When cancer cells form in the tissues of the gallbladder, it's often difficult to detect early, as symptoms can mimic other gallbladder conditions.
What is gallbladder cancer?
Gallbladder cancer is a disease in which malignant (cancerous) cells form in the tissues of the gallbladder. The gallbladder is a small, pear-shaped organ located beneath the liver that stores bile, a fluid that helps digest fats. Gallbladder cancer is relatively rare, and it's often found at a late stage when it's more difficult to treat.
Estimates from the American Cancer Society show that in 2025 there will be around 12,500 new cases of gallbladder cancer diagnosed. Around one in five gallbladder cancers are found in the early stages when it is still contained had has not spread to other parts of the body. This is often because there are not noticeable symptoms and no screening method for the disease. Once it is detected, it is important to respond quickly to help improve patient health outcomes.
AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence
At the AHN Liver, Bile Duct, and Gallbladder Cancer Center of Excellence, we provide comprehensive care for patients diagnosed with hepato-pancreato-biliary (HPB) cancers, which include hepatocellular carcinoma (HCC) and biliary tumors, like cholangiocarcinoma and gallbladder cancer. Understanding the complexities and challenges of these liver, bile duct, and gallbladder cancers, our multidisciplinary team — including oncologists, hepatologists, surgeons, pathologists, and radiologists — works together to develop personalized treatment plans that aim to achieve the best possible outcomes for each patient.
Why choose AHN for gallbladder cancer care?
Our team of pancreas and bile duct specialists is dedicated to providing compassionate care for gallbladder cancer, along with other conditions affecting these important organs. We understand that dealing with these conditions can be stressful, which is why we use the latest, gentle testing methods, like advanced endoscopy, to get you answers quickly and comfortably. The AHN difference combines a multidisciplinary care approach that creates seamless communication amongst the different medical specialties you’ll see, while tailoring treatment to your specific needs. At AHN, we see you.
Gallbladder cancer symptoms and signs
Gallbladder cancer is often diagnosed at a late stage because the early symptoms can be vague and easily mistaken for other conditions. Many people with early-stage gallbladder cancer have no symptoms. If you experience any of the following, talk with your health care professional:
- Abdominal pain: This is a common symptom, often located in the upper-right part of the stomach.
- Jaundice: A yellowing of the skin and whites of the eyes can be a sign of gallbladder cancer.
- Nausea and vomiting: Regularly feeling sick to your stomach and throwing up is a reason to seek care.
- Lumps in the abdomen: If you notice a mass in your stomach, this may be a sign of gallbladder cancer.
- Unexplained weight loss: Losing weight without trying can be an indication of gallbladder cancer.
- Dark urine and light-colored stools: If you notice urine that is darker than normal or bowel movements that appear pale or clay colored, consult your health care professional.
- Itching: Generalized itching all over the body can be a sign.
- Loss of appetite: Not feeling hungry when you normally would or not being able to eat the foods you usually enjoy can be a sign of gallbladder cancer.
- Fever: Having a sustained, elevated body temperature is a reason to see your doctor as soon as you can.
Gallbladder polyps cancer symptoms
Most gallbladder polyps are benign (noncancerous). Small polyps often cause no symptoms at all and are discovered incidentally during imaging tests done for other reasons. However, larger polyps have a higher risk of being cancerous or becoming cancerous over time. Small polyps (less than 1 cm) are usually monitored with periodic ultrasounds. Large polyps (1 cm or larger) are often removed in surgery due to the increased risk of malignancy. Symptoms related to polyps may include:
- Right upper quadrant pain: A dull or intermittent ache in the upper right side of the abdomen.
- Nausea and vomiting: Especially after eating fatty foods.
- Bloating: A feeling of fullness or distention in the abdomen.
- Indigestion: Difficulty digesting food, heartburn, or gas.
End-stage gallbladder cancer symptoms
End-stage gallbladder cancer (also referred to as advanced or metastatic gallbladder cancer) means the cancer has spread beyond the gallbladder to other parts of the body. At this stage, symptoms can be more pronounced and varied, depending on where the cancer has spread. Common symptoms of end-stage gallbladder cancer include:
- Severe abdominal pain: Constant and intense pain in the upper right abdomen.
- Jaundice: Yellowing of the skin and whites of the eyes due to bile duct obstruction.
- Ascites: Accumulation of fluid in the abdominal cavity, causing swelling and discomfort.
- Weight loss: Significant, unintentional weight loss.
- Loss of appetite: Severe lack of desire to eat.
