Gallbladder cancer

Overview

Gallbladder cancer is a growth of cells that begins in the gallbladder.

The gallbladder is a small, pear-shaped organ on the right side of the belly, just beneath the liver. The gallbladder stores a fluid called bile that the liver makes to digest food.

Gallbladder cancer is not common. The chance for a cure is good when gallbladder cancer is found when it's small. But most gallbladder cancers are found when they've grown beyond the gallbladder. Then the chance to survive, called prognosis, often is poor.

Gallbladder cancer may not be found until it's advanced because it may cause no symptoms. When they happen, the symptoms may be like those of common conditions. Also, the gallbladder is hidden inside the body. This makes it easier for gallbladder cancer to grow without being found.

Symptoms

Gallbladder cancer may have no symptoms. When there are signs and symptoms, they may include:

• Belly pain, mostly in the upper right part of the belly.
• Belly bloating.
• A mass you can feel through the skin.
• Losing weight without trying.
• Yellowing of the skin and whites of the eyes, called jaundice. Yellowing of the skin might be harder to see on Black or brown skin. Jaundice typically happens when the gallbladder cancer is very advanced.

When to see a doctor

Make an appointment with a healthcare professional if you have symptoms that worry you.

Causes

It's not clear what causes gallbladder cancer.

Healthcare professionals know that gallbladder cancer starts when healthy gallbladder cells develop changes in their DNA. A cell's DNA holds the instructions that tell the cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time.

In cancer cells, the DNA changes give different instructions. The changes tell the cancer cells to make many more cells quickly. Cancer cells can keep living when healthy cells would die. This causes too many cells.

The cancer cells might form a mass called a tumor. The tumor can grow to invade and destroy healthy body tissue. In time, cancer cells can break away and spread to other parts of the body. When cancer spreads, it's called metastatic cancer.

Most gallbladder cancer begins in the glandular cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is called adenocarcinoma. This term refers to the way the cancer cells appear when looked at under a microscope.

Risk factors

Factors that can increase the risk of gallbladder cancer include:

• Female sex. Gallbladder cancer is much more common in women than in men. Experts think it may be related to the hormone estrogen, which increases the risk of gallstones. People who are assigned female at birth most often have higher levels of estrogen in their bodies than do people assigned male at birth.
• Increasing age. Your risk of gallbladder cancer increases as you age. It's more common after age 65. But it can happen in children.
• A history of gallstones. Gallbladder cancer is most common in people who have gallstones or have had gallstones in the past. Larger gallstones may carry a larger risk. Gallstones are common. But even in people with gallstones, gallbladder cancer is rare.
• Other gallbladder conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include polyps, infections, and ongoing swelling and irritation, called chronic inflammation.
• Inflammation of the bile ducts. Primary sclerosing cholangitis causes inflammation of the ducts that drain bile from the gallbladder and liver. This condition increases the risk of gallbladder cancer.

Healthcare professionals have not found ways to prevent gallbladder cancer.

Diagnosis

Gallbladder cancer diagnosis might start with a discussion about your symptoms. A healthcare professional might use blood tests to understand how your organs are working and imaging tests to look for signs of cancer in the gallbladder.

Blood tests

Blood tests to check how your liver is working may help your healthcare professional find what's causing your symptoms.

Imaging tests

Imaging tests that may be used to make pictures of the gallbladder include ultrasound, CT scan and MRI.

Finding the extent of gallbladder cancer

Once your healthcare professional diagnoses your gallbladder cancer, the next step is to find the extent of the cancer. This is called staging. Your gallbladder cancer's stage helps show your prognosis and helps with treatment choices.

Tests and procedures used to stage gallbladder cancer include:

• Tests to look at the bile ducts. Your healthcare professional may suggest procedures to put dye into the bile ducts. An imaging test then records where the dye goes. These tests can show if the bile ducts are blocked.

  These tests may include magnetic resonance cholangiography and endoscopic retrograde cholangiopancreatography.

• Other imaging tests. Most people with gallbladder cancer will have a series of scans to help see if the cancer has spread. Common scans include CT and MRI scans of the belly area and chest.

• Exploratory surgery. If surgery is a treatment option for you, your healthcare professional first may recommend surgery to look inside your belly to see if gallbladder cancer has spread.

  In a procedure called laparoscopy, the surgeon makes a small cut called an incision in your belly and puts in a tiny camera. The camera lets the surgeon check organs around your gallbladder for signs that the cancer has spread.

Your healthcare team uses these procedures to give your cancer a stage. The stages of gallbladder cancer range from 0 to 4. A lower number generally means the cancer is small and likely to be cured.

