Gallbladder

This information should not be used for self-diagnosis or in place of a qualified physician's care.

Revised Sep 2016

The basics

Guidelines for treating this cancer have been developed by the Gastrointestinal (GI) Tumour Group.
For health 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.

What causes it and who gets it?

Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors.

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 are growths that protrude from the lining of the inside of the gallbladder. Having 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. It is recommended to have your gallbladder removed if you have this condition.
Cysts found in the bile duct (choledochal cysts) increase the risk.
Workers in rubber plants and metal-fabricating industries have a higher risk.
Methyldopa (a medicine used to treat high blood pressure), oral contraceptives and isoniazid (a medicine used to treat tuberculosis) 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: These statistics give an overview of the prevalence of gall bladder cancer in B.C. and Canada.

BC: 58 new cases were diagnosed in BC in 2012.
Canada: 500 new cases of gallbladder cancer were diagnosed in Canada in 2015.

Can I help to prevent it?

Maintian a healthy body weight

Screening for this cancer

No effective screening program exists for this cancer yet

Signs and Symptoms

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

Diagnosis & staging

Diagnosis

These are tests that may be used to diagnose this type of cancer.

Most gallbladder cancers are found because of surgery to remove the gallbladder (cholecystectomy).
Ultrasound
Endoscopic ultrasound
CT scan
MRI
Laparoscopy may be used for staging
Biopsies are usually only done for gallbladder cancer if the tumour is inoperable.

For more information on tests used to diagnose cancer, see our Recommended Websites, Diagnostic Tests section.

Types and Stages

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
Adenosquamous carcinoma
Carcinosarcoma
Signet ring carcinoma
Small cell carcinoma
Carcinoid

Stages

Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment.

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)

Primary tumour cannot be assessed

T0
No evidence of primary tumour

Tis

Carcinoma in situ - cancer cells are only found in the inner (mucosal) layer of the gallbladder

Tumour has grown into the lamina propria or the muscular layer of the gallbladder

T1a

Tumour has spread to the lamina propria

T1b

Tumour has spread to the muscular layer

Tumour has grown into the perimuscular connective tissue. The cancer has not spread beyond the serosa or into the liver.

T3
Tumour has grown through the serosa of the gallbladder or the cancer has spread to the liver or one other nearby organ or structure. Nearby organs include the stomach, duodenum, colon, pancreas, omentum or extrahepatic bile ducts

T4
Tumour has grown into one of the main blood vessels leading into the liver (portal vein or hepatic artery) or has spread to two or more nearby organs other than the liver

Treatment

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

Surgery

The only cure is surgery. Surgery is only possible in 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, also called radiotherapy, can sometimes be used to slow the growth of the cancer or to relieve pain.

Chemotherapy

Chemotherapy has been found to be useful in incurable gallbladder cancers. It can produce partial remissions or help some patients live longer. It can also relieve symptoms.

Follow-up after Treatment

Guidelines for follow-up after treatment are covered on our website.
You will be returned to the care of your family doctor or specialist for regular follow-up. If you do not have a family physician, please discuss this with your BC Cancer Agency oncologist or nurse.
Follow-up testing is based on your type of cancer and your individual circumstances.
Life after Cancer focuses on the issues that cancer survivors can face.

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