What Is Gallbladder Cancer?

Gallbladder cancer is a rare form of cancer although it is the most common type of cancer of the biliary system. The gallbladder is a small organ that is located under the liver. The function of the gallbladder is to store the digestive fluid called bile.

In most cases, gallbladder cancer is challenging to find in the early stages. Once symptoms have started, it is usually advanced and is more difficult to treat. Gallbladder carcinomas are more common in women than in men and are diagnosed more often in Latin America and certain parts of Asia.

The Gallbladder

The gallbladder is attached to the liver and is shaped like a pear. The primary function of the gallbladder is to receive the bile that's made in the liver and to store it.

Bile is a digestive fluid that is released into the small intestine via the bile ducts. It helps break down the fats and certain vitamins in food. Bile is released after eating and in particular, after having meals with a higher fat content.

Types of Gallbladder Cancer

There are a few different forms of gallbladder cancer and treatment may vary based on the type of tumor and how extensive it is.

Adenocarcinoma

The majority of gallbladder cancers are adenocarcinomas, accounting for between 76% and 90% of cases. An adenocarcinoma begins in the cells which produce mucus. Many of these types of cells are in the glands of the body, including in the gallbladder. 

Papillary Cancer

Gallbladder cancers are already rare and this is the rarest form of it, representing approximately 5% to 6% of cases. When this type of cancer forms in the gallbladder it creates projections that look like fingers. These fingers are less likely to spread to other organs (such as the liver) or into the lymph nodes.

In addition, symptoms may appear earlier in the development of the cancer because the "fingers" block the bile ducts and cause symptoms. For that reason, it is considered to be a more treatable form of gallbladder cancer. 

Squamous Cell Carcinoma and Adenosquamous Carcinoma

These two types of gallbladder cancer are estimated to account for between 2% and 10% of cases. These types of cancer tend to be associated with a worse outcome than adenocarcinoma.

Gallbladder Cancer Symptoms

Gallbladder cancer has usually advanced to the later stages before it causes any symptoms. This is because at that point, the tumor has become large or has spread outside the gallbladder to other organs or to the lymph nodes. Common symptoms of gallbladder cancer include:

• Abdominal mass on the right side
• Abdominal pain, especially in the upper right quadrant
• Jaundice (yellowing of the skin and the whites of the eyes)
• Nausea
• Vomiting

Less common symptoms of gallbladder cancer include:

• Abdominal swelling
• Dark urine
• Fever
• Itchy skin
• Loss of appetite
• Pale or greasy looking stools
• Weight loss

Causes

It's currently not known what exactly causes gallbladder cancer but there are some risk factors.

• Age: The risk of gallbladder cancer increases with age.
• Sex: Gallbladder cancer is more common in women than it is in men.
• Gallstones: Gallbladder cancer is more common in those who have a history of gallstones. This is especially true when the gallstones are larger. However, it's estimated that less than 3% of patients with gallstones are at risk for developing cancer of the gallbladder. 
• Gallbladder disease: Other conditions that affect the gallbladder, such as inflammation, polyps, and chronic infection, are also associated with a greater risk of gallbladder cancer. In some cases of gallbladder disease, it may be recommended to remove the gallbladder completely, in order to remove the risk of developing cancer.
• Primary sclerosing cholangitis (PSC): PSC is a condition that causes inflammation of the bile ducts. The risk of gallbladder cancer in people with PSC is significant. This is especially true in the first year after diagnosis and in those who also live with ulcerative colitis, which is a condition associated with PSC.

Diagnosis

A diagnosis of gallbladder cancer may be made after using one or more different tests. In some cases, gallbladder cancer is diagnosed incidentally, which means it is found when doing a test or procedure for another purpose.

Tests that may be done when symptoms of a gallbladder problem are present include:

• Computerized tomography (CT): This test is a type of X-ray that uses a series of images to create a 3D picture of the organs in the body. 
• Liver function tests: Blood tests to measure substances in the blood that give a clue as to how well the liver is working may help in diagnosing gallbladder cancer.
• Magnetic resonance imaging (MRI): An MRI is a test that uses use radio waves and strong magnets to create a picture of the organs inside the body. In some cases, an MRI is done after injecting contrast (which is a substance called gadolinium) into a vein. An MRI with contrast may help in seeing the details of the gallbladder and the bile ducts better.
• Ultrasound: This painless, non-invasive test uses sound waves to create images of the inside of the body, including the gallbladder.

Staging

When gallbladder cancer is confirmed, it is important to know what stage it is. Staging the cancer helps in making treatment decisions. Tests might also be done to see if the cancer has moved beyond the gallbladder and into other organs and body structures.

Some of the tests or procedures that might be used to stage gallbladder cancer include:

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is an invasive test that uses endoscopy and X-rays to visualize the bile and pancreatic ducts. A flexible tube with a light on the end is passed into the mouth and down through the stomach and into the small intestine. An ERCP can be used to see problems with the bile ducts and, in some cases, deliver certain treatments.

