Types of Cancer : Gallbladder Cancer

Definition

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 signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected.

Symptoms

Gallbladder cancer signs and symptoms may include:

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Itchiness
• Fever
• Loss of appetite
• Losing weight without trying
• Nausea
• Yellowing of the skin and whites of the eyes (jaundice)

When to see a doctor
Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Causes

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 cells that line the inner surface of the gallbladder. Gallbladder cancer that begins in this type of cell is most commonly called adenocarcinoma. This term refers to the way the cancer cells appear when examined under a microscope.

Risk factors

Factors that can increase the risk of gallbladder cancer include:

• Your sex. Gallbladder cancer is more common in women than it is in men.
• Your age. Your risk of gallbladder cancer increases as you age.
• A history of gallstones. Gallbladder cancer is most common in people who have had gallstones in the past. Still, gallbladder cancer is very rare in these people.
• Other gallbladder diseases and conditions. Other gallbladder conditions that can increase the risk of gallbladder cancer include porcelain gallbladder, choledochal cyst and chronic gallbladder infection.

Preparing for your appointment

You're likely to start by first seeing your family doctor or a general practitioner. If your doctor suspects you may have gallbladder cancer, you may be referred to a doctor who specializes in treating digestive conditions (gastroenterologist), a surgeon who operates on the liver or gallbladder, or a doctor who specializes in treating cancer (oncologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to absorb all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For gallbladder cancer, some basic questions to ask your doctor include:

• What is my stage of gallbladder cancer?
• Can you explain the pathology report to me? Can I have a copy of my pathology report?
• Will I need more tests?
• What are the treatment options for my gallbladder cancer?
• What are the benefits and risks of each option?
• Is there one treatment option you recommend over the others?
• What would you recommend to a loved one in my same situation?
• Should I get a second opinion from a specialist? What will that cost, and will my insurance cover it?
• Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.

Tests and diagnosis

Diagnosing gallbladder cancer
Tests and procedures used to diagnose gallbladder cancer include:

• Blood tests. 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).

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:

• Exploratory surgery. 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.

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 and may protrude into nearby organs, such as the liver, stomach, intestines or pancreas. This stage of cancer may also include less extensive tumors that have spread to nearby lymph nodes.
• Stage III. At this stage, gallbladder cancer has grown to invade more than one of the nearby organs, or it may invade the portal vein or hepatic artery.
• Stage IV. The latest stage of gallbladder cancer includes tumors of any size that have spread to distant areas of the body.

Treatments and drugs

What gallbladder cancer treatment options are available to you 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 cancers
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 most often 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 a portion 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. Still, this is controversial because few studies have tested these additional treatments.

Treatments for late-stage gallbladder cancer
Surgery can't cure gallbladder cancer that has spread beyond the gallbladder. 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, to kill cancer cells.
• Procedures to relieve blocked bile ducts. Advanced gallbladder cancer can cause blockages in the bile ducts, causing further complications. Procedures to relieve the blockage may help. For instance, surgeons can place a hollow metal tube (stent) in a duct to hold it open or surgically reroute bile ducts around the blockage (biliary bypass).