer into the search box.

What kinds of questions should I ask my doctors?
Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

  • Please describe the condition I have and what treatment options are available.
  • What is the stage of my cancer?
  • What treatment options do you recommend? Why do you believe these are the best treatments?
  • What are the pros and cons of these treatment options?
  • What are the side effects?
  • Is your medical team experienced in treating the condition I have?
  • Can you provide me with information about the physicians and others on the medical team?
  • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS

Bile duct: A tube that carries bile from the liver to the gallbladder and then to the small intestine.

Gallbladder: A pear-shaped organ located below the liver. The gallbladder collects and stores bile, a fluid made by the liver to digest fat.

Malignant: Cancerous.

Metastatic: Spreading beyond the original tumor location to other parts of the body.

Pathologist: A physician who examines tissues and fluids to diagnose disease or specific types of cancer in order to guide treatment decisions

 

Images

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Gallbladder cancer cells
Normal gallbladder cells
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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