Gall Bladder Cancer
The gallbladder is a pear-shaped organ that
lies just under the liver in the right upper
abdomen. The gallbladder stores bile, a
yellow, brown or greenish liquid 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. This
tube connects the gallbladder and liver to the
duodenum, first part of the small intestine.
Gall Bladder Cancer
Gallbladder cancer is a rare cancer. Most of
the cases are unexpectedly found
when a patient has surgery to
remove gall stones. The wall of
the gallbladder has 3 main layers of
ξ Mucosal (innermost) layer.
ξ Muscularis (middle,
ξ Serosal (outer) layer.
Primary gallbladder cancer starts in
the innermost layer and spreads
through the outer layers as it
grows. Gallbladder cancer is hard
to find and diagnose early because
there are no early symptoms.
When symptoms do occur they are like the
symptoms of many other conditions.
These are risk factors for developing
ξ Gall stone disease (cholelithiasis)
ξ Chronic gallbladder inflammation
ξ Gallbladder polyps
ξ Congenital biliary cysts
ξ Age, incidence increases with age
ξ Female gender
ξ Caucasian, Southwestern Native
American, or Mexican-American
The most common symptoms caused by
gallbladder cancer are right upper abdominal
pain followed by loss of appetite and nausea
or vomiting. Fever and bloating may occur.
Jaundice, yellowing of the skin or eyes,
may happen if there is an obstruction in the
The prognosis (chance of recovery) and
treatment options depend on:
ξ The stage of the cancer (whether the
cancer has spread from the
gallbladder to other places in the
ξ Whether the cancer can be
completely removed by surgery.
ξ The type of gallbladder cancer (how
the cancer cell looks under a
ξ Whether the cancer has just been
diagnosed or has recurred (come
Treatment options may also depend on the
patient’s age and general health, and
whether the cancer is causing any
Gallbladder cancer can be cured only if it is
found before it has spread, when it can be
completely removed by surgery. If the
cancer has spread, palliative treatment may
improve the patient’s quality of life by
controlling symptoms and complications of
Diagnosis and Staging
These tests and procedures may be used to
diagnose gallbladder cancer and determine
the stage of disease (extent of the cancer).
The stage of the disease is important to
know in order to make a treatment plan.
ξ Physical exam and complete history
of health habits, past illnesses, and
ξ Ultrasound – a radiology procedure
that bounces high-energy sound
waves (ultrasound) off tissues or
organs to form a picture called a
sonogram. An endoscopic
ultrasound is performed by a
gastroenterologist (doctor who
specializes in diseases of the
digestive tract). A small lighted tube
(scope) is passed through the mouth,
esophagus, stomach and first part of
the intestine. The ultrasound is done
ξ CT scan (CAT scan) – detailed
picture of the inside of the body
taken by a special x-ray machine that
is attached to a computer.
ξ MRI (magnetic resonance imaging)
– a radiology procedure that uses a
magnet, radio waves, and a computer
to make detailed pictures of the
inside of the body.
ξ ERCP (endoscopic retrograde
cholangiopancreatography) – a
procedure performed by a
gastroenterologist where a small
lighted tube (scope) is passed
through the mouth, esophagus,
stomach, and first part of the
intestine. A smaller tube or catheter
is passed into the ducts, a dye is
injected and x-rays are taken. If a
duct is blocked, a small flexible tube
(stent) may be inserted into the duct
to unblock it. Tissue samples
(biopsies) may be taken.
ξ 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 x-rays are taken. If a
blockage is found a flexible tube or
stent is sometimes left in the liver to
drain bile into the small intestine or
to a collection bag outside the body.
Tissue samples or biopsies may also
ξ Biopsy – the removal of cells or
tissues to be examined under the
microscope to check for cancer.
Tissue can be removed during an
ERCP, a PTC or during surgery.