Exploratory Surgery

Surgery to look inside the abdomen and at the gallbladder and surrounding organs might be done. Once inside, surgeons may decide to perform other procedures based on what is found. It may be done laparoscopically, which means that several small incisions are made, and an instrument with a camera is used to look inside the abdomen.

Prognosis

According to the American Cancer Society, the five-year survival rate for galbladder cancer is estimated to be 19%, overall.

In one study, patients with papillary cancer had a higher cure rate after surgery than did patients with adenocarcinoma. The cancer was also diagnosed earlier in the disease process in patients with papillary tumors than it was in those with adenocarcinomas.

Adenosquamous carcinoma tends to have a worse prognosis when compared with adenocarcinomas of the gallbladder. When this type of cancer has not spread beyond the gallbladder, however, the survival rate is improved. One study showed that chemotherapy after surgery may also improve the prognosis in this type of cancer.

Treatment

Some of the difficulty in treating gallbladder cancer comes from the fact that most cases are diagnosed at later stages. In addition, there is a lack of research on what the most effective treatments might be because this type of cancer is rare to begin with, and certain subtypes are even rarer.

Surgery

In most cases, treatment will start with surgery on the gallbladder to remove it; this is called cholecystectomy. People can live without their gallbladder and often do not miss it.

Parts of the other affected organs may also be removed. For instance, if the cancer has spread to the liver, part of the liver and/or some bile ducts may also be removed. If there are lymph nodes involved, those may also need to be removed through surgery.

Surgery is the main treatment for squamous cell carcinoma. In some cases radiation and chemotherapy might also be used after surgery. For adenosquamous carcinoma, surgery is most often used as a treatment, sometimes with chemotherapy.

Chemotherapy and Radiation

In some cases, chemotherapy and/or radiation may also be used after surgery. Whether or not these treatments are also used will depend greatly on the type of gallbladder cancer and the expected outcome of treatment.

For example, some patients may want to make decisions about other treatments based on whether or not those treatments may extend their lifespan or lead to remission.

Chemotherapy refers to using medications that kill certain types of cells that grow quickly in the body, like cancer cells. Chemotherapy may be given as a pill that is taken by mouth or as an infusion, which is given through an IV.

Radiation therapy is the use of energy beams to kill cancer cells. This treatment is non-invasive. A machine delivers radiation to the patient as they lie on a table.

In patients who were diagnosed with Stage 4 metastatic cancer, surgery may not be an option.

Targeted Drug Therapy

A newer treatment is being studied in clinical trials. Targeted drugs are developed to be more specific than chemotherapy and to kill the cancer cells. This therapy may be used by itself or along with chemotherapy.

Immunotherapy

In immunotherapy, a patient's own immune system is used to target the cancer cells and destroy them. This is a newer type of treatment and may only be available in clinical trials for gallbladder cancer.

Palliative Care

When the cancer has advanced to the point that surgery can not remove it all and other therapies are not expected to work, certain other treatments may be used. If bile is not draining because bile ducts are blocked, a stent may be placed into the duct during an ERCP procedure to keep it open and help with drainage.

A catheter is another treatment that can help bile drain. A thin tube is placed through the abdomen and into the bile duct by an interventional radiologist. The bile drains into a bag that's worn on the outside of the body.

Coping

Gallbladder cancer is a challenging diagnosis to receive. It is normal to feel a range of emotions, especially because when diagnosed in the later stages, gallbladder carcinomas have a poorer prognosis. It may be helpful to put some coping mechanisms into place.

Working with physicians to learn about the diagnosis and what the treatments are is one way to cope. Writing down questions to bring to appointments and having a friend or family member come along can be helpful.

Letting family and friends know about the diagnosis and next steps will allow them to be supportive. People often ask what they can do when a loved one is diagnosed with cancer.

Some things that may help include providing transportation to and from appointments, bringing meals, picking up prescriptions, doing tasks around the house like cleaning and laundry, and shopping for groceries or other necessities.

Having a trusted person to confide in is also important. This could be a close friend or family member, a therapist, a social worker, or a clergyperson.

Support groups for people with cancer may also be available at the hospital or through the oncologist's office. Every person will have their own preferred form of way of coping and having multiple options will be helpful.

A Word From Verywell

It's important to remember that gallbladder cancer is rare. The symptoms of gallbladder cancer are fairly nonspecific. They are often caused by other, less serious and more common conditions. Additionally, the symptoms of gallstones, which is a common and treatable problem, are similar to gallbladder cancer.

However, any symptoms that are persistent, especially severe pain in the abdomen, are a reason to see a healthcare provider. Severe abdominal pain, especially when accompanied by vomiting, should be addressed immediately.