What is Gallbladder Cancer?

Gallbladder cancer is a rare disease in which malignant cancer cells are found in the tissues of the gallbladder. The gallbladder stores bile, a fluid made by the liver to digest fat. According to the American Cancer Society, there will be 9,520 new cases and 3,340 deaths in the United States from gallbladder cancer in 2008.

What are the symptoms of Gallbladder Cancer?

There are often no noticeable signs or symptoms in the early stages of gallbladder cancer. When there are symptoms, they are often like the symptoms of many other illnesses. Some possible signs include:

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

What are the risk factors for Gallbladder Cancer?

Risk factors may include:

• Gallstones and Inflammation of the Gallbladder Gallstones are the most common risk factor for gallbladder cancer. Between 75 – 90% of individuals with gallbladder cancer have gallstones and chronically inflamed gallbladders when they are diagnosed. 
• Age – The highest proportion of patients with this cancer are in their 70s.
• Gender – females are at an increased risk for gallbladder cancer.
• Family History – Gallbladder cancer can run in families. Having a family history increases your risk.
• Ethnicity – Individuals of Native American ancestry, particularly in the southwestern United States, have high rate of gallbladder cancer.
• Diet – a high carbohydrate, low-fiber diet may increase a person’s susceptibility to gallbladder cancer.

Screening and Diagnosis for Gallbladder Cancer

Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Procedures are done which create pictures of the gallbladder and the area around it to help diagnose the cancer and determine how far it has spread. The following tests and procedures may be used:

• Physical exam and history
• Ultrasound exam - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
• Liver function tests
• CT (CAT) scan - A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
• Blood tests
• Chest x-ray
• MRI - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• ERCP - An endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic procedure that allows the physician to diagnose problems in the liver, gallbladder, bile ducts and pancreas. These include conditions such as: tumors, pancreatitis, gallstones and cysts. An ERCP combines the use of x-rays and an endoscope to allow the physician to examine the area, take tissue samples, remove stones and insert stents.
• Biopsy
• Laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall.
• Percutaneous Transhepatic Cholangiography (PTC) - a needle is introduced through the skin and into the liver where the dye (contrast) is deposited and the bile duct structures can be viewed by x-ray.
• CA 19-9 or Carcinoembryonic Antigten (CEA) assay – Test which measures the levels of CA 19-9 or CEA released into the bloodstream. When these levels are found higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.

Prognosis & Staging

Gallbladder cancer can be cured only if it is found before it has spread, when it can be removed by surgery. The prognosis (chance of recovery) and treatment options for gallbladder cancer depend on the following:

• The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body).
• Whether the cancer can be completely removed by surgery
• The type of gallbladder cancer (how the cancer cell looks under the microscope).
• Whether the cancer is newly diagnosed or has recurred

The following are the stages used for gallbladder cancer:

• Stage 0 (Carcinoma in Situ) - abnormal cells are found in the innermost layer of the gallbladder.  These abnormal cells may become cancer and spread into normal nearby tissue.
• Stage I – Cancer has formed. Stage I is divided into Stage IA and Stage IB.
  • Stage IA – Cancer has spread beyond the innermost layer to the connective tissue or the muscle layer.
  • Stage IB – Cancer has spread beyond the muscle layer to the connective tissue around the muscle.
• Stage II – Stage II is divided into Stage IIA and Stage IIB.
  • Stage IIA – Cancer has spread beyond the visceral peritoneum (tissue that covers the gallbladder) and/or to the liver and/or one nearby organ.
  • Stage IIB – Cancer has spread beyond the innermost layer of the connective tissue and to the lymph nodes; or to the muscle layer and nearby lymph nodes; or beyond the muscle layer to the connective tissue around the muscle and to nearby lymph nodes; or through the visceral peritoneum (tissue that covers the gallbladder) and to nearby lymph nodes.
• Stage III – Cancer has spread to a main blood vessel in the liver or to nearby organs and may have spread to nearby lymph nodes.
• Stage IV – Cancer has spread to nearby lymph nodes and/or to organs far away from the gallbladder.

The 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 (Stage II, Stage III and Stage IV) Cancer has spread through the wall of the gallbladder to surround tissues or organs or throughout the abdominal cavity. Except in patients whose cancer has spread only to the lymph nodes, the cancer is unresectable.

Treatment

There are three types of treatment used for gallbladder cancer:

• Surgery - Gallbladder cancer may be treated with a cholecystectomy, a surgery to remove the gallbladder and the surrounding tissue. If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:
  • Surgical biliary bypass – This type of surgery is done when the tumor is blocking the small intestine and bile is backing up in the gallbladder. In this operation, the gallbladder or bile duct is cut and sewn to the small intestine to create a new pathway around the blocked area.
  • Endoscopic stent placement – When the tumor is blocking a bile duct, a stent (a thin, flexible tube) may be placed inside the duct to drain the bile in the area.
  • Percutaneous Transhepatic Biliary drainage – A procedure which relieves the drainage of bile when a endoscopic stent can not be used. 
• Radiation therapy - Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. There are two ways to deliver radiation therapy:
  • external radiation (external beam therapy)
    External beam radiation is a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • internal radiation (brachytherapy, implant radiation)
    Internal radiation therapy is given inside the body as close to the cancer as possible. Substances that produce radiation, called radioisotopes, may be swallowed, injected, or implanted directly into the tumor. Some of the radioactive implants are called “seeds” or “capsules.” Internal radiation involves giving a higher dose of radiation in a shorter time span than with external radiation. Some internal radiation treatments stay in the body temporarily. Other internal treatments stay in the body permanently, though the radioactive substance loses its radiation within a short period of time. In some cases, both internal and external radiation therapies are used.
• Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

Reviewed 6/08 by S. Mobarhan, MD.