Gallbladder cancer is a rare cancer that starts in the gallbladder and affects your digestive system. When the cells in your body begin to grow out of control, it results in the occurrence of cancer. Cells from any part of your body can become cancer, and can spread to other areas of the body.
Gallbladder cancer is initiated when healthy cells in the gallbladder change and grow out of control and forms an extra mass called a tumour. However, a tumour is not always a cancer. It can either be cancerous or benign. A cancerous tumour has the property of malignancy, meaning it can spread to other parts of the body while a benign tumour lacks malignancy, which means the tumour does not spread to other areas.
Gallbladder cancer is not very common in the US and rest of the world. When discovered at an early stage, there is a high chance that the cancer can be cured. But most patients are diagnosed with gallbladder cancer at a late stage, when the prognosis is often very poor. It is difficult to diagnose early because of its hidden location. This makes it easier to grow without being detected. Also, it doesn’t cause any specific signs and symptoms that can help in early detection.
For the cancer of the gallbladder and nearby large bile ducts, The American Cancer Society has projected an estimated figure for 2018 in the United States:
For every 10 new diagnosed cases of gallbladder and nearby large bile ducts, 4 will be of gallbladder only.
Only about 1 of 5 gallbladder cancers is found in the early stages, when the cancer has not yet spread beyond the gallbladder. The stage at which gallbladder cancer is diagnosed largely determines the survival of patients.
The type of a cancer reveals about the type of cell from which it originates or the type of cell it started in. Several types of gallbladder cancer are defined based on the cells they originate from.
Since the gallbladder is composed of different types of cells, there is more than one type of gallbladder cancer. In theory, any of these cell types could develop cancer.
Adenocarcinoma counts for every 9 out of 10 gallbladder cancer and is the most common type of gallbladder cancer. It constitutes about 85-90% of the gallbladder cancers. This type of cancer starts in the gland cells present in the gallbladder lining. Normally, these gland cells produce a thick fluid known as mucus.
Adenocarcinomas of the gallbladder can be further divided into three distinct categories.
Papillary adenocarcinomas contribute for the 6% of the total gallbladder cancers. They develop in the connective tissues of the gallbladder which holds the gallbladder in its place. Progression of this kind of gallbladder cancer to the liver and nearby lymph nodes is very less likely. It is supposed to have better prognosis and outlook than most other types of gallbladder cancer.
The cancer cells in mucinous adenocarcinomas are often found in mucus pool. It is responsible for a small number of gallbladder cancer and accounts only about 1 or 2 out of every 100 gallbladder cancers (1 or 2%).
Skin like cells that form the lining of the gallbladder along with the gland cells are places where squamous cell carcinoma develops. These cancers are treated same as adenocarcinomas are treated.
Your healthcare provider may call it a mixed histology because it has both squamous cancer cells and glandular cancer cells.
Small cell carcinomas are also known by another name - oat cell carcinomas, because the cancer cells have a distinctive oat like shape.
These are rare cancers of digestive system that grow from hormone-producing tissues. The most common type of neuroendocrine tumour is called carcinoid.
The cancers originating from the connective tissues of the body are categorised as sarcoma. Sarcomas generally affect the muscles, blood vessels and nerves of your body. Sarcoma begins in the muscle layer of the gallbladder.
These types of gallbladder cancer are extremely rare and they are not necessarily treated in the same way as the other types of gallbladder cancer. For example, lymphomas respond better to chemotherapy and radiotherapy than surgery.
The exact cause of gallbladder cancer is unclear but there are several risk factors which make you more likely to develop a gallbladder cancer.
Researchers say that the primary cause of developing any kind of cancer is that healthy cells of your body are subjected to change in their DNA by a process known as mutation. DNA mutations in the cells of your body cause abnormal cell growth. These abnormal cells tend to live longer than a healthy cell which normally dies in the same time as the new healthy cells are formed to keep a balance. This mass of abnormally growing cells in your gallbladder has the potential to spread to other parts of the body.
Research indicates that chronic gallbladder inflammation is found common in most cases of gallbladder cancers irrespective of the risk factors a patient is subjected to. Therefore, scientists believe that gallbladder inflammation might have a role in the development of gallbladder cancer.
It is possible for DNA mutation to pass to the children from parents. This inheritance of mutation puts the children at risk for developing certain kinds of cancers. However, gallbladder cancer rarely occurs due to the mutations in DNA.
