Symptoms and Treatment of Gallbladder Cancer
Medically reviewed by Douglas A. Nelson, MD
Gallbladder cancer is rare, although it is the most common type of cancer affecting the biliary system. With early diagnosis and treatment, the chances of survival are greatly improved. However, a great cases many are discovered at an advanced stage when the condition is harder to treat.
One of the reasons why gallbladder cancer is diagnosed so late is that it is often asymptomatic (without symptoms) until the tumor has spread. It is only then that symptoms like abdominal pain and jaundice (yellowing of the skin and eyes) will start to develop.
This article looks at the symptoms, causes, and risk factors of gallbladder cancer, including how the disease is diagnosed and treated. It also describes current survival rates and ways to cope if you have been diagnosed with this uncommon form of cancer.
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Types of Gallbladder Cancer
The gallbladder is a small organ situated below the liver. Its primary function is to receive and store a digestive enzyme called bile from the liver and release it into the small intestine to digest fat.
Gallbladder cancer occurs when cells in the gallbladder mutate and grow out of control, damaging the organ and invading other organs and tissues.
There are four main types of gallbladder cancer:
Adenocarcinoma: The majority of gallbladder cancers are adenocarcinomas, accounting for between 76% and 90% of cases. Adenocarcinomas start in glandular cells that produce mucus inside of the gallbladder.
Papillary adenocarcinoma: This subtype of adenocarcinoma accounts for 5% to 6% of cases and affects the finger-like projections in the lining of the gallbladder (called papillae). Papillary cancers tend to cause symptoms earlier but are far less likely to spread.
Squamous cell carcinoma: These cancers account for 2% to 10% of cases and are more aggressive than other forms. Squamous cell carcinomas affect the middle and outer layers of the gallbladder.
Adenosquamous carcinoma: These are cancers composed of adenocarcinoma and squamous cell carcinoma. These tumors have a high risk of metastasis.
What Are the Symptoms of Gallbladder Cancer?
Gallbladder cancer usually progresses to a later stage before it causes any symptoms. It is only when the gallbladder or adjacent structures (like bile ducts or the pancreas or liver) are affected that symptoms occur.
Common symptoms of gallbladder cancer include:
Abdominal mass on the right side
Abdominal pain, especially in the upper right quadrant
Jaundice (yellowing of the skin and the whites of the eyes)
Nausea
Vomiting
Less common symptoms of gallbladder cancer include:
Abdominal swelling
Dark urine
Fever
Itchy skin
Loss of appetite
Weight loss
Causes and Risk Factors of Gallbladder Cancer
It is currently unknown what causes gallbladder cancer. However, certain risk factors are known to increase your vulnerability to the disease. Most of these risk factors are non-modifiable (meaning that you can't change them) but some are.
Risk factors include:
Age: The risk of gallbladder cancer increases with age. The average age of onset is 72.
Sex: Gallbladder cancer is three to four times more common in females than in males.
Obesity: Having a body mass index (BMI) over 35 increases the likelihood of gallbladder cancer.
Family history: Having a parent or sibling with gallbladder cancer increases your risk of the disease, albeit slightly.
Gallstones: Gallbladder cancer is more common in people with a history of gallstones. Even so, only around 3% of people with gallstones will go on to develop cancer
Gallbladder disease: Other conditions such as gallbladder polyps, biliary obstruction, and primary sclerosing cholangitis (PSC) can increase the risk of gallbladder cancer.
Smoking may also contribute, but studies are split on whether cigarette smoke poses a tangible risk.
How Gallbladder Cancer Is Diagnosed
Gallbladder cancer is diagnosed based on a physical exam, a review of your medical history, imaging studies, and other tests and procedures. A biopsy provides a definitive diagnosis.
Among the tests used to diagnose gallbladder cancer are:
Liver function tests: This panel of blood tests measures enzymes produced by the liver at times of stress. If the gallbladder is injured, these enzymes will go up as well.
Ultrasound: This non-invasive test bounces sound waves off organs to create images without the use of radiation.
Computed tomography (CT): This test composites multiple X-ray images to create 3D "slices" of internal organs like the gallbladder
Magnetic resonance imaging (MRI): This imaging test uses powerful radio waves and magnets to create a highly detailed picture of soft tissues.
Endoscopic retrograde cholangiopancreatography (ERCP): This form of X-ray involves the insertion of a flexible scope into your mouth and intestines to view the gallbladder and bile ducts.
Gallbladder biopsy: This is the extraction of a small sample of gallbladder tissue for evaluation in the lab. The sample may be obtained during exploratory surgery or with a fine needle inserted through the abdomen into a tumor or mass.
Staging of Gallbladder Cancer
When gallbladder cancer is confirmed, it is important to know what stage it is. Staging establishes how advanced a cancer is and helps make treatment decisions.
The staging is based on the TNM classification system which assesses the extent of tumor growth (T), the number of lymph nodes with cancer cells in them (N), or whether or not there is metastasis (M).
