About Gall Bladder Cancer
Gall bladder cancer is rare. Just under 1000 people are diagnosed with it in the UK each year. It is rare in people under 50 and is most common in people over 75. It is more common in women than men.
We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.
The gall bladder is a small pouch that stores bile. Bile is a fluid that helps us digest food and break down fats. It is made by the liver and stored in the gall bladder. The gall bladder is connected to the small intestine and the liver by small tubes called the bile ducts.
Gallbladder cancer is cancer that begins in the Gallbladder.
Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder stores bile, a digestive fluid produced by your liver.
Gallbladder cancer is uncommon. When gallbladder cancer is discovered at its earliest stages, the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, when the prognosis is often very poor.
Gallbladder cancer is difficult to diagnose because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.
The gall bladder and the bile ducts together are called the biliary system. We have separate information about cancer that starts in the bile duct (cholangiocarcinoma).
Gallbladder cancer signs and symptoms may include:
- Abdominal pain, particularly in the upper right portion of the abdomen
- Abdominal bloating
- Losing weight without trying
Yellowing of the skin and whites of the eyes (jaundice)
Gallbladder cancer doesn’t usually cause symptoms in its early stages. So by the time you know it’s there, it might be at a more advanced stage than some other types of cancer. At diagnosis, it has often spread outside the gallbladder itself to areas nearby.
It can be difficult for doctors to feel if your gallbladder is swollen or tender when they examine you. The gallbladder lies behind other organs deep inside your body, so it can be difficult to feel. Many early stage cancers of the gallbladder are found by chance. For example, when someone is having their gallbladder taken out to treat gallstones.
You may get a number of symptoms with gallbladder cancer. Most of these happen in the later stages of the disease.
Other illnesses apart from gallbladder cancer can also cause these symptoms. Even so, it is important that you see your doctor. Whatever is causing your symptoms needs treating.
Tummy (abdominal) pain
You can get an aching feeling on your right side if you have gallbladder cancer. Some people describe it as a dragging feeling. If the cancer or gallstones block the bile duct, you will have a sharper pain.
Feeling or being sick
This is very common in the later stages of gallbladder cancer.
Over half the people diagnosed with gallbladder cancer will feel or be sick quite often at some stage of their illness. This is usually fairly easy to control with anti sickness drugs.
Jaundice means either that your liver is not working properly, or that there is a blockage in your biliary system. The symptoms can include:
- yellowing skin and whites of the eyes
- severe itching in some people
- darkened urine
- pale coloured stools (bowel movements)
Jaundice is caused by a build up of bile salts in the blood. If cancer blocks the common bile duct, the bile can’t drain away into the bowel as it normally would. So bile salts build up in your blood and body tissues.
The bile salts make your skin and the whites of your eyes look yellow, and your skin itch (doctors call this itching pruritis). They also make your urine darker than normal. Because the bile is not passing into your bowel, your stools will be much paler than normal.
Nearly half the people diagnosed with gallbladder cancer have jaundice. This is often a sign that the cancer is in its later stages.
Remember – having jaundice does not always mean you have cancer. A viral infection of the liver (hepatitis) is a much more common cause of jaundice than gallbladder cancer.
If your bile duct is blocked, your gallbladder will fill up with bile and get swollen and enlarged.
Your doctor may be able to feel this during a physical examination but is more likely to see it on an ultrasound scan.
- Less common symptoms include:
- loss of appetite (anorexia)
- loss of weight without dieting
- a swollen tummy (abdomen)
Abdominal pain is a sign of many diseases that are far more common than gallbladder cancer. But it is best to be safe. So if you have any of these symptoms, do see your doctor. Most health problems are much easier to treat when they are found early.
The exact cause of gallbladder cancer isn’t known, but certain things are thought to increase your chances of developing it.
Older age – it’s more common in people over the age of 70
family history – you have a higher risk of developing gallbladder cancer if a parent, sibling or child has had the condition
having another gallbladder condition – you have a higher risk if you have already had gallstones, inflammation of the gallbladder (cholecystitis), polyps in your gallbladder or a condition called porcelain gallbladder
- being obese
It’s not clear what causes gallbladder cancer.
