Gallbladder cancer
Synonyms
Adenocarcinoma of the gallbladder, Carcinoma of the gallbladder, Gallbladder adenocarcinoma,Overview
Gallbladder cancer is an abnormal growth of cells that begins in the gallbladder.
Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver.
Gallbladder cancer is uncommon. When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor.
Gallbladder cancer may not be discovered until it’s advanced because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.
Symptoms
Gallbladder cancer is difficult to detect because symptoms don’t show up in the early stages. When symptoms appear, they’re similar to more common conditions, like gallstones or a blockage in a bile duct.
Symptoms include:
Upper abdominal pain.
Yellowed skin and yellowed whites of your eyes (jaundice).
Lumps in your abdomen.
Unexplained weight loss.
Nausea and vomiting.
Bloating.
Fever.
Causes
Gallbladder cancer occurs when healthy cells become malignant cells that grow and multiply out of control. This can happen when there are changes, or mutations, in the genetic material that tells healthy cells how to behave. With gallbladder cancer, these genetic mutations occur over time (acquired). You don’t inherit them from your biological parents.
Scientists don’t know what causes cells to become cancer cells in the first place. But they’ve identified several factors that may increase your risk.
In the U.S., gallbladder cancer is more common among certain groups, including people who are:
Women or assigned female at birth.
American Indian, Alaskan native or Mexican-American.
Over age 65. (The average age at diagnosis is 72.)
Other risk factors include having:
Gallstones or a history of gallstones.
Gallbladder polyps.
Chronic (long-term) gallbladder inflammation (cholecystitis).
Chronic Salmonella typhi infection (the bacteria that causes typhoid).
A build-up of calcium deposits in your gallbladder (porcelain gallbladder).
Chronic inflammation in your bile ducts (primary sclerosing cholangitis).
Cysts in your common bile duct (choledochal cysts).
Obesity.
It’s also possible that smoking and exposure to certain chemicals used to create textiles and rubbers can increase your risk.
Diagnosis
Because there are rarely signs or symptoms in the early stages, and those symptoms resemble other conditions, providers often diagnose gallbladder cancer late. They often discover it because you have gallstones or need your gallbladder removed.
If your provider suspects you might have gallbladder cancer, they’ll examine you and ask about your medical history. Then, they’ll perform tests.
Tests may include lab tests, imaging procedures and minor surgeries.
Lab tests
Lab tests detect substances in your blood that may be signs of cancer.
Liver function test: Measures the levels of certain substances your liver releases, which may indicate that gallbladder cancer is affecting your liver.
Carcinoembryonic antigen (CEA) assay: Measures the levels of CEA, a tumor marker released by both healthy and cancerous cells. High levels may be a sign of gallbladder cancer.
CA 19-9 assay:Measures the levels of the tumor marker CA 19-9 in your blood. High levels could indicate gallbladder or pancreatic cancer.
Imaging tests
Imaging tests allow healthcare providers to look for cancer and signs of cancer spread.
Abdominal ultrasound: An imaging test that uses sound waves to create pictures of the organs within your abdomen. You may need additional imaging procedures, like a CT scan or MRI, if an ultrasound detects a mass that could be gallbladder cancer.
CT (computed tomography) scan: A type of X-ray that takes detailed images of internal organs.
MRI (magnetic resonance imaging): An imaging test that uses a magnet, radio waves and a computer to create pictures of the inside of your body.
Endoscopic ultrasound:An ultrasound that uses a tube-like instrument called an endoscope to create pictures of your digestive tract.
Endoscopic retrograde cholangiopancreatography (ERCP): An X-ray procedure that takes pictures of your bile ducts. Gallbladder cancer can cause these ducts to narrow.
Surgeries
Surgical procedures allow healthcare providers direct access to tissue that contains cancer cells.
Biopsy: A healthcare provider removes a tissue sample and examines it under a microscope for cancer cells. A biopsy is the only way to confirm a gallbladder cancer diagnosis.
Laparoscopy: A provider inserts a laparoscope (a thin, lighted tube) into your abdomen through a small incision (cut) to look at your gallbladder and nearby tissues. A laparoscopy can help your provider determine how much the cancer has spread.
Prognosis
The prognosis for gallbladder cancer tends to be poor because it’s not usually diagnosed until it’s advanced. Only about 20% of gallbladder cancers are diagnosed in the early stages. The five-year survival rate for people with metastasized gallbladder cancer is 2%. The survival rate for localized gallbladder cancer is much higher, at 66%.
Can gallbladder cancer be cured?
Yes. But gallbladder cancer can only be cured if caught and treated early. To cure gallbladder cancer, your healthcare provider must remove it before it spreads to other organs.
Treatment
The cancer stage affects treatment and treatment goals. With early-stage cancers, the goal is often to remove the cancer, so it doesn’t return. If it’s more advanced, treatment goals may include extending your life and managing symptoms.
Early-stage gallbladder cancer that your provider can remove through surgery has the best treatment outcomes.
Surgery: A healthcare provider called a surgical oncologist may remove your gallbladder and nearby tissue (cholecystectomy). If you have a simple cholecystectomy, the surgeon will only remove your gallbladder. With an extended cholecystectomy, the surgeon will remove other tissues with cancer cells, such as affected lymph nodes or part of your liver.
Radiation therapy: This treatment uses a machine outside your body (EBRT) to direct radiation to your cancer. The radiation kills the cancer cells or slows tumor growth while minimizing damage to healthy cells. You may need this treatment after surgery to kill any remaining cancer cells. Radiation can also provide symptom relief.
Chemotherapy: Chemotherapy uses drugs to kill cancer cells or stop them from multiplying. Like radiation, chemotherapy may help destroy any remaining cancer cells after surgery. Your provider may recommend chemotherapy treatments alongside radiation therapy.
Unresectable, recurrent or metastatic gallbladder cancer treatment
Cancers that can’t be removed via surgery (unresectable), have returned (recurrent) or spread (metastatic) aren’t curable. Treatments like radiation therapy and chemotherapy won’t eliminate the cancer, but they can improve your symptoms and extend your life. Similarly, while surgeries can’t remove the cancer, you may need procedures to relieve symptoms if tumors create blockages in your digestive tract.
You may be eligible to take part in a clinical trial. A clinical trial is a study that tests new treatments and new approaches to current treatments. Current treatments for gallbladder cancer being tested in clinical trials include:
Targeted therapy: Treatment that targets cancer cells that carry certain gene mutations.
Immunotherapy: Treatment that bolsters your immune system so it’s better able to identify and destroy cancer cells.
Radiosensitizers: Treatment that makes cancer cells more sensitive to the effects of radiation therapy.
Ask your healthcare provider if you’re a candidate for a clinical trial.
Are there any side effects of gallbladder treatment?
Surgery always comes with risks, including infection, complications from anesthesia and blood clots, that you should discuss with your provider before starting treatment.
It’s also important to plan for potential chemotherapy and radiation side effects. Predicting your side effects is impossible because everyone’s treatment response is different. Still, your healthcare provider can explain possible side effects to watch out for based on your specific treatment plan.