There are several factors that can increases the chances of developing a gallbladder cancer though having one or more them does not mean that you will definitely develop it. These risk factors of gallbladder cancer include:
Most of the times, gallbladder cancer does not cause any signs and symptoms until it has progressed to late or advanced stage of the disease. Generally, by the time of its diagnosis, it has already spread to nearby tissues of the body. Even the symptoms that appear in the later stage of the gallbladder cancer are also not quite evident as they mostly overlap with other gallbladder conditions and other diseases. Therefore, there is a high chance that someone might ignore them. However, if you are experiencing any of the following symptoms, you should immediately consult your doctor or primary healthcare provider.
Various late stage symptoms of gallbladder cancer are the following:
Early detection of gallbladder cancer is very hard since your gallbladder is located very deep inside the body. Your doctor is generally unable to see or feel the early tumours during your routine physical exams. Lack of a reliable early detection technique for screening purpose is another reason for late diagnosis of the gallbladder cancer. Screening of gallbladder cancer is the testing for gallbladder cancer in people before the symptoms are visible. These difficulties cause late detection of the gallbladder cancer. The cancer is usually found only after it has grown enough and has spread to the other parts of your body.
However, some gallbladder cancers are found early before they reach to late stage or have turned metastatic, unexpectedly when a person’s gallbladder is removed because of other problems such as gallstones. When the removed gallbladder is subjected to further lab examination, small cancers or pre-cancers are found which were unable to produce any sign and symptoms in the body before it was removed from the body.
When your doctor suspects a gallbladder cancer, he or she will first perform medical history analysis of your problems to assess any risk factors that might have caused the cancer of gallbladder. He or she will do a physical exam to see if there is any visible sign relating to gallbladder cancer.
Your doctor will mainly focus on abdominal region for the physical examination to identify the presence of any lumps, tenderness in the abdominal region or accumulation of fluid in the abdominal cavity. He/she will also examine your eyes and skin for jaundice-related symptoms.
If the physical examination or the symptoms suggest that you may have gallbladder cancer, your doctor will recommend further diagnostic procedures to confirm the initial diagnosis of the gallbladder cancer. These tests may include blood test, imaging test, biopsy and other various procedures.
Blood tests are mainly done to examine the liver and gallbladder function and to confirm the presence of tumour markers.
Your doctor will recommend blood tests to evaluate the normal functioning of your liver and gallbladder by measuring the levels of metabolites such as bilirubin in the blood. Any deviation from the normal functioning of the gallbladder, bile ducts, or liver can raise the blood level of bilirubin, which is an indicator of some problems with these organs.
Other substances that are measured in your blood are albumin, alkaline phosphatase, AST, ALT, and GGT. An altered level of these substances can be an indicator of problems with your bile duct, liver or gallbladder. These tests are called liver function tests.
Tumour markers are the proteins found in the blood when certain cancers are present. In case of gallbladder cancer, CEA and CA 19-9 are the two tumour markers that can be detected in the blood. Persons with gallbladder cancer are generally found to have high levels of these markers but this is not always true. In it is due to cancer, these substances are found to be high in your blood only when the cancer has moved to the advanced stage. However, these markers can be found in other types of cancers as well such as pancreatic cancer and is not a conclusive diagnosis of the gallbladder cancer. Sometimes, even other health conditions can cause an increase in the level of these markers in your blood.
Tumour markers can help in tracking the success of cancer treatment. The level of these markers can give an idea of how well the treatment is working. If the level of these markers were found high be in your blood prior to starting the treatment regimen, this is an indication that the body is responding well to the treatment.
These tests use different principles to ultimately create an image of inside of your body. The images can reveal many things. The purpose of these tests is:
Various imaging tests that your doctor may recommend for the diagnosis of gallbladder cancer are explained below.
Ultrasound works on the principle of sound waves in which a small instrument called a transducer emits sound waves and records the bounced echoes of the sound from the organs inside the body. The bounced echoes are used to generate an image of the organs inside the body and are displayed on a screen. The image created by the echoes can help to find the tumours and show if they have progressed into nearby areas.
This technique is also used to guide the needles in a biopsy procedure known as ultrasound-guided needle biopsy.
Ultrasound helps your doctor in deciding the extent to which the cancer has affected the gallbladder wall which further helps in deciding the course of treatment such as planning the surgery to remove the tumour etc. It is also helpful in diagnosing if the cancer has reached the nearby lymph nodes as the lymph nodes get enlarged.
Usually, this is the first imaging test your doctor will recommend if you are experiencing symptoms that might be a result of gallbladder problems.
The procedure for this test is easy and it uses no radiation. Your ultrasound technician will instruct you to lie on a table and apply gel on your upper abdomen to lubricate it. Then he/she will move the transducer over your right upper abdomen along the skin and will record the echo on the system which finally generates an image.
