Gallbladder cancer is a type of tumour that develops in the gallbladder, which is a small, pear-shaped organ located under the liver. The function of the gallbladder is to store bile, a liquid produced by the liver that aids in digestion and is transported through bile ducts to the small intestine.
There are four classifications of gallbladder cancer, which are categorised by the type of cells the tumour develops from. The most common type is adenocarcinoma, which is cancer originating in glandular tissue. Rarer forms of gallbladder cancer include squamous cell carcinomas (cancer forming from squamous cells in skin or tissue lining), sarcomas (bone and soft tissue cancer) and lymphomas (cancer of the lymphatic system).
Gallbladder cancer is most commonly diagnosed in people of 65 years old and is more prevalent in women; however, anyone at any age can develop this type of cancer.
Treatment
If gallbladder cancer is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumour) indicates the size and depth of the tumour.
- N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
- Stage I: cancer cells have begun to spread to nearby tissues. It is not deeply embedded into nearby tissue and has not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including age, stage of disease and overall health. The types of treatments generally don’t vary between adults and children.
Treatment options for gallbladder cancer may include:
- Surgery, potentially including:
- Tumour resection.
- Cholecystectomy (removal off the gallbladder).
- Pancreaticduodenectomy/Whipple procedure (removal of portions of the pancreas, gallbladder, bile ducts, small intestine and/or the stomach).
- Radiation therapy.
- Chemotherapy.
- Immunotherapy.
- Targeted therapy.
- Clinical trials.
- Pallative care.
For more information about treatment options, please refer to the Rare Cancers Australia treatment options page.
Risk factors
Some of the risk factors for gallbladder cancer include:
- Previous gallbladder conditions, such as gallstones, gallbladder polyps, choledochal cysts, calcified gallbladder, or inflammation.
- Family history of gallbladder cancer.
- Being overweight or obese.
- Older age.
- Being female.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Early symptoms
Common symptoms of gallbladder cancer include:
- Abdominal pain (usually on the upper right side).
- Jaundice (yellowing of the skin and/or eyes).
- Fever.
- Unexplained weight loss.
- Nausea and/or vomiting.
- Abdominal bloating.
- Unusual abdominal lumps.
- Fatigue.
- Darker urine.
- Clay-coloured stools.
Not everyone with the symptoms above will have cancer, but see your GP if you are concerned.
Diagnosis/diagnosing
If your doctor suspects you have gallbladder cancer, they may order the following tests to confirm the diagnosis and refer you to a specialist for treatment.
Physical examination
Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.
Imaging & blood tests
The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), ultrasounds, x-rays, and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and looks for signs of metastasis. Additionally, a blood test may be taken to assess your overall health, your liver function, and help guide treatment decisions.
Biopsy
Once the location of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. This can be done during a diagnostic laparoscopy, which is a minimally invasive day surgery. Small incisions will be made in your abdomen, and a long, thin, tube with a camera and a light attached will be inserted to observe your gallbladder. A biopsy can also be done during an endoscopic retrograde cholangiopancreatography, which involves inserting a long, thin, tube with a camera and a light down your throat and into the gallbladder for observation.
Prognosis (Certain factors affect the prognosis and treatment options)
While it is not possible to predict the exact course of the disease, your doctor will be able to give you a general idea based on rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage gallbladder cancers have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis is not as good and there is a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis.
References
Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.