Gallbladder Cancer

Overview

What is gallbladder cancer?

Gallbladder cancer occurs when malignant (cancer) cells grow in your gallbladder, a pear-shaped organ located under your liver in your upper abdomen.

The outside of your gallbladder is made up of four layers of tissue:

  • The inner layer (mucosal layer).
  • The muscle layer.
  • The connective tissue layer.
  • The outer layer (serosal layer).

Gallbladder cancer begins in the mucosal layer and moves outward. It is often found by chance after gallbladder surgery or it’s not discovered until it has progressed to a late stage.

Can gallbladder cancer spread to other areas of your body?

Yes. This is called metastasis. Cancer can spread through your:

  • Tissue: Cancer grows into nearby areas.
  • Lymph system: Cancer goes through the lymph vessels to other areas.
  • Blood: Cancer travels through the blood vessels to other areas.

Cancers are named after where they began. If you have cancer in your liver that started in your gallbladder, it’s called metastatic gallbladder cancer.

What are the stages of gallbladder cancer?

One of the biggest concerns about cancer is whether it has spread (metastasized) beyond its original (primary) location. To determine the amount of spreading, your healthcare provider will assign a number (zero through five) to the diagnosis. The process is called staging; 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): The cancer is confined to the mucosal (inner) layer of the gallbladder.
  • Stage 1: The cancer has spread up to the muscle layer.
  • Stage 2: The cancer has spread beyond the muscle layer to the connective tissue layer.
  • Stage 3: The cancer has moved to the liver or to organs near it, or the outer layer (serosal) and possibly to the lymph nodes.
  • Stage 4: The cancer has moved to more than three adjacent lymph nodes, nearby vessels and/or to organs that are located far from the gallbladder.

How common is gallbladder cancer?

Gallbladder cancer is rare. Each year from 2007 through 2011, around 3,700 individuals in the United States were diagnosed with it, and about 2,000 people died.

Who is most likely to get gallbladder cancer?

Women are more likely than men to get gallbladder cancer. You’re also more likely if you’re of a certain ethnic group:

  • American Indian.
  • An Alaskan native.
  • Black.
  • Asian American.

You’re also more likely if you are:

  • A smoker.
  • Exposed to chemicals used in the textile and rubber industries.
  • Diagnosed with primary sclerosing cholangitis (PSC).
  • Experiencing cysts in your common bile duct.
  • Older. The average age of diagnosis is 72.
  • Obese.
  • Experiencing gallbladder polyps, inflammation and/or infections.
  • Infected with salmonella.
  • Eating an unhealthy diet.

If you get gallstones, that doesn’t mean you’ll get gallbladder cancer, but it does increase your risk.

Is gallbladder cancer hereditary (inherited)?

No, gallbladder cancer is not thought to be hereditary.

Does gallbladder cancer hurt?

Abdominal pain can be a symptom of gallbladder cancer.

Can gallbladder cancer be mistaken for gallstones?

Both gallstones and gallbladder cancer can cause pain in your upper right abdomen, where your gallbladder is located. Sometimes gallbladder cancer is discovered when a healthcare provider is diagnosing gallstones.

Is gallbladder cancer fatal? What’s the survival rate?

Gallbladder cancer is usually not found until it’s in a later stage. One study discovered that 43% of gallbladder cancers were diagnosed after the cancer spread to nearby organs or lymph nodes, and 42% were found after the cancer spread to distant organs or lymph nodes. Because it’s often found late, after it has spread to other areas of the body, gallbladder cancer can be deadly.

Symptoms and Causes

What causes gallbladder cancer?

It’s not clear what causes gallbladder cancer.

What are the symptoms of gallbladder cancer?

Gallbladder cancer is difficult to detect early on because of the lack of obvious symptoms and because, when symptoms do appear, they are similar to those of other, less-serious conditions. In addition, the gallbladder's location makes it more difficult to find the cancer. The following symptoms may be signs of gallbladder cancer:

  • Jaundice (yellowed skin and yellowed whites of your eyes).
  • Pain above the stomach area.
  • Fever.
  • Nausea and vomiting.
  • Bloating.
  • Abdominal lumps.

Diagnosis and Tests

How is gallbladder cancer diagnosed?

Because there are rarely signs or symptoms in the early stages and those symptoms resemble other illnesses, gallbladder cancer is often diagnosed late. It's usually discovered because you have gallstones or need your gallbladder removed.

If your healthcare provider suspects that you might have gallbladder cancer, they’ll examine you and ask about your medical history. Then your provider will perform other tests, including:

Lab tests:

  • Blood chemistries: Measures the levels of specific types of substances in your blood, including those that may indicate cancer.
  • Liver function test: Measures the levels of certain substances released by your liver, which may indicate that your liver has been affected by gallbladder cancer.
  • Carcinoembryonic antigen (CEA) assay: Measures the levels of CEA (a tumor marker released by both healthy and cancerous cells).
  • CA 19-9 assay: Measures the levels of the tumor marker, CA 19-9, in your blood. This substance is released by both healthy and cancer cells. Higher levels could indicate gallbladder or pancreatic cancer.

Imaging tests:

  • Abdominal ultrasound: Uses sound waves to create pictures of the organs within your abdomen.
  • CT (or CAT) scan: A type of X-ray that takes detailed images of internal organs.
  • Chest X-ray.
  • MRI (magnetic resonance imaging): A procedure that takes images inside the body using a magnet, radio waves and a computer.
  • Endoscopic retrograde cholangiopancreatography (ERCP): An X-ray procedure that takes pictures of the bile ducts. Gallbladder cancer can cause narrowing of these ducts.
  • Endoscopic ultrasound.

