Gallbladder Cancer

The most common types of gallbladder cancer are adenocarcinomas. In fact, they make up 90% of gallbladder cancer cases. Uncommon types include adenosquamous carcinomas, squamous cell carcinomas, small cell carcinomas and sarcomas.

Adenocarcinoma

The vast majority of gallbladder cancers are adenocarcinomas. They start in the mucus glands that line the inside of the gallbladder. Similarly, bile duct cancers that are adenocarcinomas also start in the gland-like cells lining the organs of the digestive tract.

Papillary adenocarcinoma

Also falling under the umbrella of adenocarcinoma, this subtype often comes with a better prognosis. This is because papillary cancers are less likely to spread to other organs, such as the liver or nearby lymph nodes.

What causes gallbladder cancer is unknown, but many of the risk factors cause chronic inflammation, which is linked to cancer.

Gallbladder cancer risk factors and conditions that increase risk include the following:

Gallstones

The most common risk factor for gallbladder cancer, gallstones are small masses of cholesterol and other substances that form in the gallbladder. More than 75% of people with gallbladder cancer have gallstones when the cancer is diagnosed. But gallstones are very common, and most people who have gallstones do not develop gallbladder cancer.

Porcelain gallbladder

This occurs when calcium deposits cover the wall of the gallbladder, often after long-term inflammation caused by another condition, such as gallstones.

Reflux

People who have a bile duct defect that allows digestive juices from the pancreas to flow back (reflux) into the bile ducts have a higher risk of gallbladder cancer.

Primary sclerosing cholangitis

This is inflammation of the bile ducts that forms scar tissue.

Choledochal cysts

These bile-filled sacs are connected to the bile duct that carries bile from the gallbladder to the small intestines.

Gallbladder polyps

These are growths that form on the surface of the gallbladder wall.

Gender

In the United States, gallbladder cancer affects twice as many women as men, and women are more likely to have gallstones and gallbladder inflammation.

Weight

People with gallbladder cancer are more likely to be overweight. Excess weight also raises the risk of gallstones, which in turn raises the risk of cancer.

Age

More than 2 out of 3 people diagnosed with gallbladder cancer are age 65 or older.

Family history

A family history of gallbladder cancer may raise the risk, but most people who have gallbladder cancer do not have a family history of the disease. Inherited gene mutations do not seem to be a risk factor.

If you’re concerned about your risk for gallbladder cancer, talk to your doctor.

There is no effective gallbladder cancer screening exam, because no tests can detect it at an early stage. This is different than other types of cancer where routine screening exams can help detect tumors early, even if a person doesn’t have symptoms or a high risk of developing the disease. 

Because the gallbladder is deep inside the body, small tumors cannot be felt during routine physical exams. In fact, most gallbladder cancers aren’t found until they start to cause symptoms.

Gallbladder cancer cannot be completely prevented unless the gallbladder is removed. Sometimes, people who have gallstones that cause other problems may have their gallbladder removed. But this is not recommended for cancer prevention, because the risks of surgery can be greater than the risk of developing cancer.

Generally, gallbladder cancer symptoms are rare until the disease has advanced, but in some cases they may appear sooner.

Symptoms of gallbladder cancer may include:

• Jaundice, or yellowing of the skin and eyes
• Pain in the abdomen, often in the upper right area
• Nausea or vomiting
• Lumps in the right side of the belly

Having any of these symptoms doesn’t mean you have gallbladder cancer. In fact, many of these symptoms are likely to be caused by other conditions. For example, gallstones may cause some of these symptoms. Even so, if you have symptoms that persist or worsen, it’s important to have them checked by a doctor so that the cause can be found and treated, if needed.

Scripps cancer specialists are experts in diagnosing and staging gallbladder cancer to plan the best course of treatment. Our gastroenterologists, pathologists and radiologists use advanced diagnostic testing methods to detect gallbladder cancer.

Blood tests

Blood tests check for substances called tumor markers, bilirubin and other indicators of cancer in the blood.

Ultrasound

Ultrasound uses sound waves to show any growths in the liver, which may be tumors.

Computed tomography (CT) scan

A CT scan uses X-rays to provide detail about the size, shape and location of any growths in the liver or surrounding areas.

Magnetic resonance imaging (MRI)

MRI uses radio waves to provide detailed images of the liver and any abnormal growths.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give doctors the ability to view a picture of potentially cancerous areas through the PET, while also seeing more detailed images from a CT scan.

Biopsy

Biopsy removes a small sample of the suspicious tissue for testing and analysis in the lab by a pathologist.

Doctors determine a patient’s gallbladder cancer stage by how far the cancer has spread from where it originally started. Nearly all gallbladder cancers start in the epithelium (the inside wall of the gallbladder). As they progress, they grow through the layers of the gallbladder, and may grow through the gallbladder wall into lymph nodes, blood vessels and other parts of the body.

Stage 0

Stage 0 gallbladder cancer is found only in the epithelial layer of the gallbladder. It has not spread outside the gallbladder.

Stage I

Stage I gallbladder cancer is when the tumor has grown into the connective or muscle tissue inside the gallbladder wall, but has not spread outside the gallbladder.

