Gallbladder cancer
June 16th, 2024 | MedAsk Team
What is Gallbladder cancer?
It is a cancer that affects the gallbladder, which is a small organ located just under the liver, that is part of a person’s upper digestive tract and produces and stores bile before it is released into the small intestine to help with food digestion (1). Gallbladder cancer is a relatively uncommon cancer that affects fewer than 2 per 100,000 people per year in the United States. Most tumors are adenocarcinomas, with a small percent being squamous cell carcinomas. Gallbladder cancer is difficult to detect (find) and diagnose early. If it is diagnosed early enough, it can be treated by removing the gallbladder and surrounding lymph nodes, but most often it is diagnosed in later stages, when surgery is not possible or has a worse prognosis.
Risk factors
In each instance of gallbladder cancer, it is impossible to say what caused it, but there are known risk factors that increase the likelihood that this cancer will develop. They are:
- Gender — about twice as common in women than men
- Obesity
- Having a brother, sister, or parent who had gallbladder cancer
- Congenital abnormalities
- Certain medical conditions, such as gallbladder stones, gallbladder polyps, chronic cholecystitis, and primary sclerosing cholangitis
How to lower your chance of getting gallbladder cancer
You cannot always prevent gallbladder cancer. But making healthy changes can lower your chances of getting it (2). You can:
- Lose weight if you’re overweight
- Cut down on alcohol – avoid drinking more than 14 units a week
- If you are a smoker, quit smoking
Gallbladder cancer symptoms
Symptoms often develop only in later stages of the cancer growth. In the beginning, they most often are not present or are not symptomatic of the disease. The most common are: pain in the upper right abdomen, dyspepsia (uncomfortable feeling in the stomach), bloating, vomiting, loss of appetite, general weakness, weight loss, and jaundice (yellowing of the skin).
Early symptoms mimic gallbladder inflammation due to gallstones. Later, the symptoms may be that of biliary and stomach obstruction (3).
Many of these symptoms are very common and can be caused by many different conditions. Having them does not definitely mean you have gallbladder cancer. But it’s important to get them checked by a GP. This is because if they’re caused by cancer, finding it earlier makes it more treatable.
If you’re experiencing symptoms that concern you, consult with MedAsk, our AI-driven symptom assessment tool, to gain insights into your condition and receive personalized recommendations.
Diagnosing gallbladder cancer
Due to symptoms developing in later phases and often not being typical of the disease, an early diagnosis is generally not possible. A large number of gallbladder cancers are found incidentally while diagnosing people with gallbladder stones.
The process used to find out if cancer cells have spread within and around the gallbladder is called staging. Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. They are:
- Liver function tests: A small blood sample is taken, and levels of certain substances that indicate how the liver is performing its functions are checked. Higher or lower than normal amounts of some of those substances can be indicative of gallbladder cancer.
- CT scan: A procedure that uses an X-ray machine linked to a computer. It takes many pictures of the inside of the body and produces renderings in the form of slices that a clinician can examine to find signs of a disease. In the case of gallbladder cancer, it can show an enlarged gallbladder and possibly its invasion into neighboring tissues. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Ultrasound exam: A procedure that utilizes high-energy sound waves to form an image of the patient’s internal organs. 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 needle is inserted through the skin into the liver. Dye is injected into the liver or bile ducts, and an x-ray is taken.
- ERCP (endoscopic retrograde cholangiopancreatography): A procedure used to x-ray the bile ducts (tubes). The operator uses an endoscope that is passed through the patient’s mouth to access the small intestine. There, he inserts a catheter into the bile ducts. A dye is injected, and an x-ray is taken that can show if the bile ducts are obstructed (blocked). A fine tube may be inserted into the duct to unblock it. Tissue samples may also be taken.
- MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells, so they show up brighter in the picture.
- Endoscopic ultrasound (EUS): A procedure where an endoscope is used with an ultrasound probe at the end of it to make US images of internal organs and structures. It is inserted into the body, usually through the mouth or rectum, and can show signs of gallbladder cancer or its metastases.
- Laparoscopy: A surgical procedure where small incisions are made in the wall of the abdomen, and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. It is used for observing the state of inner organs and disease progression, but can also be used to perform procedures such as removing organs or taking tissue samples for biopsy. 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: It is the process of taking a tissue sample of the suspected diseased part of an organ and viewing it under a microscope, usually 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. Biopsy is the only diagnostic procedure that confirms a cancer diagnosis with certainty.
Treatment of gallbladder cancer
Early-stage gallbladder cancer can be treated by surgery. It is a complex procedure where the surgeon removes the gallbladder and surrounding structures, including part of the liver and lymph nodes. In addition to surgery, patients may receive chemotherapy and sometimes radiation therapy to help prevent local and distant recurrence (4).
In later stages, when gallbladder cancer is more advanced, the treatment usually consists of a combination of chemotherapy and immunotherapy. Depending on the genetic properties of the cancer, targeted therapy is also sometimes possible (in about 20% of cases).
Follow-up tests may be needed
As a patient goes through treatment, they will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests (5).
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if the condition has changed or if the cancer has recurred (came back).
Bottom line
Gallbladder cancer is a relatively uncommon cancer. At its onset, there are no or very few symptoms, which become apparent only in later stages. You cannot prevent it with certainty, but it is associated with risk factors (stated above) that can be mitigated. It is diagnosed with imaging techniques and confirmed by biopsy. The treatment used depends on the type and progression of the cancer. Major treatment types are surgery, chemotherapy, radiation therapy, and targeted therapy.
For personalized advice on navigating your health concerns, try MedAsk, our AI-powered symptom assessment tool.
Sources
- https://www.cancer.gov/types/gallbladder (Accessed June 15, 2024)
- https://www.mayoclinic.org/diseases-conditions/gallbladder-cancer/symptoms-causes/syc-20353370 (Accessed June 15, 2024)
- https://www.nhs.uk/conditions/gallbladder-cancer/(Accessed June 15, 2024)
- https://www.ncbi.nlm.nih.gov/books/NBK442002/ (Accessed June 16, 2024)
- Mukkamalla SKR, Kashyap S, Recio-Boiles A, Babiker HM. Gallbladder Cancer. 2023 Jul 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28723031.