Gallbladder Cancer

There are several different types of gallbladder cancer:

Adenocarcinoma accounts for around 85% of all gallbladder cancers. It starts in the gallbladder’s lining. There are three types of gallbladder adenocarcinoma:

• non-papillary adenocarcinoma
• papillary adenocarcinoma
• mucinous adenocarcinoma.

Less common types of gallbladder cancer include:

• squamous cell cancer
• adenosquamous cancer of the gallbladder
• small cell cancer.  

The exact cause of gallbladder cancer isn’t completely understood, but there are a few factors that can increase your risk, including:⁵

Gallstones and inflammation
If you have a history of gallstones or you’ve had inflammation of the gallbladder (cholecystitis), there’s an increased risk of developing gallbladder cancer. About 8 out of 10 people diagnosed with gallbladder cancer have a history of gallstones.

Polyps
These non-cancerous growths on the gallbladder may develop into cancer over a long period of time

Abnormal bile ducts
People who are born with abnormalities of the bile ducts have a slightly increased risk of gallbladder cancer.

Smoking
Evidence suggests that people who smoke cigarettes are at greater risk of developing gallbladder cancer.

Family history
If you have a close relative (a parent or sibling) with gallbladder cancer, you’re around five times more likely to develop this type of cancer.

Obesity
Being overweight increases the risk of developing gall bladder cancer.

References

⁵ Macmillan Cancer Support, Gall bladder cancer. http://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Gallbladder/Gallbladdercancer.aspx

Early gallbladder cancer often doesn’t show any symptoms and is usually discovered when a gallstone is removed. As a result, about 20% of gallbladder cancers are found through gallstone removal.⁶

Because of the lack of symptoms, many tumours are only discovered at an advanced stage. The gallbladder also sits behind your other organs, which makes it difficult for a doctor to feel if it’s swollen or tender.

Symptoms to look out for include nausea, high temperatures, weight loss, pain in your tummy and jaundice.

If the cancer blocks the gallbladder’s bile duct it can stop the flow of bile into the small bowel. This causes bile to flow back into the blood and body tissues, which can lead to jaundice, where the skin and whites of the eyes become yellow, and may become itchy.

The urine can also turn a dark yellow colour, while stools (poo) are paler in appearance.

All of these symptoms do not necessarily indicate gallbladder cancer – they can be caused by other problems such as gallstones or an infection of the gallbladder. But it’s always important to get anything unusual checked by your doctor.

Diagnosing gallbladder cancer
Diagnosis usually begins by seeing your GP who will examine you, ask about your general health and other symptoms. If necessary, your doctor will refer you to a hospital specialist for any tests, expert advice and treatment.

At hospital, your consultant will also want to talk to you about your general health and any previous medical problems. They will then examine you and take blood samples to assess your general health and check that your liver is working properly. Your consultant might also check for signs of jaundice by looking at the whites of your eyes and your skin for any yellowing. They might also look at and feel the lymph glands in your neck and groin to see if they’re swollen.

There are also a number of common tests used to diagnose gallbladder cancer.⁷

Ultrasound scan
Uses sound waves to build a picture of the gallbladder and its surrounding organs.

CT (computerised tomography) scan
Takes a series of X-rays to create a three-dimensional picture of the inside of the body, using small, safe amounts of radiation.

MRI (magnetic resonance imaging) scan
Similar to a CT scan, but uses magnetism instead of X-rays to create a detailed image of internal organs.

MRCP (magnetic resonance cholangiopancreatography) scan
This is a type of MRI scan that uses a strong magnetic field and radio waves to create detailed pictures of your gallbladder, liver, bile ducts and pancreas.

ERCP (endoscopic retrograde cholangio-pancreatography)
This procedure can be used to take an X-ray picture of the pancreatic duct and bile duct and take biopsies, and may also be used as an opportunity to unblock the bile duct if necessary.

Laparoscopy
A small operation that allows the doctors to look at the gall bladder, the liver and other internal organs in the area around the gall bladder, performed under a general anaesthetic and requiring a short stay in hospital.

In some cases, the gallbladder may be removed during a laparoscopy, to treat gallstones or chronic inflammation of the gallbladder – the procedure is called a laparoscopic cholecystectomy. But, if gallbladder cancer is found during this operation, the surgeon will change the operation to an open cholecystectomy, where the gall bladder and its surrounding tissues are removed.

Stages of gallbladder cancer

There are four stages of gallbladder cancer:

• Stage 1 | Cancer only affects the top layers of tissues that line the gallbladder. Around 1 in 4 cancers are at this stage when diagnosed
• Stage 2 | Cancer has grown through the muscle layer of the gallbladder and into the connective tissue underneath
• Stage 3 | Cancer has grown through the gallbladder wall and may have spread to the lymph nodes close to the gall bladder
• Stage 4 | Cancer is advanced and may have spread into the main blood vessels leading to the liver, or into organs outside the liver. The cancer may also have spread to distant lymph nodes and organs far away from the gallbladder.

⁶ Macmillan Cancer Support, Gall bladder cancer http://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Gallbladder/Gallbladdercancer.aspx
⁷ Macmillan Cancer Support, Gall bladder cancer http://www.macmillan.org.uk/Cancerinformation
/Cancertypes/Gallbladder/Gallbladdercancer.aspx

The type of treatment you’re offered depends on the type of gallbladder cancer you have, also your general health, the position and size of the cancer in the gallbladder and whether the cancer has spread.

Surgery
Surgery is usually the main treatment for gallbladder cancer. For early gallbladder cancer, the tumour may be removed in a simple laparoscopic (keyhole) cholecystectomy or in an open cholecystectomy.

If the gallbladder cancer has spread beyond the organ, a radical cholecystectomy may be done. This major operation removes the gallbladder, its surrounding tissues, lymph nodes and any other organs affected by the cancer.

Radiotherapy
Radiotherapy is usually alongside other treatment. It treats gallbladder cancer using high-energy X-rays to destroy the cancer cells, and is sometimes used for cancer of the gallbladder.

Chemotherapy
Chemotherapy uses anti-cancer drugs (called cytotoxics) to destroy cancer cells, and may be used after gallbladder surgery if all the cancer couldn't be removed. Chemotherapy treatment aims to shrink or slow down the growth of a cancer, while relieving symptoms. Chemotherapy can also be used if the cancer is too large or has spread too far to be removed by surgery.

Stent insertion
If gallbladder cancer seems to be causing a blockage in the bile duct, it may be possible to insert a small tube (called a stent) during a procedure called an ERCP (which stands for endoscopic retrograde cholangiopancreatography), a treatment that uses endoscopy to help relieve jaundice without surgery.

After treatment
You’ll have regular check-ups following your treatment. How often and for how long depends on the kind of treatment that you had, but may include blood tests, being examined by your doctor, a CT scan or an ultrasound scan.

If you’re worried or spot any new symptoms between appointments, you should tell your consultant specialist as soon as you can.

Paying for your treatment 
You have two options to pay for your treatment – your costs may be covered by your private medical insurance, or you can pay for yourself. Check with your private medical insurer to see if your diagnostic costs are covered under your medical insurance policy. If you are paying for your own treatment the cost of the procedure will be explained and confirmed in writing when you book the operation.

Ask the hospital for a quote beforehand, and ensure that this includes the consultants’ fees and the hospital charge for your procedure.

Want to know more?
If you’d like to read more about gall bladder cancer, treatment or living with gall bladder cancer, please visit cancerresearchuk.org.uk.