Gallbladder Cancer

Gallbladder cancer is a rare but serious disease that often goes undetected in its early stages, making early diagnosis crucial for successful treatment.

Table of contents

• What is Gallbladder Cancer?
• Where the Gallbladder is Located
• Signs and Symptoms
• Causes and Risk Factors
• How Gallbladder Cancer is Diagnosed
• Treatment Options
• Living with Gallbladder Cancer
• Outlook and Survival

What is Gallbladder Cancer?

Gallbladder cancer is a disease in which malignant (cancer) cells grow in the gallbladder. Malignant means the cells can spread and cause harm to other parts of the body^[1]. This type of cancer is rare, affecting about 2 people per 100,000 in the United States^[2].

The cancer typically begins in the innermost layer of the gallbladder, called the mucosal layer, and then spreads outward through the other layers^[2]. Most gallbladder cancers are a type called adenocarcinomas, though other less common types exist, including squamous, adenosquamous, and neuroendocrine tumors^[4].

When found early and while the cancer is still small, the chance for a cure is good^[1]. However, most gallbladder cancers are found when they have grown beyond the gallbladder, and at that point, the chance to survive is often poor^[1].

Where the Gallbladder is Located

• Gallbladder
• Liver
• Bile ducts
• Small intestine

The gallbladder is a small, pear-shaped organ located in the upper right part of your belly, just beneath the liver^[1]. It stores a digestive fluid called bile that the liver makes to help digest fats in the food you eat^[1].

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^[6].

The gallbladder’s location deep within your body and under your liver makes it harder to detect cancer cells growing there^[2]. This hidden position is one of the main reasons why gallbladder cancer is often diagnosed late.

Signs and Symptoms

Gallbladder cancer may not cause any symptoms at all, or the symptoms may be hard to spot, especially in the early stages^[1]. When there are signs and symptoms, they are often similar to those of common conditions like gallstones or a blockage in a bile duct^[2].

The main symptoms of gallbladder cancer include^[1]:

• Belly pain, mostly in the upper right part of the belly
• Belly bloating
• A mass you can feel through the skin
• Losing weight without trying
• Yellowing of the skin and whites of the eyes, called jaundice

Yellowing of the skin might be harder to see on Black or brown skin. Jaundice typically happens when the gallbladder cancer is very advanced^[1]. Other symptoms can include feeling sick to your stomach, vomiting, fever, or having dark-colored urine and pale-colored stools^[9].

If you have symptoms that worry you, make an appointment with a healthcare professional^[1]. It’s important to remember that these symptoms are very common and can be caused by many different conditions, so having them does not definitely mean you have gallbladder cancer. But it’s important to get them checked^[9].

Causes and Risk Factors

Gallbladder cancer occurs when healthy cells become malignant cells that grow and multiply out of control. This can happen when there are changes, or mutations, in the genetic material that tells healthy cells how to behave^[2]. With gallbladder cancer, these genetic mutations occur over time and are not inherited from your biological parents^[2].

Scientists don’t know what causes cells to become cancer cells in the first place, but they have identified several factors that may increase your risk. Chronic gallbladder inflammation is the most common pathway associated with gallbladder cancer^[4].

In the United States, gallbladder cancer is more common among certain groups, including people who are female, American Indian, Alaskan native, or Mexican-American, and those over age 65^[2]. The average age at diagnosis is 72 years old^[2].

Other risk factors include having^[2]:

• Gallstones or a history of gallstones (the strongest risk factor)
• Gallbladder polyps
• Chronic (long-term) gallbladder inflammation, also called cholecystitis
• Chronic Salmonella typhi infection (the bacteria that causes typhoid)
• A build-up of calcium deposits in your gallbladder (porcelain gallbladder)
• Chronic inflammation in your bile ducts (primary sclerosing cholangitis)
• Cysts in your common bile duct (choledochal cysts)
• Obesity

It’s also possible that smoking and exposure to certain chemicals used to create textiles and rubbers can increase your risk^[2]. Although gallstones are the most common risk factor, the overall risk is low, and most people with gallstones do not develop gallbladder cancer^[11].

How Gallbladder Cancer is Diagnosed

Gallbladder cancer is difficult to detect and diagnose early for several reasons. People rarely have signs or symptoms in the early stages of the disease. The symptoms, when present, are like those of many other illnesses. Also, the gallbladder is hidden behind the liver, making it hard to examine^[11].

Because there are rarely signs or symptoms in the early stages, and those symptoms resemble other conditions, healthcare providers often diagnose gallbladder cancer late. They often discover it by chance when the gallbladder is removed for other reasons, such as gallstones^[2].

