Gallbladder Cancer

gallbladder and bile duct passage

Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.

The wall of the gallbladder has 3 main layers of tissue.

  • Mucosal (inner) layer.
  • Muscularis (middle, muscle) layer.
  • Serosal (outer) layer.

Between these layers is supporting connective tissue. Primary gallbladder cancer starts in the inner layer and spreads through the outer layers as it grows.

Risk Factors
Symptoms
Screening and Diagnosis
Staging
Treatment
Support

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Risk Factors

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for gallbladder cancer include the following:

  • Being female.
  • Being Native American.

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Symptoms

These and other signs and symptoms may be caused by gallbladder cancer or by other conditions. Check with your doctor if you have any of the following:

  • Jaundice (yellowing of the skin and whites of the eyes).
  • Pain above the stomach.
  • Fever.
  • Nausea and vomiting.
  • Bloating.
  • Lumps in the abdomen.

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Screening and Diagnosis

Gallbladder cancer is difficult to detect and diagnose for the following reasons:

  • There are no signs or symptoms in the early stages of gallbladder cancer.
  • The symptoms of gallbladder cancer, when present, are like the symptoms of many other illnesses.
  • The gallbladder is hidden behind the liver.

Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.

Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.

Procedures that make pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the gallbladder is called staging.

In order to plan treatment, it is important to know if the gallbladder cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. The following tests and procedures may be used:

  • Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
  • Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer.
  • Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.
  • CA 19-9 assay: A test that measures the level of CA 19-9 in the blood. CA 19-9 is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.
  • Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound is done to diagnose gallbladder cancer.
  • PTC (percutaneous transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • ERCP (endoscopic retrograde cholangiopancreatography): A procedure used to x-ray the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes gallbladder cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. An endoscope (a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter (a smaller tube) is then inserted through the endoscope into the bile ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken.
  • Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy. The laparoscopy helps to find out if the cancer is within the gallbladder only or has spread to nearby tissues and if it can be removed by surgery.
  • Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.

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Staging

Tests and procedures to stage gallbladder cancer are usually done at the same time as diagnosis.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

  • Tissue. The cancer spreads from where it began by growing into nearby areas.
  • Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
  • Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if gallbladder cancer spreads to the liver, the cancer cells in the liver are actually gallbladder cancer cells. The disease is metastatic gallbladder cancer, not liver cancer.

The following stages are used for gallbladder cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the inner (mucosal) layer of the gallbladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed and has spread beyond the inner (mucosal) layer to a layer of tissue with blood vessels or to the muscle layer.

Stage II

In stage II, cancer has spread beyond the muscle layer to the connective tissue around the muscle.

Stage IIIA

In stage IIIA, cancer has spread through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).

Stage IIIB

In stage IIIB, cancer has spread to nearby lymph nodes and:

  • beyond the inner layer of the gallbladder to a layer of tissue with blood vessels or to the muscle layer; or
  • beyond the muscle layer to the connective tissue around the muscle; or
  • through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).

Stage IVA

In stage IVA, cancer has spread to a main blood vessel of the liver or to 2 or more nearby organs or areas other than the liver. Cancer may have spread to nearby lymph nodes.

Stage IVB

In stage IVB, cancer has spread to either:

  • lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone; or
  • to organs or areas far away from the gallbladder.

For gallbladder cancer, stages are also grouped according to how the cancer may be treated. There are two treatment groups:

Localized (Stage I)

Cancer is found in the wall of the gallbladder and can be completely removed by surgery.

Unresectable, recurrent, or metastatic (Stage II, Stage III, and Stage IV)

Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer have unresectable cancer.

Recurrent cancer is cancer that has recurred (come back) after it has been treated. Gallbladder cancer may come back in the gallbladder or in other parts of the body.

Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic gallbladder cancer may spread to surrounding tissues, organs, throughout the abdominal cavity, or to distant parts of the body.

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Treatment

At Huntsman Cancer Institute, gallbladder cancer is treated by a team of specialists, including surgeons, medical oncologists (doctors who treat cancer with medicine, radiation oncologists (doctors who treat cancer with radiation), gastroenterologists (doctors who treat diseases of the digestive system), nurses, dietitians, and social workers.

Different types of treatments are available for patients with gallbladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Three types standard treatments are used:

New treatments are being tested in clinical trials.

Surgery

Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

  • Surgical biliary bypass: If the tumor is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
  • Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An x-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Learn more about this treatment in our introduction to chemotherapy video.

 

Clinical trials

This section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. For more information, visit HCI's clinical trials website.

Radiation sensitizers - Clinical trials are studying ways to improve the effect of radiation therapy on tumor cells, including the following:

  • Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs.
  • Radiosensitizers: Drugs that make tumor cells more sensitive to radiation therapy. Giving radiation therapy together with radiosensitizers may kill more tumor cells.