- Nausea and vomiting: Persistent nausea and vomiting, often related to bile duct blockage or the cancer's effects on the digestive system.
- Fatigue: Extreme tiredness and weakness.
- Hepatomegaly: Enlargement of the liver, which can cause discomfort and pain.
- Fever: May occur due to infection or inflammation.
- Swelling in the legs and ankles (edema): Can occur due to fluid retention and poor circulation.
- Bone pain: If the cancer has spread to the bones.
- Breathing difficulties: If the cancer has spread to the lungs or is causing significant ascites that restricts lung function.
- Confusion or mental changes: If the cancer has spread to the brain, though this is rare.
Causes and risk factors
While the exact cause of gallbladder cancer is not fully understood, it is believed to develop when healthy gallbladder cells undergo genetic mutations that cause them to grow uncontrollably and form a tumor. Several factors can increase the risk of developing gallbladder cancer. These include:
- Gallstones: This is the most significant risk factor. Chronic inflammation caused by gallstones is thought to contribute to the development of cancer.
- Chronic gallbladder inflammation: Conditions causing long-term inflammation of the gallbladder, such as chronic cholecystitis, can increase risk.
- Porcelain gallbladder: This condition, where the gallbladder wall becomes calcified, is associated with an increased risk of gallbladder cancer.
- Gallbladder polyps: Larger polyps (greater than 1 cm) have a higher risk of being cancerous.
- Choledochal cysts: These are cysts in the bile ducts, present from birth, that can increase the risk.
- Obesity: Being overweight or obese is associated with an increased risk.
- Gender: Gallbladder cancer is more common in women than in men.
- Age: The risk increases with age, with most cases diagnosed in older adults.
- Ethnicity: Certain ethnic groups, such as Native Americans and Hispanics, have a higher incidence of gallbladder cancer.
- Family history: Having a family history of gallbladder cancer may increase your risk.
- Exposure to certain chemicals: Occupational exposure to certain chemicals, such as those used in the rubber and textile industries, may increase the risk.
Gallbladder cancer screening and diagnosis
There is no standard screening for gallbladder cancer in the general population. Gallbladder cancer is relatively rare, and there are no proven, effective screening tests to detect it early in people without symptoms. Screening might be considered in certain high-risk situations, but this is not routine and is based on individual circumstances including:
- Porcelain gallbladder: This condition, where the gallbladder wall becomes calcified, is associated with a higher risk of gallbladder cancer. Some doctors recommend gallbladder removal (cholecystectomy) for patients with porcelain gallbladder.
- Gallstones and polyps: While gallstones are very common and most polyps are benign, large gallbladder polyps (especially those larger than 1 cm) have a higher risk of being cancerous. Regular monitoring or gallbladder removal may be recommended.
Diagnosis typically involves a combination of medical history, physical examination, and various tests. Your doctor will inquire about your symptoms, risk factors, and medical history. A physical exam may reveal tenderness in the abdomen or, less commonly, a palpable mass.
Blood tests
While blood tests alone cannot definitively diagnose gallbladder cancer, they can provide valuable clues and help guide further diagnostic procedures. Here's how:
- Liver function tests (LFTs): Elevated levels of bilirubin, alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) can indicate a problem with the gallbladder or bile ducts. An LFT can give information to your care team to look for these elevated levels.
- Tumor markers: Certain blood tests will help detect the presence of tumor markers, which are the substances that cancer cells produce. A blood test can give information on:
- CA 19-9: May be elevated in gallbladder cancer, but it's not specific and can be elevated in other conditions.
- CEA (Carcinoembryonic Antigen): Another tumor marker that may be elevated, but less specific than CA 19-9.
Imaging tests
Imaging tests play a crucial role in detecting, staging, and monitoring gallbladder cancer. They allow your AHN care team to visualize the gallbladder, bile ducts, and surrounding structures to identify abnormalities that may indicate the presence of cancer. Commonly used imaging techniques include:
- Ultrasound: Often the first imaging test ordered. It can detect gallstones, gallbladder thickening, and masses.
- Computed tomography (CT) scan: Provides detailed images of the gallbladder, liver, and surrounding structures. It can help determine the size and extent of the tumor and look for spread to lymph nodes or distant sites.
- Magnetic resonance imaging (MRI): Offers good soft tissue contrast and can be useful for evaluating the gallbladder and bile ducts.
- Magnetic resonance cholangiopancreatography (MRCP): A noninvasive MRI technique that provides detailed images of the bile ducts and pancreatic ducts.