A stage 1 gallbladder cancer means the cancer is only in the gallbladder. As the cancer grows larger and grows beyond the gallbladder, the stages go up. A stage 4 gallbladder cancer means the cancer has grown through the gallbladder and into nearby organs. Stage 4 also may mean the cancer has spread to other parts of the body.

Treatment

Treatment for gallbladder cancer often involves surgery. If the cancer grows into nearby organs, surgery might not be possible. Treatment might start with radiation therapy or medicines, such as chemotherapy, instead. What gallbladder cancer treatments are best for you depend on the stage of your cancer, your health and what you prefer.

Surgery

Surgery is used to treat gallbladder cancer that hasn't spread beyond the gallbladder. Types of surgery include:

• Surgery to remove the gallbladder. Early gallbladder cancer that hasn't grown beyond the gallbladder is treated with an operation to remove the gallbladder. This operation is called cholecystectomy.
• Surgery to remove the gallbladder and part of the liver. Gallbladder cancer that grows beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as parts of the liver and bile ducts that surround the gallbladder.

If your gallbladder cancer is small and all of it can be removed with cholecystectomy, you may not need other treatments.

Chemotherapy

Chemotherapy treats cancer with strong medicines. Most chemotherapy medicines are given through a vein. Some come in pill form.

Your healthcare professional might suggest chemotherapy after surgery if there's a risk that some gallbladder cancer cells might remain. Sometimes, healthcare professionals give chemotherapy before surgery. It also can be used to control the cancer when surgery isn't possible.

Radiation therapy

Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.

Radiation therapy is sometimes used with chemotherapy after surgery for gallbladder cancer if all the cancer couldn't be removed. Radiation therapy also can control gallbladder cancer that's causing pain and jaundice when surgery isn't possible.

Targeted therapy

Targeted therapy for cancer is a treatment that uses medicines that attack certain chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Targeted therapy medicines are used only in people whose cancer cells have certain changes that can be targeted. Your cancer cells may be tested to see if targeted therapy is likely to help you.

Immunotherapy

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system find and kill the cancer cells.

Immunotherapy is typically used for gallbladder cancers that grow very large or spread to other parts of the body.

Coping and support

Learning to cope with a life-threatening illness, such as gallbladder cancer, will take time. Some ideas for learning to cope with gallbladder cancer include:

Ask questions about gallbladder cancer

Write down questions you have about your cancer. Ask these questions at your next appointment. Also ask your healthcare team for good sources where you can get more information.

Knowing more about your gallbladder cancer and your treatment choices may help you make decisions about your care.

Stay close to friends and family

Your cancer diagnosis can be stressful for friends and family too. Try to keep them involved in your life.

Your friends and family will likely ask if there's anything they can do to help you. Think of tasks you might like help with, such as caring for your home if you have to stay in the hospital or just being there when you want to talk.

You may find comfort in the support of a caring group of your friends and family.

Find someone to talk with

Find someone you can talk to who has worked with people facing a life-threatening illness. Consult a counselor, medical social worker or clergy member. You also may wish to join a support group for people with cancer. Ask your healthcare team to connect you to these resources.

Write down your medical wishes

Take steps to ensure that your wishes are known and carried out. Ask your care team about advance directives. Advanced directives allow you to say what types of treatment you'd want if you couldn't talk about your wishes.

Also ask about naming a medical power of attorney. This is someone you choose to make your choices for you if you can't make them yourself.

Preparing for an appointment

Start by making an appointment with a healthcare professional if you have symptoms that worry you.

If your healthcare professional thinks that you may have gallbladder cancer, you may be sent to a specialist, such as:

• A doctor who specializes in treating digestive conditions, called a gastroenterologist.
• A surgeon who operates on the liver or gallbladder.
• A doctor who specializes in treating cancer, called an oncologist.

Here's some information to help you get ready for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, including any that may not seem linked to the reason for your appointment, and when they began.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medicines, vitamins or supplements you take, including doses.
• Ask a family member or friend to go with you. Someone who's with you can help you remember the information you get.
• Write down questions to ask your healthcare professional.

For gallbladder cancer, some basic questions to ask include:

• Has my gallbladder cancer gone beyond my gallbladder?
• Will I need more tests?
• What treatments are there for my gallbladder cancer?
• What are the benefits and risks of each treatment?
• Is there one treatment you suggest over the others?
• Should I see a specialist?
• Are there brochures or other printed materials that I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare team is likely to ask you questions, including:

• Have your symptoms been constant or do they come and go?
• How bad are your symptoms?
• What, if anything, seems to make your symptoms better?
• What, if anything, appears to make your symptoms worse?