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Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

  • Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
  • The G. Mitchell Morris Cancer Learning Center has hundreds of free brochures and over 3,000 books, DVDs, and CDs available for checkout or talk one-on-one with cancer information specialists.
  • Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to Huntsman Cancer Institute (HCI) patients and their families.
  • The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.

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Adapted from the National Cancer Institute's Physician Data Query (PDQ®) Cancer Information Summaries
This information last updated on HCI website December 2013

*If you are interested in a trial that is currently marked *Not Open, please contact the Patient Education team at 1-888-424-2100 or patient.education@hci.utah.edu for other trial options. Enrollment is updated daily.

Forte Research Systems in partnership with Huntsman Cancer Institute

Paul J. Campsen, M.D.

Locations
Huntsman Cancer Hospital (801) 585-2708
University Hospital (801) 585-2708
University Hospital (801) 581-2634

Specialties: Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Kidney Transplant, Liver Cancer, Liver Disease, Liver Transplant, Pancreas Transplant, Renal Transplantation, Surgery, General

Robert E. Glasgow, M.D.

Locations
Huntsman Cancer Hospital (801) 585-6035
University Hospital (801) 585-6035

Specialties: Acute Care Surgery, Barrett's Esophagus, Colorectal Surgery, Endocrine Surgery (Adrenal, Thyroid, Parathyroid), Esophageal Diseases, Esophageal Surgery, GI Motility, Gastric/Esophageal Surgery, Gastroesophageal Reflux Disease (GERD), Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Hernia Surgery (open and laparoscopic), Minimally Invasive Gastrointestinal Surgery, Minimally Invasive Lung & Esophageal Surgery, Soft Tissue Sarcoma Surgery, Surgery, General, Therapeutic Endoscopy, Upper Gastrointestinal Tract Surgery

Ying J. Hitchcock, M.D.

Locations
Huntsman Cancer Hospital (801) 581-2396

Specialties: Gastrointestinal Cancers, Head and Neck Cancers, Radiation Oncology, Soft Tissue Sarcomas

Robin D. Kim, M.D.

Locations
Huntsman Cancer Hospital (801) 585-6140
Primary Children's Hospital (801) 585-6140
University Hospital (801) 585-6320

Specialties: Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Kidney Transplant, Liver Cancer, Liver Disease, Liver Transplant, Pancreas Transplant, Surgery, General, Transplant Surgery

Sean J. Mulvihill, M.D.

Locations
Huntsman Cancer Institute (801) 581-7167

Specialties: Biliary Cancer, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Laparoscopy, Liver Cancer, Pancreatic Cancer, Surgery, General

N. Jewel Samadder, M.Sc., M.D.

Locations
Huntsman Cancer Hospital (801) 213-9797
South Jordan Health Center (801) 213-9797

Specialties: Clinical Genetics, Colon Cancer, Gastroenterology, Gastrointestinal Cancers, Pancreatic Cancer

Courtney L. Scaife, M.D.

Locations
Huntsman Cancer Institute (801) 585-6911

Specialties: Colorectal Surgery, Esophageal Surgery, Gastric/Esophageal Surgery, Gastrointestinal Stromal Tumors, Hepatopancreatobiliary (Liver/Pancreas/Biliary) Surgery, Minimally Invasive Gastrointestinal Surgery, Oncology Surgery, Pancreatic Cancer, Sarcoma, Soft Tissue Sarcoma Surgery, Surgery, General, Upper Gastrointestinal Tract Surgery

Dennis C. Shrieve, M.D., Ph.D.

Locations
Huntsman Cancer Hospital (801) 581-2396

Specialties: Brain Tumors, Gastrointestinal Cancers, Genitourinary Cancers, Lung Cancer, Pediatric Radiation Therapy, Prostate Cancer, Radiation Oncology, Soft Tissue Sarcomas

Jonathan D. Tward, M.D., Ph.D.

Locations
Huntsman Cancer Hospital (801) 581-2396
South Jordan Health Center (801) 213-4320

Specialties: Bladder Cancer, Brachytherapy, Gastrointestinal Cancers, Genitourinary Cancers, Intensity-Modulated Radiation Therapy (IMRT), Lymphomas, Penile Cancer, Prostate Cancer, Radiation Oncology, Robotic Prostatectomy, Seed Implants, Stereotactic Body Radiation Therapy (SBRT), Urologic Oncology

HCI Resources

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Care coordinator: Christy Steele
Phone: 801-587-4422
E-mail: christy.steele@hci.utah.edu

Did You Know?

  • Being female can increase the risk of developing gallbladder cancer.
  • Possible signs of gallbladder cancer include jaundice, pain, and fever.
  • Stages of gallbladder cancer are grouped according to how the cancer may be treated: localized (resectable) or unresectable.
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