ξ Liver function tests – blood tests
that measure the amounts of certain
substances released into the blood by
the liver. Higher than normal
amounts can be a sign of liver
disease that may be caused by the
ξ Laparoscopy –surgery to look at the
organs inside the abdomen to check
for signs of disease. A thin, lighted
tube (laparoscope) is inserted into a
small incision in the abdomen.
Tissue samples (biopsies) may be
taken. The laparoscopy helps
determine if the cancer can be
surgically removed or if it has spread
to other areas in thestomach .
ξ Positrom emissions tomography(PET
scan)- a PET scan is a way to make
a picture of the organs and tissue
inside the body.A small amount of
radioactive sugar is placed into a
vein.This sugar substance is take up
by cells that use the most energy.
Because cancer tends to use energy
actively,it absorbs more of the
radiaoactive substance.A scanner
then detects this substance and
shows images of the inside of the
Stages of Gallbladder Cancer
Stage 0 (Carcinoma in situ) – cancer is
found in the innermost (mucosal) layer
of the gallbladder only.
Stage I is divided into stage IA and
ξ Stage IA – cancer has spread beyond
the innermost layer to the connective
tissue between the first and second
layers or to the muscle (muscularis)
Stage IB –A tumopr is only in the
gallbladder and has not spread
Stage II is divided into stage IIA and stage
Stage IIA – cancer has spread beyond the
visceral peritoneum (tissue that covers the
gallbladder and other organs in the
abdomen) and/or to the liver and/or one
nearby organ (such as the stomach, small
intestine, colon, pancreas, or bile ducts
outside the liver).
Stage IIB –A tumor has extended to the
perimuscular connective tissue(the layer
between the muscle layer and the seros-
outer later) but has not spread elsewhere.
Stage III A –A tumor has spread beyond the
gallbladder but not to nearby arteries or
veins.It has not spread to any lymphnodes or
other parts of the body.
Stage III B: A tumor of any size has
spread to nearby lymphnodes but not to
nearby arteries and /or veins or to other parts
of the body.
Stage IV – cancer has spread to nearby
lymph nodes and/or to organs far away from
Recurrent: Gallbladder cancer that comes
back after treatment
ξ Localized (Stage I) and resectable
– the cancer is found in the wall of
the gallbladder and can be
completely removed by surgery.
ξ Unresectable (Stage II, Stage III,
and Stage IV) – cancer has spread
through the wall of the gallbladder to
surrounding tissues or organs or
throughout the abdominal cavity.
Except in patients whose cancer has
spread only to lymph nodes, the
cancer is unresectable (cannot be
completely removed by surgery).
Methods of Treatment
The standard surgery for gallbladder cancer
is to remove the gallbladder, a wedge
resection of the liver, resection of the extra
hepatic (outside of the liver) bile duct, and
resection of the regional lymph nodes. If an
unsuspected gallbladder cancer is found
after a laparoscopic cholecystectomy
(gallbladder removal through a scope), more
surgery may be needed to remove any
Radiation therapy uses high-energy x-rays
or other types of radiation to kill cancer
cells. There are two types of radiation
therapy. External beam radiation uses a
machine outside the body to send radiation
to the cancer. Internal beam radiation uses
a radioactive substance sealed in needles,
seeds, wires, or catheters that are placed
directly into or near the cancer. Radiation
may be given in combination with
chemotherapy. The way radiation therapy is
given, or if it is given, depends on the type
and stage of the cancer being treated.
Chemotherapy uses drugs to stop the growth
of cancer cells, either by killing the cells or
by stopping the cells from dividing. Unlike
surgery and radiation therapy, chemotherapy
is a systemic treatment that can reach cancer
cells throughout the body. Chemotherapy is
sometimes used along with radiation therapy
to make the radiation therapy more
Clinical trials, exploring ways of improving
local control, may be available using
chemotherapy with or without radiation.
This information has been reproduced with permission of the National Cancer Institute. For
more information please visit their website at www.nci.nih.gov
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