Doctors know that gallbladder cancer forms when healthy gallbladder cells develop changes (mutations) in their DNA. These mutations cause cells to grow out of control and to continue living when other cells would normally die. The accumulating cells form a tumor that can grow beyond the gallbladder and spread to other areas of the body.
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 examined under a microscope.
Gall bladder cancer is more common in people over the age of 75.
Gallstones and inflammation
People with a history of gallstones or an inflamed gall bladder (cholecystitis) have a higher risk. But most people who have gallstones or an inflamed gall bladder do not develop gall bladder cancer.
These are non-cancerous (benign) tumours of the gall bladder. Having polyps increases the risk of developing gall bladder cancer.
Porcelain gall bladder
This is when calcium builds up in the wall of the gall bladder. People with this condition have a slightly increased risk.
Abnormal bile ducts
Gall bladder cancer is slightly more common in people born with abnormal bile ducts.
People who smoke cigarettes have a higher risk.
Being very overweight can also increase your risk.
Close relatives of people with gall bladder cancer have a slightly higher risk. A close relative is a parent, brother or sister.
Tests and procedures used to diagnose gallbladder cancer include:
Blood tests to evaluate your liver function may help your doctor determine what’s causing your signs and symptoms.
Procedures to create images of the gallbladder.
Imaging tests that can create pictures of the gallbladder include ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI).
ERCP (endoscopic retrograde cholangio-pancreatography)
This test uses x-rays to look at the gall bladder and bile ducts. Your doctor may also look at the ducts that connect the pancreas (see diagram above) to the small bowel.
You will be asked not to eat or drink anything for about six hours before the test. This is so the stomach and first part of the small bowel (the duodenum) are both empty. The doctor will give you a tablet or injection to make you relax (a sedative). They will use a local anaesthetic spray to numb your throat. Rarely, it may be done using a general anaesthetic.
The doctor will then pass a thin, flexible tube called an endoscope through your mouth. This goes into your stomach and into the small bowel just beyond it.
The doctor will look down the endoscope to find the openings where the bile duct and the duct of the pancreas drain into the duodenum. They can inject a dye that can be seen on x-rays into these ducts. This helps to show whether there are any abnormalities or blockages.
Determining the extent of gallbladder cancer
Once your doctor diagnoses your gallbladder cancer, he or she works to find the extent (stage) of your cancer. Your gallbladder cancer’s stage helps determine your prognosis and your treatment options.
Tests and procedures used to stage gallbladder cancer include:
Your doctor may recommend surgery to look inside your abdomen for signs that gallbladder cancer has spread.
In a procedure called laparoscopy, the surgeon makes a small incision in your abdomen and inserts a tiny camera. The camera allows the surgeon to examine organs surrounding your gallbladder for signs that the cancer has spread.
Tests to examine the bile ducts
Your doctor may recommend procedures to inject dye into the bile ducts. This is followed by an imaging test that records where the dye goes. These tests can show blockages in the bile ducts.
These tests may include endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiography and percutaneous transhepatic cholangiography.
Additional imaging tests
Most people with gallbladder cancer will undergo a series of scans to help determine whether the cancer has spread or remains localized. Which scans should be performed vary depending on your circumstances. Common scans include a CT of the chest and abdomen, ultrasonography, and an MRI of the liver.
Stages of gallbladder cancer
The stages of gallbladder cancer are:
Stage I. At this stage, gallbladder cancer is confined to the inner layers of the gallbladder.
Stage II. This stage of gallbladder cancer has grown to invade the outer layer of the gallbladder.
Stage III. At this stage, gallbladder cancer has grown to invade one or more nearby organs, such as the liver, small intestine or stomach. The gallbladder cancer may have spread to nearby lymph nodes.
Stage IV. The latest stage of gallbladder cancer includes large tumors that involve multiple nearby organs and tumors of any size that have spread to distant areas of the body.
What gallbladder cancer treatment options are available to you will depend on the stage of your cancer, your overall health and your preferences.
