Gallbladder Cancer: Cancer Institute Overview

The gallbladder, an organ located in the upper abdomen, under the liver, stores bile produced by the liver to digest fat.

The bile travels from the gallbladder to the liver and small intestine by way of the common bile duct.

The gallbladder has three layers:

• The innermost layer
• The middle layer (muscularis)
• The outermost layer (serosal)

Gallbladder cancer occurs when malignant (cancer) cells appear in the gallbladder. In primary gallbladder cancer, the cancer begins in the mucosal or innermost layer and moves outward. Gallbladder cancer can be cured only if it is found before it begins to spread.

What are the symptoms of gallbladder cancer?

Gallbladder cancer is difficult to detect early on because of the lack of obvious symptoms and because, when symptoms do appear, they are similar to those of other, less-serious conditions. In addition, the gallbladders location makes it more difficult to find the cancer.

The following symptoms may be signs of gallbladder cancer:

• Jaundice (yellowed skin and yellowed whites of the eyes)
• Pain above the stomach area
• Fever
• Nausea and vomiting
• Bloating
• Abdominal lumps

How is gallbladder cancer diagnosed?

If your doctor suspects that you might have gallbladder cancer, he or she will examine you and ask about your medical history. Then the doctor will perform other tests, including:

• Blood chemistries: Measures the levels of specific types of substances in the blood, including those that may indicate cancer
• Abdominal ultrasound: Uses sound waves to create pictures of the organs within the abdomen
• Liver function test: Measures the levels of certain substances released by the liver, which may indicate that the liver has been affected by gallbladder cancer
• Carcinoembryonic antigen (CEA) assay: Measures the levels of CEA (a substance released by both healthy and cancerous cells)
• CA 19-9 assay: Measures the levels of the tumor marker, CA 19-9, in the blood. This substance is released by both healthy and cancer cells. Higher levels could indicate gallbladder or pancreatic cancer.
• CT (or CAT) scan: A type of X-ray that takes detailed images of organs
• Chest X-ray
• MRI (magnetic resonance imaging): A procedure that takes images inside the body using a magnet, radio waves, and a computer
• Endoscopic retrograde cholangiopancreatography (ERCP): An X-ray procedure that takes pictures of the bile ducts. Gallbladder cancer can cause narrowing of these ducts.
• Biopsy: A procedure in which tissues or cells are removed and examined for cancer under a microscope
• Laparoscopy: A surgical procedure in which a laparascope (a thin, lighted tube) is inserted into the abdomen through a small incision to look for cancer
• Percutaneous transhepatic cholangiography (PTC): An X-ray of the bile ducts and liver using a dye injection

What are the stages of gallbladder cancer?

One of the biggest concerns about cancer is whether it has spread (metastasized) beyond its original (primary) location. To determine the amount of spreading, a doctor assigns a number (0 through IV) to the diagnosis. The process is called staging; the higher the number, the more the cancer has spread throughout the body.

The stages of gallbladder cancer are:

• Stage 0 (also known as carcinoma in situ): The cancer is confined to the mucosal (inner) layer of the gallbladder.
• Stage I: The cancer has spread to the connective tissue or the muscularis layer.
• Stage II: The cancer has spread beyond the tissue that covers the gallbladder (the visceral peritoneum) to the liver and/or another nearby organ, such as the stomach, small intestine, pancreas, or bile ducts, or to the muscle, connective tissue, or adjacent lymph nodes.
• Stage III: The cancer has moved to the liver or to organs near it, and possibly to the lymph nodes.
• Stage IV: The cancer has moved to adjacent lymph nodes and/or to organs that are located far from the gallbladder.

How is gallbladder cancer treated?

The standard treatments for gallbladder cancer are surgery, chemotherapy, or radiation. A treatment plan may include a combination of all three. The age and overall health of the patient are factors in the treatment process.

The surgical removal of a gallbladder and nearby tissue is called a cholecystectomy. The surgeon also may remove lymph nodes located near the gallbladder.

In Stage I gallbladder cancer, the malignant cells are found within the gallbladder and can be removed by surgery. In Stages II, III, and IV, the cancer has spread beyond the gallbladder to other tissues and organs and cannot be removed completely by surgery. (The exception to this is cancer that has spread only to nearby lymph nodes.)

Radiation therapy uses high levels of radiation to kill the cancer cells or stop them from multiplying, while minimizing damage to healthy cells. Radiation can be external -- which uses a machine outside of the body to direct radiation to the cancer -- or internal, in which a radioactive material is placed directly in the body near the location of the cancer.

Chemotherapy is the use of drugs to kill cancer cells or stop them from multiplying. Chemotherapy drugs may be taken by mouth or injected.

How does staging affect treatment of gallbladder cancer?

The stage of the cancer affects the treatment. Localized cancer (Stage I) may be treated with surgery, followed by radiation and/or chemotherapy. Stage I cancer also may be treated solely by radiation and/or chemotherapy.

Cancer in stages II through IV cannot be treated with surgery. The treatment for these stages is intended to relieve pain and symptoms (palliative care) with surgery, radiation, and chemotherapy.