• Patients with gallbladder cancers are treated by members of the BC Cancer Agency’s Gastrointestinal (GI) Tumour Group.
• For healthcare professional information on treating this cancer, please see our Cancer Management Guidelines.
• The gallbladder is a small pear-shaped pouch found underneath the liver.  It is usually about 3 to 4 inches long and about 1 inch wide.
• The gallbladder stores bile and releases it into the small intestine through a tube called the bile duct. Bile is a fluid made in the liver to help digest fats in the small intestine.
• The gallbladder can be removed without any long-term effects.

• Gallbladder cancer is rare.
• It occurs more often in women than in men.
• It is more common in people over 65 years old.
• It is more common among Mexican Americans and Native Americans.
• 75 to 90% of people with gallbladder cancer have gallstones (hard deposits of cholesterol and bile salts in the gallbladder). However, most people with gallstones never develop gallbladder cancer.
• Gallbladder polyps can increase the risk of gallbladder cancer.
• People with porcelain gallbladder (calcium deposits on the wall of the gallbladder) have a higher risk of gallbladder cancer.
• Cysts found in the bile duct (choledochal cysts) increase the risk.
• Workers in rubber plants and metal-fabricating industries have a higher risk.
• Methyldopa, oral contraceptives and isoniazid are associated with an increase in gallbladder cancer.
• People who have had typhoid fever or who are carriers of the disease have an increased risk of gallbladder cancer.
• A history of gallbladder cancer in the family may slightly increase a person’s chances of developing gallbladder cancer.
• Statistics
• BC: 59 new cases were diagnosed in BC in 2005.
• Canada: 417 new cases of gallbladder cancer were diagnosed in Canada in 2004.

• Avoid obesity.

• No blood or other screening tests are available to detect gallbladder cancer at an early stage.

• There are usually no symptoms in the early stages of gallbladder cancer.
• Common symptoms that are often present in later stages include:
• Pain in the upper right abdomen
• Nausea or vomiting
• Jaundice (yellowing of the skin and whites of the eyes)
• Gallbladder enlargement
• Less common symptoms may include:
• Loss of appetite
• Unexplained weight loss
• Abdominal swelling
• Fever
• Itching of the skin
• Black tarry stools

• The majority of cancers are diagnosed incidentally, during and after surgery to remove the gallbladder (cholecystectomy).
• Ultrasound
• Endoscopic ultrasound
• CT scan
• Biopsies are usually only done for gallbladder cancer if the tumour is inoperable.
• For more information on all cancer diagnostic tests, see our Recommended Websites, Diagnosis section.

• T describes the site and size of the main tumour (primary);
• N describes involvement of lymph nodes;
• M relates to whether the cancer has spread (presence or absence of distant metastases).

Stages

Stage 0	The cancer is limited to the lining of the gallbladder.
Stage IA	The cancer is limited to the gallbladder.
Stage IB	The cancer has spread to the perimuscular connective tissue around the gallbladder.
Stage IIA	The cancer has spread outside the gallbladder, but not to nearby arteries, veins or lymph nodes, or to organs far from the gallbladder.
Stage IIB	The cancer has spread to nearby lymph nodes, but not to nearby arteries or veins, or to organs far from the gallbladder.
Stage III	The cancer has spread to nearby arteries, veins or lymph nodes, but has not spread to organs far from the gallbladder.
Stage IV	The cancer has spread to organs far from the gallbladder.

Types

• Adenocarcinomas
• About 95% of gallbladder cancers are adenocarcinomas.
• Adenocarcinomas begin in the cells that line the gallbladder. They invade the gallbladder wall as they grow.
• There are three types of adenocarcinomas:
• Non-papillary –more than 75% of adenocarcinomas are of the non-papillary type.
• Papillary adenocarcinomas – start in the connective tissues of the gallbladder and are less likely to spread than other types of adenocarcinomas. About 6% of gallbladder cancers are papillary adenocarcinomas.
• Mucinous – the least common type of adenocarcinoma.
• Rarer types of gallbladder cancer include:
• Sarcoma
• Squamous cell carcinoma
• Squamous cell carcinoma begins in the skin-like cells in the gallbladder.
• Adenosquamous carcinoma
• Carcinosarcoma
• Signet ring carcinoma
• Small cell carcinoma
• Carcinoid

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below.

Surgery

• The only cure is surgery, although surgery is possible in only 10-30% of patients.
• If the cancer is discovered during surgery for gallstones and it has not penetrated the gallbladder wall, over 60% of people can be successfully treated and enjoy a normal life expectancy.
• If the cancer has produced symptoms, only 5% of people will have a normal life expectancy.
• Cholecystectomy is surgery to remove just the gallbladder.
• An extended cholecystectomy is the removal of the gallbladder, part of the liver, the common bile duct and nearby lymph nodes.
• Radical cholecystectomy involves the removal of the gallbladder, part of the liver, the common bile duct, nearby lymph nodes, and other organs such as the pancreas, small intestine or the colon.
• If the tumour cannot be removed, surgery may be performed to bypass a blockage or a stent (metal or plastic tube) may be inserted into the bile duct to keep it open.

Radiation Therapy

• Radiation therapy can sometimes be used to slow the growth of the tumour or to relieve pain

Chemotherapy

• The effectiveness of chemotherapy is still being studied.
• Cisplatin with 5-fluorouracil is sometimes used at the BC Cancer Agency. Gemcitabine may also be considered.

Follow-up after Treatment

• Guidelines for follow-up after treatment has ended have been developed by the BC Cancer Agency and are listed on our website.
• You will be returned to the care of your family doctor or specialist for regular follow-up.
• Follow-up testing is based on your type of cancer and your individual circumstances.
• The BCCA Survivorship Research Centre focusses on the issues that cancer survivors can face.

Coping with Cancer

The Coping with Cancer section of our website is a joint project among different BC Cancer Agency departments and programs. This website section provides information and links that can help cancer patients with the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.

The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue

• The BC Cancer Agency Library has many resources about cancer, coping, talking to children, etc. Please visit the Library in your Centre, call a librarian, or visit the Library online to see the many resources available.

Recommended websites
The BC Cancer Agency has selected and evaluated these useful websites for your further information.

Gall bladder cancer
Websites for cancer survivors, and how to stay healthy after treatment.

Videos
View videos on cancer-related topics that the BC Cancer Agency produces.

How can I help with research at BCCA?
BC Cancer Agency patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help:

• The BCCA is deeply involved in cancer research.  We operate various Research Programs, the BC Cancer Research Centre and Canada's Michael Smith Genome Sciences Centre.
• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. What are the pros and cons of joining a clinical trial?
• Tumour Tissue Bank – support our research by donating some of your cancer tissue.
• BC Cancer Foundation – support our research with a donation of money.

This information has been reviewed and approved by a member of the Gastrointestinal Tumour (GI) Group.