Based on the TNM classification system, there are four stages of gallbladder cancer:
Stage 1: Cancer is localized to the gallbladder with no involvement of lymph nodes.
Stage 2: Cancer has now spread to nearby lymph nodes.
Stage 3: Cancer has spread to the lining of the abdomen (peritoneum), stomach, intestine, or pancreas but not the liver.
Stage 4: Cancer has spread to the liver and/or distant organs.
Related: ERCP Procedure to Diagnose and Treat Digestive Conditions
How Is Gallbladder Cancer Treated?
Some of the difficulty in treating gallbladder cancer comes from the fact that most cases are diagnosed at later stages. In addition, there is a lack of research on what the most effective treatments might be because this type of cancer is rare to begin with, and certain subtypes are even rarer.
Surgery
In most cases, treatment will start with surgery on the gallbladder to remove it; this is called cholecystectomy. People can live without their gallbladder and often do not miss it.
Parts of the other affected organs may also be removed. For instance, if the cancer has spread to the liver, part of the liver and/or some bile ducts may also be removed. If there are lymph nodes involved, those may also need to be removed through surgery.
Surgery is the main treatment for squamous cell carcinoma. In some cases, radiation and chemotherapy might also be used after surgery. For adenosquamous carcinoma, surgery is most often used as a treatment, sometimes with chemotherapy.
Chemotherapy and Radiation
In some cases, chemotherapy and/or radiation may also be used after surgery. Whether or not these treatments are also used will depend greatly on the type of gallbladder cancer and the expected outcome of treatment.
For example, some patients may want to make decisions about other treatments based on whether or not those treatments may extend their lifespan or lead to remission.
Chemotherapy involves using medications that kill certain types of cells that grow quickly in the body, like cancer cells. Chemotherapy may be given as a pill that is taken by mouth or as an infusion, which is given through an IV.
Radiation therapy is the use of energy beams to kill cancer cells. This treatment is non-invasive. A machine delivers radiation to the patient as they lie on a table.
In patients who are diagnosed with Stage 4 metastatic cancer, surgery may not be an option.
Targeted Drug Therapy
A newer treatment is being studied in clinical trials. Targeted drugs are developed to be more specific than chemotherapy and to kill the cancer cells. This therapy may be used by itself or along with chemotherapy.
Immunotherapy
In immunotherapy, a patient's own immune system is used to target the cancer cells and destroy them. This is a newer type of treatment and may only be available in clinical trials for gallbladder cancer.
Palliative Care
When the cancer has advanced to the point that surgery can not remove it all and other therapies are not expected to work, certain other treatments may be used. If bile is not draining because bile ducts are blocked, a stent may be placed into the duct during an ERCP procedure to keep it open and help with drainage.
A catheter is another treatment that can help bile drain. A thin tube is placed through the abdomen and into the bile duct by an interventional radiologist. The bile drains into a bag that's worn on the outside of the body.
Related: What is Palliative Care and How Does it Differ From Hospice?
What Is the Survival Rate of Gallbladder Cancer?
According to the American Cancer Society (ACS), the relative five-year survival rate for gallbladder cancer is 20%. This means that roughly one of every five people will live for five years or more following treatment.
The survival rate can improve significantly based on whether the cancer is "localized" to the gallbladder, has become "regional" and spread to nearby tissues, or is "distant" and has metastasized.
Based on these definitions, the ACS reports the following five-year survival rates for people with gallbladder cancer:
Localized: 69%
Regional: 28%
Distant: 3%
How to Cope With Gallbladder Cancer
Gallbladder cancer is a challenging diagnosis to receive. It is normal to feel a range of emotions, especially because when diagnosed in the later stages, gallbladder carcinomas have a poorer prognosis. It may be helpful to have some coping mechanisms in place.
Working with physicians to learn about the diagnosis and what the treatments are is one way to cope. Writing down questions to bring to appointments and having a friend or family member come along can be helpful.
Letting family and friends know about the diagnosis and next steps will allow them to be supportive. People often ask what they can do when a loved one is diagnosed with cancer.
Some things that may help include providing transportation to and from appointments, bringing meals, picking up prescriptions, doing tasks around the house like cleaning and laundry, and shopping for groceries or other necessities.
Having a trusted person to confide in is also important. This could be a close friend or family member, a therapist, a social worker, or a clergyperson.
Support groups for people with cancer may also be available at the hospital or through the oncologist's office. Every person will have their own preferred form of way of coping and having multiple options will be helpful.
Summary
Gallbladder cancer involves different types of cancers affecting different parts of the gallbladder. Because gallbladder cancer is often asymptomatic in the early stages, symptoms like jaundice may not appear until the cancer is advanced.
Gallbladder cancer can be diagnosed with blood tests, imaging studies, and a biopsy. Based on the stage of the disease, surgery, radiation, chemotherapy, immunotherapy, or targeted drugs may be used to cure or control the disease.
People with early-stage gallbladder cancer have better chances of long-term, disease-free survival.
Read the original article on Verywell Health.
