Gallbladder Cancer

What is cancer of the gallbladder?
Cancer of the gallbladder, an uncommon cancer, is a disease in which cancer (malignant) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. Bile, a fluid made by the liver, is stored in the gallbladder. When food is being broken down (digested) in the stomach and the intestines, bile is released from the gallbladder through a tube called the bile duct that connects the gallbladder and liver to the first part of the small intestine. The bile helps to digest fat.

Cancer of the gallbladder is more common in women than in men. It is also more common in people who have hard clusters of material in their gallbladder (gallstones).

Cancer of the gallbladder is hard to find (diagnose) because the gallbladder is hidden behind other organs in the abdomen. Cancer of the gallbladder is sometimes found after the gallbladder is removed for other reasons. The symptoms of cancer of the gallbladder may be like other diseases of the gallbladder, such as gallstones or infection, and there may be no symptoms in the early stages. A doctor should be seen if the following symptoms persist:

• Pain above the stomach
• Loss of weight without trying
• Fever
• Yellowing of the skin (jaundice)

If there are symptoms, a doctor may order x-rays and other tests to see what is wrong. However, usually the cancer cannot be found unless the patient has surgery. During surgery, a cut is made in the abdomen so that the gallbladder and other nearby organs and tissues can be examined.

The chance of recovery (prognosis) and choice of treatment depend on the stage of cancer (whether it is just in the gallbladder or has spread to other places) and on the patient's general health.

Stages of cancer of the gallbladder
Once cancer of the gallbladder is found, more tests will be done to find out if cancer cells have spread to other parts of the body. A doctor needs to know the stage to plan treatment. The following stages are used for cancer of the gallbladder:

Localized
Cancer is found only in the tissues that make up the wall of the gallbladder, and it can be removed completely in an operation.

Unresectable
All of the cancer cannot be removed in an operation. Cancer has spread to the tissues around the gallbladder, such as the liver, stomach, pancreas, or intestine and/or to lymph nodes in the area. (Lymph nodes are small, bean-shaped structures that are found throughout the body. They produce and store infection-fighting cells.)

Recurrent
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the gallbladder or in another part of the body.

How cancer of the gallbladder is treated
There are treatments for all patients with cancer of the gallbladder. Three treatments are used:

• Surgery (taking out the cancer or relieving symptoms of the cancer in an operation)
• Radiation therapy (using high-dose x-rays to kill cancer cells)
• Chemotherapy (using drugs to kill cancer)

Surgery is a common treatment of cancer of the gallbladder if it has not spread to surrounding tissues. The doctor may take out the gallbladder in an operation called a cholecystectomy. Part of the liver around the gallbladder and lymph nodes in the abdomen may also be removed.

If the cancer has spread and cannot be removed, the doctor may do surgery to relieve symptoms. If the cancer is blocking the bile ducts and bile builds up in the gallbladder, the doctor may do surgery to go around (bypass) the cancer. During this operation, the doctor will cut the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or other procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area. During these procedures, the doctor may place the catheter so that it drains through a tube to the outside of the body or so that it goes around the blocked area and drains the bile into the small intestine.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation for gallbladder cancer usually comes from a machine outside the body (external-beam radiation therapy). Radiation may be used alone or in addition to surgery.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for cancer of the gallbladder is usually put into the body by a needle inserted into a vein. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells outside the gallbladder. Chemotherapy or other drugs may be given with radiation therapy to make cancer cells more sensitive to radiation (radiosensitizers).

Treatment by stage
Treatments for cancer of the gallbladder depend on the stage of the disease and the patient's general health.

Standard treatment may be considered because of its effectiveness in past studies, or participation in a clinical trial may be considered. Most patients with gallbladder cancer are not cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in many parts of the country for patients with cancer of the gallbladder. To learn more about clinical trials, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Localized Gallbladder Cancer
Treatment may be one of the following:

Unresectable Gallbladder Cancer
Treatment may be one of the following:

Recurrent Gallbladder Cancer
Treatment for recurrent cancer of the gallbladder depends on the type of treatment the patient received before, the place where the cancer has recurred and other facts about the cancer, and the patient's general health. The patient may wish to consider taking part in a clinical trial.

Source: National Institutes of Health; National Cancer Institute