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General Information About Gallbladder Cancer
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Gallbladder cancer is a disease in which malignant (cancer) cells form in
the tissues of the gallbladder.
Gallbladder cancer is a rare disease in which malignant (cancer) 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. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.
The wall of the gallbladder has 3 main layers of tissue.
- Mucosal (innermost) layer.
- Muscularis (middle, muscle) layer.
- Serosal (outer) layer.
Between these layers is supporting connective tissue. Primary gallbladder cancer starts in the innermost layer and spreads through the outer layers as it grows.
Being female can increase the risk of developing gallbladder cancer.
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for gallbladder cancer include the following:
- Being female.
- Being Native American.
Possible signs of gallbladder cancer include jaundice, pain, and fever.
These and other symptoms may be caused by gallbladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Jaundice (yellowing of the skin and whites of the eyes).
- Pain above the stomach.
- Fever.
- Nausea and vomiting.
- Bloating.
- Lumps in the abdomen.
Gallbladder cancer is difficult to detect (find) and diagnose early.
Gallbladder cancer is difficult to detect and diagnose for the
following reasons:
- There aren't any noticeable signs or symptoms in the early stages of gallbladder
cancer.
- The symptoms of gallbladder cancer, when present, are like the
symptoms of many other illnesses.
- The gallbladder is hidden behind the liver.
Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.
Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.
Procedures
that create pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. The process used
to find out if cancer cells have spread within and around the gallbladder is
called staging.
In order to plan treatment, it is important to know if the gallbladder cancer can be removed by surgery. Tests and procedures
to detect, diagnose, and stage gallbladder cancer are usually done at the same
time. The following tests and
procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominal ultrasound is done to diagnose gallbladder cancer.
- Liver function tests: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer.
- Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.
- CA 19-9 assay: A test that measures the level of CA 19-9 in the blood. CA 19-9 is released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer or other conditions.
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). A dye may be injected into the gallbladder area so the ducts (tubes) that carry
bile from the liver to the
gallbladder and from the gallbladder to the small intestine will show up better in the image. This procedure is called MRCP (magnetic resonance cholangiopancreatography). To create detailed pictures of blood vessels near the gallbladder, the dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography).
- ERCP (endoscopic
retrograde cholangiopancreatography): A procedure used to x-ray the
ducts (tubes) that carry
bile from the liver to the
gallbladder and from the gallbladder to the small intestine. Sometimes gallbladder cancer
causes these ducts to narrow and block or slow the flow of bile, causing
jaundice. An endoscope (a thin, lighted tube) is passed through the
mouth, esophagus, and stomach into the first part of the small intestine. A
catheter (a smaller tube) is then
inserted through the endoscope into the bile ducts. A dye is injected
through the catheter into the ducts and an x-ray is taken. If the ducts are
blocked by a tumor, a fine
tube may be inserted into the duct to unblock it. This tube (or stent) may be left in
place to keep the duct open. Tissue samples may also be taken.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.
- Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions (cuts) are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy. The
laparoscopy helps to determine if the
cancer is within the gallbladder only or has spread to nearby tissues and if it
can be removed by surgery.
- PTC (percutaneous
transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.
Certain factors affect the prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body).
- Whether the cancer can be completely removed by surgery.
- The type of gallbladder cancer (how the cancer cell looks under a microscope).
- Whether the cancer has just been diagnosed or has recurred (come back).
Treatment may also depend on the age and general health of the patient and whether the cancer is causing symptoms.
Gallbladder cancer can be cured only if it is found before it
has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the
symptoms and complications of this disease.
Taking part in one of the clinical
trials being done to improve treatment should be considered.
Information about ongoing clinical trials is available from the
NCI Web site.
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