Gallbladder Cancer Symptoms, Tests, Prognosis, and Stages (PDQ®)–Patient Version
General Information About Gallbladder Cancer
- 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.
The wall of the gallbladder has 4 main layers of 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.
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.
- 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.
- 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.
- MRI (magnetic resonance imaging) with gadolinium : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
- 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 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
- 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 III
- Stage IV
- 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.
There are three ways that cancer spreads in the body.
- 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.
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 mucosa (innermost layer) of the gallbladder wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
- In stage IIA, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the side of the gallbladder that is not near the liver.
- In stage IIB, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the same side as the liver. Cancer has not spread to the liver.
- In stage IIIA, cancer has spread through the connective tissue layer of the gallbladder wall and one or more of the following is true:
- In stage IIIB, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle, connective tissue, or serosa (layer of tissue that covers the gallbladder) and may have also spread to the liver or to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver). Cancer has spread to one to three nearby lymph nodes.
Stage IV is divided into stages IVA and IVB.
- In stage IVA, cancer has spread to the portal vein or hepatic artery or to two or more organs or structures other than the liver. Cancer may have spread to one to three nearby lymph nodes.
- In stage IVB, cancer may have spread to nearby organs or structures. Cancer has spread:
- to four or more nearby lymph nodes; or
- to other parts of the body, such as the peritoneum and liver.
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)
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.