Gallbladder Cancer

What is gallbladder cancer?

Gallbladder cancer occurs when malignant (cancer) cells grow in your gallbladder. Your gallbladder is a pear-shaped organ in the upper right of your abdomen, just under your liver. It stores and delivers bile, a fluid your liver secretes to help you digest fats in foods you eat.

Gallbladder cancer begins in the innermost layer of your gallbladder, called the mucosal layer, and spreads outward. It often doesn’t cause signs or symptoms in the early stages. Instead, healthcare providers often find the cancer by chance after gallbladder surgery.

The cure rate for gallbladder cancer is excellent if it’s in the early stages and healthcare providers can remove it with surgery. Unfortunately, most people don’t receive a diagnosis until the cancer has spread beyond their gallbladder. Gallbladder cancer is difficult to treat at this point.

How common is gallbladder cancer?

Gallbladder cancer is rare in the U.S., affecting about 2 people per 100,000. It’s more common in India, Japan, Korea, Poland and certain countries in South America. These countries have higher rates of gallstones and other conditions that are risk factors for gallbladder cancer.

What are the symptoms of gallbladder cancer?

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.

What causes gallbladder cancer?

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.

What are the risk factors for developing gallbladder cancer?

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.

How is gallbladder cancer diagnosed?

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.

What tests will be done to diagnose gallbladder cancer?

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.

What are the stages of gallbladder cancer?

Cancer staging allows your healthcare provider to determine whether cancer has spread (metastasized) beyond its original (primary) location. To determine the extent of cancer spread, your provider will assign a number (zero through four) to your cancer. The higher the number, the more the cancer has spread throughout your body.

The stages of gallbladder cancer are:

• Stage 0 (also known as carcinoma in situ):Abnormal, precancerous cells are in your gallbladder’s inner (mucosal) layer.
• Stage 1: Cancer cells are in the mucosal layer and may spread to the muscle wall of your gallbladder.
• Stage 2:Cancer has spread beyond the muscle layer to the connective tissue layers of your gallbladder.
• Stage 3: Cancer has spread to your liver or nearby organs or to the outer (serosal) layer of your gallbladder and possibly to your lymph nodes.
• Stage 4: Cancer has spread to more than three nearby lymph nodes, blood vessels and/or to organs far from your gallbladder.

Healthcare providers describe Stage 1 gallbladder cancer as local, meaning cancer hasn’t spread beyond your gallbladder. Stage 1 cancers are potentially curable. Stages 2 through 4 cancers are much more challenging to treat.

Where does gallbladder cancer spread first?

Gallbladder cancer spreads from the inner layer of your gallbladder to the outer layers. Eventually, it may spread to nearby lymph nodes or organs, such as your liver and bile ducts. Metastatic gallbladder cancer can travel to other organs through your lymphatic system or bloodstream.

How is gallbladder cancer treated?

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 treatment

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.

How can I prevent gallbladder cancer?

Gallbladder cancer can’t be prevented. You can do your best to avoid risk factors of gallbladder cancer. For example, you can work with your healthcare provider to maintain a healthy weight for you. Still, there’s no guarantee that your actions will prevent gallbladder cancer.

What’s the survival rate for gallbladder cancer?

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.

How do I care for myself with a gallbladder cancer diagnosis?

Be sure you understand your diagnosis, including all the benefits and risks associated with treatment. Ask questions about your prognosis, too. Your cancer care team is your best resource for explaining likely treatment outcomes.

Connecting with palliative care professionals can help you manage your symptoms. Palliative care can help you navigate your diagnosis. They attend to your comfort and needs regardless of your prognosis. Ask your healthcare provider if they recommend palliative care.

What questions should I ask my healthcare provider about gallbladder cancer?

You may want to go to your healthcare provider with a list of questions you have about gallbladder cancer. Possible questions include:

• What tests will I need to stage my cancer?
• What stage is my gallbladder cancer?
• What’s the best treatment for my gallbladder cancer?
• What are the benefits and risks associated with treatment?
• What resources do you recommend to provide support during this time?

A note from Cleveland Clinic

Gallbladder cancer is a rare and very serious disease. Be sure to see your healthcare provider as soon as possible if you experience the symptoms of gallbladder cancer. While other cancers show signs early on, remember that gallbladder cancer may not be obvious until it’s in the later stages. It’s vital to get treated as soon as possible.