This technique gives more detailed images than a standard ultrasound because the transducer used in the ultrasound is placed closer to the gallbladder in the stomach either by passing through the mouth (endoscopic ultrasound) or through a small surgical cut in the belly (laparoscopic ultrasound).
Ultrasound transducer is attached to the end of a thin, lighted tube which is also accompanied by an attached viewing device at another end. The tube is passed through the mouth or by making incision in the belly for the procedure.
A computed tomography scan for gallbladder cancer uses x-rays to produce cross sectional and detailed image of inside of the gallbladder. In comparison to the conventional X-rays, this technique creates exceptionally detailed images of the bones, organs and tissues. During the procedure, multi angular X-rays are captured and then are combined with the help of a computer to create a cross-sectional image.
CT scan for the gallbladder cancer can help in finding the location of a tumour, evaluate the extent of the cancer in the body and it metastasis and also to assess whether the disease is responding to treatment. Sometimes, this technology is also helpful in accurately guiding the cancer treatment during a procedure.
This technique is often used to diagnose gallbladder cancer. Unlike CT scan, an MRI uses radiofrequency waves and magnetic fields instead of X-rays, to produce detailed and cross sectional images of inside of the body. The results of this test can be used to find out if the cancer has migrated outside of the gallbladder. It is also used in the measurement, staging and grading of the tumour inside the gallbladder or the place where it has moved from the gallbladder.
MRI scan is also able to distinguish between a diseased cell and a normal cell and it plays an important role in diagnosis, staging and treatment planning of the gallbladder cancer.
You may find this procedure a little bit more uncomfortable than a CT scan and it may take up to an hour for the procedure to complete.
This is an imaging technique specifically used for the examination of bile ducts to identify the problems such as blocking, narrowing, or dilation of the bile duct. If your bile duct is getting blocked by the development of tumour there, this technique will be able to diagnose it. This is also helpful in surgery planning.
There are many types of cholangiograms each with their own advantages and disadvantages. These are:
This is the most used technique by doctors to get the images of the bile ducts as it doesn’t use any contrast agent and is no-invasive. The procedure is performed with the help of the same machine that is used in an MRI scan. But it can’t be used to get biopsy samples of tumours or help in keeping the ducts open by placing stents in case the doctor decides for it after the MRCP.
This procedure can be used to see inside of the body. During this procedure, the patient is lightly sedated since it an invasive procedure. Your doctor places an endoscope through the mouth via oesophagus into the stomach and small bowel. A small tube or catheter is passed through the endoscope and into the bile ducts. The doctor takes x-ray images after the dye has been injected into the ducts so that presence of tumour can be confirmed in the area around the bile ducts.
Only an experienced professional should perform this procedure. This test is more useful for the diagnosis of cancer of bile ducts than that of gallbladder cancer, but the cancer which has spread from the gallbladder to the bile ducts can also be diagnosed with the help of this test.
The advantage of this technique is that it allows drawing of cells or fluids from the bile to look under the microscope for further examination of the cell but this is more invasive than a MRCP.
This procedure is used as a last resort and is not tried unless ERCP has already been tried or can be done owing to some medical condition.
In this procedure, you will be administered medicine through IV to make you sleepy before the test and a local anaesthetic is used at the place where the needle is to be inserted. After this, the doctor passes a thin, hollow needle through the skin of the belly and into a bile duct within the liver. A contrast dye is passed through the needle, and x-ray images are taken as the dye passes through the bile ducts.
Like an ERCP, this procedure can also be used to draw fluid or tissue samples for examination under a microscope. This technique of diagnosis is more invasive and may cause more pain than ERCP.
Angiography is another procedure for the diagnosis of gallbladder cancer. This is same as a cholangiography, except that the dye used in this procedure is used to examine flow of blood in the blood vessels, around the gallbladder and possible tumour in the gallbladder.
During this procedure, X-rayimages are taken after a contrast dye is injected into the body to reveal the gallbladder and surrounding areas.
Biopsy is the procedure of taking a sample of cells and looking at it under a microscope which can show if the area of abnormal growth is cancer or not. The sample can be taken out from either your gallbladder, liver, or enlarged lymph nodes around the gallbladder.
During the procedure, your doctor uses a specialised needle to take one or more samples of cells by putting a thin, flexible tube down your throat (an ERCP) or a tube called a laparoscope through the skin of your tummy (a laparoscopy).
Another variation of this test is fine needle aspiration (FNA) where your doctor uses a very thin needle to draw some cells and fluids. The needle is guided using an ultrasound scan or CT scan to take out sample from a precise location. There are various ways through which a biopsy or fine needle aspiration can be performed, which includes:
Biopsy is thought to be a confirmatory diagnosis of gallbladder cancer and it can also help in checking whether the cancer has spread to other parts of the body or not.