Other tests:

  • Biopsy: A procedure in which tissues or cells are removed and examined for cancer under a microscope.
  • Laparoscopy: A surgical procedure in which a laparoscope (a thin, lighted tube) is inserted into your abdomen through a small incision to look inside your body.

Management and Treatment

What kind of healthcare provider treats/manages gallbladder cancer?

You may see many different healthcare providers to help treat your gallbladder cancer:

  • Surgeon/surgical oncologist: A surgeon who is a cancer treatment specialist.
  • Medical oncologist: This type of healthcare provider will help you with chemotherapy and other medications.
  • Radiation oncologist: This provider uses radiation to help manage the spread of cancer.
  • Gastroenterologist: These providers specialize in your digestive system.

Can gallbladder cancer be cured? How is gallbladder cancer treated? What medicines may help with gallbladder cancer?

To cure gallbladder cancer, it must be found before it has spread to other organs. The stage of cancer affects the treatment. Localized cancer (stage 1) may be treated with:

  • Surgery: The surgical removal of your gallbladder and nearby tissue is called a cholecystectomy. The surgeon also may remove lymph nodes located near the gallbladder and part of the liver near the gallbladder.
  • Radiation: Radiation therapy uses high levels of radiation to kill the cancer cells or stop them from multiplying, while minimizing damage to healthy cells. Radiation uses a machine outside of your body to direct radiation to your cancer. If you have a radiation treatment you may experience side effects such as: skin problems, nausea and vomiting, tiredness, liver damage and/or diarrhea.
  • Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells or stop them from multiplying. Chemotherapy drugs may be injected or taken orally (by mouth). Examples of chemo drugs include Gemcitabine (Gemzar®), cisplatin (Platinol®), 5-fluorouracil (5-FU), capecitabine (Xeloda®) and oxaliplatin (Eloxatin®). Chemo side effects include tiredness, easy bruising, easy bleeding, infections, hair loss, mouth sores, loss of appetite, diarrhea and nausea and vomiting.

Some clinical trials are trying new types of treatment:

  • Radiation sensitizers.
  • Targeted therapy.
  • Immunotherapy.

How does gallbladder cancer surgery work?

Modern gallbladder cancer surgeries are usually laparoscopic surgeries with smaller incisions. In addition to removing your gallbladder, your surgeon may also remove tissues surrounding it. If you have a simple cholecystectomy, your surgeon will remove your gallbladder. An extended cholecystectomy is where other tissues are cut out in addition to the gallbladder.

Is the surgery inpatient or outpatient?

Talk to your surgeon about whether you’ll need to spend some time in the hospital or not.

What kind of healthcare provider performs the surgery?

A surgical oncologist.

What happens after surgery for gallbladder cancer?

You may need to have additional surgery. You may also need to be treated with chemotherapy or radiation to lower the chances of cancer coming back.

What do I have to do after I go home?

Attend follow-up appointments as required. Your healthcare provider might recommend that you get additional testing done every six months for at least two years.

Are there any side effects of gallbladder surgery?

Surgery always comes with risks that you must weigh. Potential risks include:

  • Extra bleeding.
  • Blood clots.
  • Pneumonia.
  • Complications from anesthesia.
  • Infection.

How soon after treatment will I feel better?

It may take several weeks after surgery before you fully heal.

What’s palliative care?

Palliative care is where the disease isn’t cured, but the symptoms are managed. Your healthcare provider may suggest this type of care if you can’t have surgery on your gallbladder while you get treatment with chemotherapy or radiation.

Prevention

How can I prevent gallbladder cancer?

Gallbladder cancer can’t be prevented. You can do your best to avoid a few of the risk factors of gallbladder cancer — you can try eating well and maintaining a healthy weight — but there’s no guarantee that your actions will prevent it.

Are there any supplements, foods or drinks that prevent gallbladder cancer?

No supplements, foods or drinks are known to help prevent gallbladder cancer at this time.

Outlook / Prognosis

What’s the prognosis (outlook) for people with gallbladder cancer?

Your chance of recovery depends on four things:

  • The stage of your cancer.
  • Whether your gallbladder can be successfully removed.
  • If your cancer has recurred (come back).
  • Your general health.

Can gallbladder cancer just go away on its own?

No. Gallbladder cancer requires treatment.

When can I go back to work/school?

Talk to your healthcare provider about a timeline regarding when you can return to your normal activities.

Can gallbladder cancer get worse?

With time, yes, the cancer can spread to other parts of your body.

Can gallbladder cancer come back after it’s been treated?

Yes, gallbladder cancer can be “recurrent.” After it’s treated it can return to the gallbladder area, or come back in another organ.

Living With

When should I see my healthcare provider?

See your healthcare provider as soon as you experience the symptoms of gallbladder cancer. It’s important to get a diagnosis and treatment as soon as possible.

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 your gallbladder cancer. Possible questions include:

  • In what stage is my gallbladder cancer?
  • What’s the best treatment for my gallbladder cancer?
  • How soon can I start treatment?

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. 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.

Last reviewed by a Cleveland Clinic medical professional on 06/14/2021.

References

  • American Cancer Society. . Accessed 6/12/2021. Gallbladder Cancer (https://www.cancer.org/cancer/gallbladder-cancer.html)
  • American Cancer Society. . Accessed 6/12/2021. Gallbladder Cancer Early Detection, Diagnosis, and Staging (https://www.cancer.org/content/dam/CRC/PDF/Public/8631.00.pdf)
  • Centers for Disease Control and Prevention. . Accessed 6/12/2021. Gallbladder Cancer Incidence and Death Rates (https://www.cdc.gov/cancer/dcpc/research/articles/gallbladder.htm)
  • NIH National Cancer Institute. . Accessed 6/12/2021.Gallbladder Cancer – Patient Version (https://www.cancer.gov/types/gallbladder)

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