- Endoscopic ultrasound (EUS): Combines ultrasound with endoscopy to provide detailed images of the gallbladder and surrounding structures. Allows for tissue biopsies to be taken.
Cholangiography
Cholangiography is an imaging technique used to visualize the bile ducts. The bile ducts are the tubes that carry bile from the liver and gallbladder to the small intestine. There are a few different methods for performing cholangiography, each with its own approach. The two main types are:
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure where a flexible tube with a camera is inserted through the mouth into the bile ducts. It allows for visualization of the bile ducts, tissue biopsies, and placement of stents to relieve blockages if needed.
- Percutaneous transhepatic cholangiography (PTC): A procedure where a needle is inserted through the skin into the bile ducts to inject contrast dye and take X-rays. It can be used to visualize the bile ducts and take tissue samples.
Laparoscopy
In some cases, a laparoscopy (a minimally invasive surgical procedure) may be performed to examine the gallbladder and surrounding tissues. During laparoscopy, a surgeon can take tissue samples (biopsies) for examination under a microscope.
Biopsy
A biopsy, taking a sample of tissue or cells, is the only way to confirm the diagnosis of gallbladder cancer. Tissue samples can be obtained during:
- Laparoscopy: A minimally invasive surgical procedure where a small incision is made, and a camera and specialized instruments are inserted to visualize and operate on internal organs.
- Endoscopic retrograde cholangiopancreatography (ERCP): A procedure where a flexible tube with a camera is inserted through the mouth to visualize the bile ducts and pancreatic ducts, allowing for diagnosis, biopsies, and treatment (like stent placement).
- EUS (endoscopic ultrasound): A procedure that combines endoscopy with ultrasound to obtain detailed images of the digestive tract and surrounding structures. It allows for biopsies to be taken through the scope.
- Surgical resection: The surgical removal of tissue or an organ. If the gallbladder is removed (cholecystectomy), this is considered a surgical resection.
Types and stages of gallbladder cancer
Gallbladder cancer is categorized by the type of cells that make up the tumor. The main types of gallbladder cancer are:
- Adenocarcinoma: This is the most common type, accounting for approximately 80 – 90% of all gallbladder cancers. Adenocarcinomas develop from the glandular cells that line the inside of the gallbladder. These cells produce mucus and other fluids.
- Papillary adenocarcinoma: This is a subtype of adenocarcinoma that grows in finger-like projections (papillae). It tends to be less aggressive and has a better prognosis than other types of adenocarcinoma.
- Squamous cell carcinoma: This is a rare type of gallbladder cancer that develops from the flat, scale-like cells that can sometimes be found in the gallbladder lining.
- Adenosquamous carcinoma: This is a rare type of gallbladder cancer that contains both adenocarcinoma and squamous cell carcinoma components.
- Small cell carcinoma: This is a very rare, aggressive type of gallbladder cancer that is made up of small, round cells.
- Sarcoma: This is a rare type of gallbladder cancer that develops from the connective tissues of the gallbladder, such as muscle or blood vessels.
- Carcinoid tumor: These are rare tumors that start in specialized cells called neuroendocrine cells.
Gallbladder cancer treatment
Treatment for gallbladder cancer depends on several factors, including the stage of the cancer, the patient's overall health, and individual preferences. The primary goal is to remove or control the cancer, relieve symptoms, and improve the patient's quality of life. Here are the main treatment options:
Surgery
Surgery is often the main treatment for gallbladder cancer, especially if it hasn’t spread. Your AHN care team will help you understand what your options are and will work to use minimally invasive surgical techniques that can speed up recovery. Your surgery options may include:
- Cholecystectomy (gallbladder removal): This is the primary treatment for early-stage gallbladder cancer. Many gallbladder cancers are incidentally found after a cholecystectomy for what was thought to be gallstone disease. Often times the cholecystectomy is sufficient but occasionally may require additional surgery.
- Radical cholecystectomy: Removal of the gallbladder along with a wedge of the liver tissue surrounding the gallbladder, nearby lymph nodes, and potentially a portion of the bile duct. This is typically performed for more advanced gallbladder cancers.
- Liver resection: Removal of a portion of the liver if the cancer has spread to the liver.
- Bile duct resection: Removal of a portion of the bile duct if the cancer has spread to the bile duct.
- Pancreaticoduodenectomy (Whipple procedure): In some advanced cases where the cancer has spread to the pancreas and duodenum, this complex surgery may be necessary. Learn more about Whipple procedures.
- Palliative surgery: Surgical procedures to relieve symptoms, such as bypassing a blocked bile duct.