Stage II

Stage II gallbladder cancer is when the tumor has grown into the fibrous tissue but has not spread outside the gallbladder.

Stage IIIA

Stage IIIA gallbladder cancer is when the tumor has grown through the outer covering of the gallbladder and/or directly into the liver and/or one other nearby structure. It has not spread to nearby lymph nodes or tissues.

Stage IIIB

Stage IIIB gallbladder cancer is when the tumor has reached nearby lymph nodes, but has not grown into the main blood vessels leading into the liver, or reached more than one nearby organ other than the liver. It has not spread to organs or tissues far away from the gallbladder.

Stage IVA

Stage IVA is when the tumor has grown into the main blood vessels leading into the liver or has reached more than one nearby organ other than the liver. It may or may not have spread to nearby lymph nodes, but has not spread to tissues or organs far away from the gallbladder.

Stage IVB

Stage IVB is when the main tumor may or may not have grown outside the gallbladder, and either:

• Has spread to lymph nodes further away from the gallbladder, but not to tissues or organs far away from the gallbladder, or
• Might or might not have spread to lymph nodes, but has spread to tissues or organs far away from the gallbladder

Grading gallbladder cancer

Doctors also may assign a grade to gallbladder cancer, which describes how closely the cancerous cells resembles normal tissue under a microscope. Gallbladder cancer is graded from G1 to G4, where G1 looks the most like normal tissue and G4 looks very abnormal. Generally, low-grade gallbladder cancers grow and spread more slowly than high-grade cancers.

Resectable and unresectable gallbladder cancer

Treatment also depends on whether the cancer is resectable or unresectable.

• Resectable gallbladder cancer is when the cancer can be removed completely by surgery.
• Unresectable gallbladder cancer is when the cancer cannot be removed completely by surgery.

Unfortunately, only a small portion of gallbladder cancers are found early enough to be resectable. 

No one wants to hear that they have cancer. You may feel frightened, overwhelmed, anxious or sad. All of these feelings are perfectly normal. The more you learn about your diagnosis and next steps, the sooner you can begin to make informed decisions about your treatment.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your gallbladder cancer diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of gallbladder cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer care team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones at Scripps.

At Scripps, you’ll have a multidisciplinary team of professionals caring for you, including physicians, surgeons, radiation oncologists and oncology nurses who specialize in gallbladder cancer care. In most cases, you’ll be partnered with a nurse navigator, who will help coordinate your care and ensure you get the support you need throughout your treatment and recovery. For more on our patient-focused approach to treating cancer, visit our section on all the reasons why Scripps is a top choice for cancer care.

Several factors determine the most effective treatments for gallbladder cancer, including the type and stage of the cancer, other medical conditions, and the patient’s age and overall health.

Surgery is the best treatment for early-stage gallbladder cancer, but many cases aren’t detected early enough for surgery. Radiation therapy may be used before surgery to shrink the tumor, after surgery to help prevent cancer from returning, or instead of surgery if the cancer cannot be completely removed. Chemotherapy also may be used with radiation.

Gallbladder surgery

Scripps surgeons may perform staging laparoscopy to learn if the gallbladder cancer can be removed surgically and if it has spread. After making a small incision in the abdomen, the surgeon uses a laparoscope — a lighted tube with a tiny camera — to examine the gallbladder and surrounding area.

Cholecystectomy

Cholecystectomy is the surgical removal of the entire gallbladder. Whenever possible, Scripps surgeons will perform this surgery using minimally invasive techniques.

Extended (radical) cholecystectomy

Scripps surgeons remove the gallbladder, liver tissue and regional lymph nodes, and may also remove additional tissues. Extended (radical) cholecystectomy is the most common surgical treatment for gallbladder cancer.

Palliative surgery

When cancer has spread too far to be completely removed, Scripps surgeons may perform palliative surgery to help relieve or prevent symptoms.

Radiation therapy

Scripps has the most comprehensive radiation therapy offerings in San Diego for gallbladder cancer, with advanced technology that precisely targets tumors.

3-D conformal radiation therapy

With 3-D conformal radiation therapy, our radiation oncologists can visualize a patient’s anatomy in 3-D, enabling them to match the radiation dose to the shape of the tumor while minimizing radiation exposure to surrounding healthy tissues and organs.

Intensity-modulated radiation therapy (IMRT)

Using intensity-modulated radiation therapy (IMRT) — an advanced form of radiation therapy — our radiation oncologists can specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.

Chemotherapy

Chemotherapy may be used as part of a treatment plan with the aim of eliminating cancer cells or lowering the risks that the cancer may return.

In some cases, clinical trials are a part of a patient’s gallbladder cancer treatment plan. Talk with your physician about whether a clinical trial is right for you. See a list of clinical trials currently enrolling patients.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your gallbladder cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, chemotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your gallbladder cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need. 

Your team may include:

• Gastroenterologists
• Pathologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more information on Scripps Cancer Center's multi-disciplinary approach to treatment.

In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics such as:

• Nutrition
• Expressive writing
• Yoga
• Meditation

Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.

For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.