The initial goal of treatment is to remove the gallbladder cancer, but when that isn’t possible, other therapies may help control the spread of the disease and keep you as comfortable as possible.
Surgery for early-stage gallbladder cancer
Surgery may be an option if you have an early-stage gallbladder cancer. Options include:
Surgery to remove the gallbladder. Early gallbladder cancer that is confined to the gallbladder is treated with an operation to remove the gallbladder (cholecystectomy).
Surgery to remove the gallbladder and a portion of the liver. Gallbladder cancer that extends beyond the gallbladder and into the liver is sometimes treated with surgery to remove the gallbladder, as well as portions of the liver and bile ducts that surround the gallbladder.
It’s not clear whether additional treatments after successful surgery can increase the chances that your gallbladder cancer won’t return. Some studies have found this to be the case, so in some instances, your doctor may recommend chemotherapy, radiation therapy or a combination of both after surgery.
Discuss the potential benefits and risks of additional treatment with your doctor to determine what’s right for you.
Treatments for late-stage gallbladder cancer
Surgery can’t cure gallbladder cancer that has spread to other areas of the body. Instead, doctors use treatments that may relieve signs and symptoms of cancer and make you as comfortable as possible.
Options may include:
Chemotherapy. Chemotherapy is a drug treatment that uses chemicals to kill cancer cells.
Radiation therapy. Radiation uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells.
Clinical trials. Clinical trials are studies testing experimental or new medications to treat gallbladder cancer. Talk to your doctor to see whether you’re eligible to participate in a clinical trial.
Types of gallbladder cancer
The type of a cancer tells you which type of cell it started in. There are several types of gallbladder cancer.
There is more than one type of gallbladder cancer because there are lots of different types of cells in the gallbladder. Any of these cell types could, in theory, develop into cancer.
So if the cancer started in gland cells, it is an adenocarcinoma. If it started in the skin like cells lining the gallbladder, it is a squamous cell cancer, and so on.
This is the most common type of gallbladder cancer. More than 85 out of every 100 gallbladder cancers (85%) are adenocarcinomas. The cancer starts in gland cells in the gallbladder lining. These gland cells normally produce mucus (thick fluid).
There are three types of adenocarcinomas of the gallbladder. You might hear your doctor talking about:
- non papillary adenocarcinoma
- papillary adenocarcinoma
- mucinous adenocarcinoma
Only about 6 out of every 100 gallbladder cancers (6%) are papillary adenocarcinomas. They develop in the tissues that hold the gallbladder in place (connective tissues). This type of gallbladder cancer is less likely to spread to the liver and nearby lymph nodes. It tends to have a better outlook than most other types of gallbladder cancer.
With mucinous adenocarcinomas, the cancer cells are often in pools of mucus. Only about 1 or 2 out of every 100 gallbladder cancers (1 or 2%) are mucinous adenocarcinoma.
Squamous cell cancer
Squamous cell cancers develop from the skin like cells that form the lining of the gallbladder, along with the gland cells. They are treated in the same way as adenocarcinomas.
Adenosquamous carcinomas are cancers that have both squamous cancer cells and glandular cancer cells. Your doctor might call this a mixed histology. These cancers are treated in the same way as adenocarcinomas.
Small cell cancer
Small cell carcinomas are also called oat cell carcinomas. This is because the cancer cells have a distinctive oat like shape.
Sarcoma is the name for a cancer that affects the supportive or protecting tissues of the body, also called the connective tissues. Muscles, blood vessels and nerves are all connective tissues. So a cancer that begins in the muscle layer of the gallbladder is called a sarcoma.
Neuroendocrine tumours are rare cancers that grow from hormone producing tissues, usually in the digestive system. The most common type of neuroendocrine tumour is called carcinoid.
Lymphoma and melanoma
These are extremely rare types of gallbladder cancer. They are not necessarily treated in the same way as the other types. For example, lymphomas tend to respond well to chemotherapy and radiotherapy. So it is very unlikely that you would have surgery to treat a lymphoma.