Gallbladder Cancer

Alternative names: Carcinoma of the gallbladder

Gallbladder cancer is a rare disease in which cancer cells form in the tissues of the gallbladder.  The gallbladder is a small, pear-shaped organ under the liver and behind the lower right ribs.

There are several types of gallbladder cancers:

• Adenocarcinoma, which accounts for 90% of all gallbladder cancer, starts in cells with gland-like properties that line many internal and external surfaces of the body, including the digestive system

  • Papillary adenocarcinoma, accounting for about 6% of gallbladder cancer, is not as likely to spread to neighboring organs and therefore has a better prognosis.
• Adenosquamous carcinomas
• Squamous cell carcinomas
• Small cell carcinomas
• Sarcomas

Incidence; Contributing Risk Factors

Women are more than twice as likely to develop gallbladder cancer as men.  It is seen mainly in the elderly, the average age of diagnosis being 72.  More than two-thirds of diagnoses are in the 65+ age group.

Factors that increase one's risk of developing gallbladder cancer include:

• Chronic gallbladder inflammation (for example due to gallstones) is the most common risk factor: at least 75% of diagnosed gallbladder cancer patients also have gallstones
• Gallbladder polyps
• Obesity
• Choledochal cysts (bile-filled sacs that are attached to the bile duct)
• Bile duct abnormalities
• 'Porcelain gallbladder' (a gallbladder covered in calcium deposits)
• Primary sclerosing cholangitis (PSC)
• Chemical exposure
• Typhoid (chronic salmonella infection)

Signs and Symptoms

There are no obvious signs or symptoms of gallbladder cancer in its early stages, which unfortunately means that it is not generally detected until an advanced stage.  When symptoms can be detected early, the patient's chances of survival are greatly improved.

Symptoms match those of many other diseases and include:

• Abdominal pain, usually in the upper-right abdomen or above the stomach
• Nausea
• Vomiting
• Jaundice (yellowing of the skin and whites of the eyes)
• Lumps in the abdomen.  These can be due to gallbladder swelling (due to bile ducts blocked by cancer), or cancer that has spread to the liver nearby.
• Weakened appetite
• Unexplained weight loss
• Abdominal swelling
• Fever
• Itchy skin
• Dark yellow urine
• Light-colored stools
• Greasy stools
• Enlarged lymph nodes above the collarbone and/or other locations, if cancer has spread to lymph nodes

Diagnosis and Tests

Unfortunately, 80% of gallbladder cancers are not found until at an advanced stage, spreading and causing obvious symptoms.

Because gallbladder cancer is uncommon, other more common causes of symptoms should be ruled out first.  Examples include gallstones and viral hepatitis.

During a physical examination, the doctor will check for jaundice, lumps, tenderness or fluid buildup.  If gallbladder cancer is suspected as being a possibility, further tests will be performed.

Blood tests are used to test liver and gallbladder function, and measure how much bilirubin is in the blood, as well as albumin, alkaline phosphatase, AST, ALT, and GGT, which can all be at abnormal levels in cases of liver, bile duct, or gallbladder disease.  Tumor markers are often found in the blood of patients with gallbladder cancer.

Imaging tests (X-ray, MRI, CT scan, ultrasound, cholangiogram, angiogram) can show suspicious growths such as cancer, blockage, narrowing or dilation of ducts, as well as whether it has spread.  They can also assist in deciding on treatment options, guide a surgeon during treatment, and show whether the cancer returns after treatment.

As with most cancers, a biopsy can be used to confirm diagnosis.  A small sample of tissue is removed and examined under a microscope to look for cancer cells.  It can also indicate whether the cancer has spread.  However, because a biopsy can cause the cancer to spread, the doctor may decide to assume cancer is present and proceed directly to surgery.

After being diagnosed, a cancer needs to be staged.  The stage of a cancer indicates how far it has spread and is an important factor in selecting treatment options and gauging the patient's prognosis.

Gallbladders that have been removed for other reasons – such as gallstones or chronic inflammation – are routinely checked under a microscope for cancer cells.

Treatment and Prevention

Treatment options for gallbladder cancer include surgery, radiation therapy, chemotherapy and palliative therapy (controlling symptoms, but not curing the cancer).

The gallbladder is helpful, but you do not need it to live.  Many people have their gallbladders removed and go on to live normal lives.  If cancer is detected early, this is an option.  If the cancer has spread beyond the gallbladder, radical cholecystectomy is an option.  A major operation, this procedure removes the gallbladder as well as surrounding tissues, lymph nodes and parts of other organs that may be affected by the cancer.

Prognosis

Prognosis depends on the stage at which the cancer was discovered, whether it was completely removed by surgery, the type of cancer, and whether it has recurred.  The 5-year survival rate for stage 0, 1, 2, 3 and 4 cancers are approximately 80%, 50%, 28%, 8% and 3% respectively.