How Does My Doctor Know I Have Gallbladder Cancer?

Cancer of the gallbladder is often hard to find. That’s partly due to its interior location. And it’s also because many people do not have any symptoms in the early stages of the disease.

If you’re having symptoms that may be due to gallbladder cancer, your doctor will ask you about:

  • Your medical history

  • Your family history of cancer

  • Your other risk factors

Your doctor will also do a physical exam to determine if your abdomen is enlarged or if you have any lymph node swelling that could be due to gallbladder cancer. Your doctor may also order some of these imaging exams and other tests to evaluate whether or not you have gallbladder cancer.

Imaging Exams and Tests

The following are used to determine if you have gallbladder cancer:

  • Ultrasonography. An ultrasound uses sound waves to look for abnormalities inside your body. It works much like a sonar system on a submarine. The sound waves bounce off body parts and send back signals to the computer. A computer analyzes these signals and makes an image of the body part being scanned.

  • Endoscopic ultrasound (EUS). This test combines 2 others: endoscopy and ultrasound. It provides images and information about the digestive tract and nearby tissue and organs. Endoscopy is a procedure that uses a tool called an endoscope. It’s a long bendable tube that’s placed into the mouth or the rectum to reach the digestive tract. In EUS, a small ultrasound tool is put on the end of the endoscope. It lets the doctor see high-quality ultrasound pictures of your organs. An EUS may help your doctor tell the difference between a cancerous (malignant) and noncancerous (benign) tumor. During EUS, a small piece of tissue can also be taken to examine later under a microscope. This provides your doctor with even more information about whether or not a cancerous tumor is present. 

  • Computed tomography (CT scan). A CT scan can help identify a gallbladder tumor or tell if the cancer has spread. A CT scanner takes many X-rays as it rotates around you. A computer combines these images to create detailed pictures that your doctor can view.

  • Magnetic resonance imaging (MRI) scan. Instead of X-rays, an MRI scan uses radio waves and strong magnets to create detailed images of your body. Your doctor may use an MRI scan to assess organs, blood vessels, and lymph nodes.

  • Cholangiography. These are X-ray tests in which a dye is injected into the bile ducts to see if they are blocked or narrowed. These tests can also be used to get samples of cells or fluid to look for cancer, or to place a stent (small tube) inside a duct to keep it open:

    • Endoscopic retrograde cholangiopancreatography (ERCP). The ducts are reached by passing an endoscope down the throat and into the small intestine.

    • Percutaneous transhepatic cholangiography (PTC). The ducts are reached by passing a needle through the skin and into the liver. 

  • Laparoscopic cholecystectomy. This is a type of surgery to take out the gallbladder. It uses a tool called a laparoscope. This thin, lighted tube lets a doctor see your gallbladder and nearby organs. The doctor makes a small cut just above your belly button to insert the tube. Long surgical instruments are then passed through other cuts in the skin to remove the gallbladder. Many gallbladder cancers are found without being expected at the time of laparoscopic surgery for another problem, such as gallstones. They may be found when a pathologist checks your gallbladder after it is taken out for another suspected problem. A pathologist is a doctor who specializes in looking at cells under a microscope to check for problems, including cancer. This type of surgery is not done if gallbladder cancer is suspected; instead, a more extensive operation will be needed. 

  • Biopsy. A biopsy may be taken in the operating room during a laparoscopy. Or a fine needle biopsy may be done to help make the diagnosis of cancer. A fine needle biopsy is usually done with the aid of a CT scan to help locate the tumor. This is called a CT scan-guided biopsy. Or an ultrasound can be used to find the tumor instead of a CT scan. Once the tumor is located, the doctor inserts a needle using the images as a guide and extracts a tissue sample. A specialized doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.

  • Liver function tests. These are blood studies that help determine how well the liver is working. They can help diagnose liver and bile duct diseases. The gallbladder is located directly beneath the liver and is considered part of the liver and bile duct system. These tests are an important tool because gallbladder cancer can affect liver function. Here are the most common liver function tests:

    • Albumin

    • ALT (alanine aminotransferase) 

    • AST (aspartate aminotransferase)

    • AP (alkaline phosphatase)

    • Bilirubin

    • GGT (gamma glutamyl transpeptidase)

    • PT (prothrombin time)

  • Tumor marker tests. Blood levels of the tumor markers CEA and CA 19-9 are sometimes (but not always) elevated in people with gallbladder cancer. But other health conditions can cause these markers to be high as well.