Gallbladder Cancer
General Information About Gallbladder Cancer
Stages of Gallbladder Cancer
Treatment Option Overview
The gallbladder lies just under the liver in the upper
abdomen. The gallbladder stores bile, a fluid made by the liver that
helps digest fat.
Almost all gallbladder cancers are adenocarcinomas (cancers
that begin in cells that make and release mucus and other fluids).
Gallbladder cancer is hard to diagnose in the early stages
because there are no signs or symptoms. Gallbladder cancer may be found
when the gallbladder is checked for gallstones or removed.
General Information About Gallbladder Cancer
Key Points
- Gallbladder cancer is a disease in which malignant (cancer)
cells form in the tissues of the gallbladder.
- Being female can increase the risk of developing
gallbladder cancer.
- Signs and symptoms of gallbladder cancer include jaundice,
fever, and pain.
- Gallbladder cancer is difficult to detect (find) and
diagnose early.
- Tests that examine the gallbladder and nearby organs are
used to detect (find), diagnose, and stage gallbladder cancer.
- Certain factors affect the prognosis (chance of recovery)
and treatment options.
Gallbladder
cancer is a disease in which malignant (cancer) cells form in the
tissues of the gallbladder.
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.
Anatomy of the gallbladder.
The gallbladder is just below the liver. Bile is stored in the
gallbladder and flows through the cystic duct and the common bile duct
into the small intestine when food is being digested.
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.
Being
female can increase the risk of developing gallbladder cancer.
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.
Signs
and symptoms of gallbladder cancer include jaundice, fever, and pain.
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.
Gallbladder
cancer is difficult to detect (find) and diagnose early.
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.
- 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.
Certain
factors affect the prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment
options 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 a microscope).
- Whether the cancer has just been diagnosed or has recurred (come back).
Treatment may also
depend on the age and general health of the patient and whether the
cancer is causing signs or symptoms.
Gallbladder cancer can be
cured
only if it is found before it has spread, when it can be removed by
surgery. If the cancer has spread,
palliative
treatment can improve the patient's
quality of life by
controlling the symptoms and
complications
of this disease.
Stages of Gallbladder Cancer
Key Points
- 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 may spread from where it began to other parts of the
body.
- The following stages are used for gallbladder cancer:
- Stage 0 (Carcinoma in Situ)
- Stage I
- Stage II
- Stage IIIA
- Stage IIIB
- Stage IVA
- Stage IVB
- For gallbladder cancer, stages are also grouped according
to how the cancer may be treated. There are two treatment groups:
- Localized (Stage I)
- Unresectable, recurrent, or metastatic (Stage II, Stage
III, and Stage IV)
Tests
and procedures to stage gallbladder cancer are usually done at the same
time as diagnosis.
See the General
Information section for a description of tests and procedures used to
detect, diagnose,
and stage gallbladder cancer.
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.
Treatment Option Overview
Key Points
- There are different types of treatment for patients with
gallbladder cancer.
- Three types of standard treatment are used:
- Surgery
- Radiation therapy
- Chemotherapy
- New types of treatment are being tested in clinical trials.
- Patients may want to think about taking part in a clinical
trial.
- Patients can enter clinical trials before, during, or after
starting their cancer treatment.
- Follow-up tests may be needed.
There
are different types of treatment for patients with gallbladder cancer.
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 of standard treatment are used:
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 or keep them from growing. 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. External radiation therapy is used to
treat gallbladder cancer.
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.
New
types of treatment are being tested in clinical trials.
This summary section
describes treatments that are being studied in clinical trials. It may
not mention every new treatment being studied. Information about
clinical trials is available from the NCI 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.
Patients
may want to think about taking part in a clinical trial.
For some patients,
taking part in a clinical trial
may be the best treatment choice. Clinical trials are part of the
cancer research process. Clinical trials are done to find out if new
cancer treatments are safe and effective or better than the standard treatment.
Many of today's
standard treatments for cancer are based on earlier clinical trials.
Patients who take part in a clinical trial may receive the standard
treatment or be among the first to receive a new treatment.
Patients who take
part in clinical trials also help improve the way cancer will be
treated in the future. Even when clinical trials do not lead to
effective new treatments, they often answer important questions and
help move research forward.
Patients
can enter clinical trials before, during, or after starting their
cancer treatment.
Some clinical trials
only include patients who have not yet received treatment. Other trials
test treatments for patients whose cancer has not gotten better. There
are also clinical trials that test new ways to stop cancer from recurring (coming back) or
reduce the side effects
of cancer treatment.
Clinical trials are
taking place in many parts of the country. See the Treatment Options
section that follows for links to current treatment clinical trials.
These have been retrieved from NCI's
listing of clinical trials.
Follow-up
tests may be needed.
Some of the tests
that were done to diagnose
the cancer or to find out the stage
of the cancer may be repeated. Some tests will be repeated in order 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.
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 your
condition has changed or if
the cancer has
recurred
Treatment Options for Gallbladder Cancer
Localized Gallbladder Cancer
Treatment of localized gallbladder cancer
may include the following:
- Surgery
to remove the gallbladder
and some of the tissue
around it. Part of the liver
and nearby lymph nodes
may also be removed. Radiation
therapy with or without chemotherapy
may follow surgery.
- Radiation therapy with or without chemotherapy.
- A clinical trial
of radiation therapy with radiosensitizers.
Check the
list of NCI-supported cancer clinical trials that are now accepting
patients with localized gallbladder cancer. For more specific results,
refine the search by using other search features, such as the location
of the trial, the type of treatment, or the name of the drug. Talk with
your doctor about clinical trials that may be right for you. General
information about clinical trials is available from the NCI website.
Unresectable, Recurrent, or Metastatic
Gallbladder Cancer
Treatment of unresectable, recurrent, or metastatic gallbladder cancer is
usually within a clinical trial.
Treatment may include the following:
- Percutaneous
transhepatic biliary drainage or the placement of stents to relieve symptoms caused by blocked bile ducts. This may be
followed by radiation therapy
as palliative treatment.
- Surgery
as palliative treatment to relieve symptoms caused by blocked bile
ducts.
- Chemotherapy.
- A clinical trial of new ways to give palliative radiation
therapy, such as giving it together with hyperthermia
therapy, radiosensitizers,
or chemotherapy.
- A clinical trial of new drugs
and drug combinations.
-NIH