Laparoscopy is a type of minor surgery or operation to directly look into your tummy and gallbladder to see any signs of the cancer there. It also helps in determining the size of tumour if present and whether it has become malignant.
In this procedure, your doctor first makes a small incision in the front of the abdomen to look at various organs including your gallbladder by inserting a thin tube via an incision. The tube is attached with a light and a small camera at one of its ends. This procedure is performed on an outpatient basis under general anaesthesia.
If needed, your doctor may insert another tube to take out a sample for biopsy during the laparoscopy procedure. If the gallbladder cancer is found during the procedure, your doctor may convert this keyhole surgery into an open surgery to remove the gallbladder and lower the chances of releasing cancerous cells inside your abdomen while removing the gallbladder. However this shift from a laparoscopic surgery into an open surgery also depends on the size of the cancer and whether the open surgery will be able to remove all the cancer.
After a patient is diagnosed with gallbladder cancer, his/her doctor finds its stage according to different staging system which describes the nature, location, size and the extent to which the cancer has spread in the body.
Assigning these labels to the cancer is done by a process known as staging. It helps your doctor choose the best treatment for your case according to the state of your cancer. Generally, doctors use TNM system of staging for staging gallbladder cancer.
TNM is abbreviated form of tumour, node and metastasis. Most doctors use this system for staging gallbladder cancer and decide treatment options accordingly. TNM staging system is based on three key pieces of information.
There are a total of 5 stages of tumour size ranging from T0 to T4
There are 3 main stages of gallbladder cancer involving lymph nodes:
There are two stages that constitute the M stage of the gall bladder cancer:
T, N and M stages together reveals your complete condition and cancer state and description of the stage of your cancer.
For example, if you have been assigned a T3, N0, M0 cancer, you will have a tumour that has completely grown through the main wall of the gallbladder and it’s possible that it has spread into a nearby organ or structure but distant metastasis has not yet happened.
In this system of staging, there are four main stages of gallbladder cancer, numbered as 1 to 4. Some doctors also include the stage 0.
Your doctor may use a simple system of grouping of the different stages of the gallbladder cancer and decide the kind of treatment you may need for the cancer. This system usually groups the stages of the cancer in following three categories.
This covers the stage 1 and 2 of the above described stages and is localised well within the gallbladder and can be removed by surgery.
This stage usually refers to the stage 3 and stage 4 of the gallbladder cancer where the cancer has spread to the tissues outside of the gallbladder and can’t be removed with the help of surgery alone.
However, there is a possibility of removing the cancer of early stage 3 and therefore stage 3 cancers are not categorised in this class.
This is the coming back of the gallbladder cancer after a successful treatment. The recurrence of the cancer can happen either in the gallbladder and/or in other organs of the body. Your doctor may sometime call it a stage 4 gallbladder cancer.
The main aim of gallbladder cancer treatment is to completely remove the tumour by surgery and some of the surrounding tissues as well. But surgery is generally limited for the cancers which are localised and resectable. Gallbladder cancer which gets diagnosed in the early stages has more chance of being cured successfully.
The kind of gallbladder cancer treatment you might need depends on many factors, including the type, location and stage of the cancer, possible side effects, and your overall health and preferences. Your doctor will also plan treatment for possible side effects and their symptoms which is an important part of cancer care. You should consult your doctor in detail about all these factors and the options available for your case.
Various treatment options available for the gallbladder cancer are:
The main aim of surgery is to remove the tumour and some surrounding healthy tissues during an operation. This option is most suited for patients who have their cancer in early stages.
There are various types of surgery that can be considered for the treatment of gallbladder cancer. These may include:
The procedure involves removal of the gallbladder. It is also called simple cholecystectomy. Another type of this procedure is an extended cholecystectomy which involves the removal of gallbladder, an inch or more of the liver tissue located next to the gallbladder, and all of the lymph nodes in the region.
Radical gallbladder resection is a bit more invasive than a cholecystectomy and involves the removal of the following parts for the treatment of cancer of the gallbladder.
This procedure may be recommended even if a prior simple cholecystectomy has been already done.
Palliative surgery is used to relieve symptoms caused by gallbladder cancer, even when your doctor is not able to remove the tumour completely due to your health condition or some other reasons. For example, surgery may help in relieving the blockage of intestines or bile ducts, or relieve bleeding.
Surgery for gallbladder cancer can cause serious side effects which depend on the type of the surgery, how much tissue is removed or how extensive it is. You might require several weeks for recovery after the surgery.