If your healthcare professional suspects gallbladder cancer, they may use several tests to make a diagnosis^[12]:

• Blood tests to check how your liver is working may help find what’s causing your symptoms
• Imaging tests that create pictures of the gallbladder, including ultrasound, CT scan, and MRI
• Procedures to look at the bile ducts, such as magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography (ERCP), which involve putting dye into the bile ducts to see if they are blocked

Once gallbladder cancer is diagnosed, the next step is to find the extent of the cancer. This process is called staging^[12]. The cancer’s stage helps show your outlook and helps with treatment choices. Tests used to stage the cancer may include additional imaging studies and sometimes surgery to see how far the cancer has spread.

Treatment Options

Treatment for gallbladder cancer depends on the size and type of cancer, where it is located, whether it has spread, and your general health^[17]. The main treatment options include surgery, chemotherapy, radiation therapy, and newer treatments like immunotherapy and targeted medicines.

Surgery

Surgery is the main treatment for gallbladder cancer and offers the best chance for a cure^[4]. If gallbladder cancer is found early and has not spread, you may be able to have surgery to remove it. This usually involves removing all of the gallbladder and sometimes parts of other organs or lymph nodes around it. Lymph nodes are part of your body’s immune system that help fight infections^[17].

For more extensive disease, doctors may perform an extended or radical removal of the gallbladder, which includes removing the gallbladder, some liver tissue next to the gallbladder, and all lymph nodes in the region^[19]. Depending on the case, surgeons might also remove a larger section of the liver, the pancreas, the bile duct, and additional lymph nodes.

If the cancer has spread too far and cannot be removed, you may have surgery to help control symptoms, such as surgery to unblock the bile duct or stop it from getting blocked, which helps with jaundice^[17].

Chemotherapy

Chemotherapy uses medicines to kill cancer cells^[17]. You may have chemotherapy before surgery to help make the cancer smaller, after surgery to get rid of any remaining cancer and help stop the cancer from coming back, or to help make the cancer smaller and control symptoms if you’re not able to have surgery.

Radiation Therapy

Radiation therapy uses high-energy rays of radiation to kill cancer cells^[17]. You may have radiation therapy after surgery to help stop your cancer from coming back or to help control and improve the symptoms of advanced cancer.

Immunotherapy and Targeted Medicines

Immunotherapy is where medicines are used to help your immune system kill cancer. Targeted medicines work by attacking specific features of cancer cells^[17]. You may have immunotherapy if the cancer has spread to another part of your body. You may receive targeted medicines or immunotherapy either on their own or with chemotherapy.

If you have advanced gallbladder cancer and it cannot be cured, the aim of your treatment will be to limit the cancer and its symptoms and help you live longer^[17]. You will be referred to a special team of doctors and nurses called the palliative care team or symptom control team, who will work with you to help manage your symptoms and make you feel more comfortable.

Living with Gallbladder Cancer

Coping with gallbladder cancer can be difficult. At first, you are likely to feel very upset, frightened, and confused^[20]. You might have a number of different feelings when you’re told you have cancer, including feeling shocked, numb, frightened and uncertain, confused, angry, guilty, or sad. Everyone reacts in their own way.

Talking to your friends and relatives about your cancer can help and support you, though some people might find it scary and won’t want to talk. You might find it easier to talk to someone other than your own friends and family^[20]. Specialist nurses can help if you’re finding it difficult to cope or if you have any problems.

Diet and Eating

Many people who have gallbladder cancer lose their appetite, and some may lose weight. You may have problems with your diet after surgery, including loose or watery stools (diarrhea), nausea, and difficulty digesting food^[24].

After having your gallbladder removed, diarrhea can be a problem because bile is no longer stored in the gallbladder and flows directly from the liver into your small bowel^[24]. You may find it easier to have lots of small meals throughout the day rather than sticking to three large meals. Your doctor can recommend medicines to slow down your bowel and help bind the bile.

If you have jaundice, it can be difficult for your body to take in fat from your diet. You might need to take supplements to boost your calorie intake, and you may need to avoid fatty food until you have had treatment to relieve the jaundice^[24].

Follow-up Care

You’ll have regular check-ups during and after any treatments. You may also have tests and scans^[1]. If you have any symptoms or side effects that you’re worried about, talk to your specialists. You do not need to wait for your next check-up.

Outlook and Survival

The cure rate for gallbladder cancer is excellent if it’s in the early stages and healthcare providers can remove it with surgery^[2]. Unfortunately, most people don’t receive a diagnosis until the cancer has spread beyond their gallbladder, and at that point, gallbladder cancer is difficult to treat^[2].

The overall prognosis is poor, with 5-year survival rates of less than 20%^[4]. Certain factors affect the outlook and treatment options, including the stage of the cancer (whether it has spread within and around the gallbladder or to other parts of the body), whether the cancer can be removed completely by surgery, the type of gallbladder cancer, and whether the cancer has just been diagnosed or has come back.

Most gallbladder cancers are found when they’ve grown beyond the gallbladder, which is why the chance to survive is often poor^[1]. Recent advances in studying the genetic drivers and molecular profile of these tumors have led to the use of targeted agents, which may improve the prognosis of this disease^[4].