Chemotherapy involves the use of anti-cancer drugs administered either by oral route or given into your vein. These agents reach all parts of your body via blood and are helpful in mitigating the effects of distant tumours of the gallbladder cancer. It might prove beneficial for some patients but so far its efficacy against the gallbladder cancer has been found to be limited.
It is usually used as adjuvant therapy for the resectable gallbladder cancer after the surgery and help in reducing the risk of cancer that may return. In advanced stages of the gallbladder cancer, doctors may use chemotherapy, but it may not cure the cancer completely. It is only helpful in slowing the growth of tumour and helps it shrink.
Chemotherapy is given in repeating cycles where each period of treatment is followed by a rest period which gives the body a recovery time. A typical cycle of chemotherapy generally last about 3 to 4 weeks. Patients with poor health are not recommended chemotherapy.
Various drugs used in chemotherapy for gallbladder cancer includes:
Chemotherapy has its own side effects. It mainly affects the rapidly dividing cells of your body. These side effects mainly depend on the type of anti-cancer drug used; its dose and duration for the drugs are taken. The side effects may include:
Though these side effects are short-termed and usually go away after the treatment is complete, but they can still cause serious concerns or discomfort to the patient. In case you experience any of the above side-effects, you should consult your healthcare provider for immediate respite.
Some anti-cancer drugs have their specific side effects. For example, cisplatin can damage your nerves known as neuropathy and causes numbness, tingling and weakness in the hands and feet. Though, the effect goes away after the treatment is complete but in some case, people can have long lasting effects.
In a radiation therapy, high-energy X-rays or other types of radiation are used to kill cancer cells. There are mainly two types of radiation therapy, which includes:
The type and stage of the cancer being treated determines the procedure of radiation therapy. In case of a gallbladder cancer, a machine is used to generate beams of X-rays which are directed towards the cancerous cells to kill them. This is known as external beam radiation therapy (EBRT).
Radiation therapy can be used as an adjuvant therapy after the surgery to remove gallbladder, as part of the main therapy for some advanced gallbladder cancer cases or as a palliative therapy.
Possible side effects of radiation therapy include:
Often, these side effects are short-termed and go away after the treatment. These side effects can worsen when radiation is given along with chemotherapy. You should talk to your doctor regarding the side effects of radiotherapy and also the treatments to relieve them.
Palliative therapy does not try to cure the cancer rather it is a treatment to help control or reduce the symptoms caused by an advanced gallbladder cancer. If the cancer has reached the malignant state, where it has spread too far in the body to be removed completely by surgery, your doctors may advise palliative operations, radiation, chemotherapy, or other treatments to improve your quality of live by making you feel better or to help prevent possible complications from the cancer.
If your gallbladder cancer is not responding to any available therapy, or if you have recurrent cancer after the surgery, you should think of trying clinical trials for gallbladder cancer. These are studies that try new treatment approaches or therapy for gallbladder cancer. You should talk to your doctor if you are eligible for any of these studies.
Unfortunately, stage 4 gallbladder cancer is not curable even with the help of surgery. In this advanced stage of gallbladder cancer, your doctor may suggest surgery to relieve the symptoms caused by the cancer or chemotherapy and radiotherapy. But, these measures are aimed for symptomatic relief only and none of them can provide a complete cure of the stage 4 gallbladder cancer.
Doctors also treat recurrent gallbladder cancer in the same way as a stage 4 gallbladder cancer is treated. Your healthcare provider may suggest you to join clinical trials if you are eligible for them.
Survival rate for gallbladder cancer is determined based on different factors such as the type of cancer, your individual condition, treatment and level of fitness. The exact time for which you will be alive after being diagnosed with the gallbladder cancer is not certain. Survival stats or survival rates are based on large groups of patients and they can’t predict what will happen in an individual case.
Generally, the survival rate for any kind of cancer patient is estimated in terms of 5 year survival rate. The 5-year survival rate is an estimation that tells what percent of people live at least 5 years after the confirmed diagnosis of that type of cancer.
The overall 5-year survival rate for people with gallbladder cancer is 19%. The following statistics show the 5 year survival rate for different stages of the gallbladder cancer, according to the American Cancer Society.
There is no way to prevent gallbladder cancers. Many of the known factors which make you more likely to develop gallbladder cancer are out of your control such as age, gender, ethnicity, and bile duct abnormalities. There are however some ways that might help you in lowering these risks.
A major risk factor for developing gallbladder cancer is gallstones. Managing the problem of gallstones can help in reducing the chances of getting gallbladder cancer. However, gallbladder cancer is rare even in people with gallstones; therefore gallbladder removal should not be recommended until the stones are causing serious problems.