Biliary drainage
Biliary drainage is a procedure used to relieve a blockage in the bile ducts. Bile ducts are the tubes that carry bile from the liver and gallbladder to the small intestine. When these ducts become blocked, bile can build up, causing jaundice (yellowing of the skin and eyes), itching, abdominal pain, and potentially infection (cholangitis). Gallbladder cancer can often block the bile ducts, so biliary drainage is used to relieve these symptoms and improve the patient's quality of life. Your biliary drainage treatment may include:
- Stenting: If the bile duct is blocked, a stent (a small tube) can be placed to keep it open and allow bile to drain.
- Percutaneous biliary drainage (PBD): A catheter is inserted through the skin into the bile duct to drain bile.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells throughout the body. It's often used in combination with other treatments like surgery and radiation therapy. In the context of gallbladder cancer, chemotherapy is used in several situations:
- Adjuvant chemotherapy: If the gallbladder cancer has been completely removed with surgery, chemotherapy may be given afterward to kill any remaining cancer cells and reduce the risk of the cancer returning.
- Neoadjuvant chemotherapy: In some cases, chemotherapy may be given before surgery to shrink the tumor and make it easier to remove. This is more common when the cancer is locally advanced (meaning it has spread to nearby tissues but not to distant organs).
- Palliative chemotherapy: Used to slow the growth of advanced cancer, relieve symptoms, and improve quality of life when surgery is not possible.
- Common chemotherapy drugs: Gemcitabine, cisplatin, fluorouracil (5-FU), oxaliplatin are common chemotherapy drugs. Chemotherapy drugs are usually given intravenously (through a vein) in cycles. A cycle consists of a period of treatment followed by a period of rest, allowing the body to recover. The number of cycles and the specific drugs used will depend on the individual patient and the stage and characteristics of their cancer.
Radiation therapy
Radiation therapy uses high-energy rays (such as X-rays or protons) to kill cancer cells or shrink tumors. It's a local treatment, meaning it targets cancer cells in a specific area of the body. In gallbladder cancer, radiation therapy is used in several ways:
- External beam radiation therapy (EBRT): Delivers radiation from outside the body to the tumor.
- Stereotactic body radiation therapy (SBRT): Delivers high doses of radiation to a small area, minimizing damage to surrounding tissues.
- Intraoperative radiation therapy (IORT): Radiation is delivered directly to the tumor during surgery.
- Palliative radiation therapy: Used to relieve symptoms such as pain or blockage.
Targeted therapy
While surgery, chemotherapy, and radiation therapy are the mainstays of gallbladder cancer treatment, targeted therapies are emerging as a promising option for some patients, particularly those with advanced or recurrent disease. However, it's important to note that targeted therapies are not yet as widely used in gallbladder cancer as they are in some other types of cancer. Research is ongoing to identify more effective targeted therapies for this disease.
Immunotherapy
Immune checkpoint inhibitors help the immune system recognize and attack cancer cells. Pembrolizumab may be used in some cases of advanced gallbladder cancer, particularly if the cancer has certain genetic characteristics (e.g., high microsatellite instability or mismatch repair deficiency).
Gallbladder cancer FAQs
Being at higher risk for developing gallbladder cancer or facing a diagnosis can bring about many emotions. AHN is here to help and to be your go-to resource for any and all questions. To help you understand more about gallbladder cancer, we’ve included answers to frequently asked questions that may help in your conversations with your AHN care team.
What is the life expectancy of a person with gallbladder cancer?
The life expectancy for someone with gallbladder cancer varies significantly depending on several factors:
- Stage at diagnosis: The stage of the cancer (how far it has spread) at the time of diagnosis is the most important factor. Early-stage gallbladder cancer that is completely removed with surgery has a much better prognosis than advanced-stage cancer that has spread to distant organs.
- Overall health: The patient's overall health and ability to tolerate treatment also play a role.
- Treatment response: How well the cancer responds to treatment (surgery, chemotherapy, radiation therapy, targeted therapy) affects life expectancy.
- Age: Younger patients often have better outcomes than older patients.
How aggressive is gallbladder cancer?
Generally, gallbladder cancer is considered aggressive based on the fact it is often hard to spot early on. This later diagnosis can lead to it spreading more easily. Also, gallbladder cancer can grow and spread relatively quicky to nearby organs, lymph nodes, and distant sites like the liver, lungs, and lining of the abdominal cavity.
How fast does gallbladder cancer spread?
The speed at which gallbladder cancer spreads can vary, but generally, it is known to spread relatively quickly compared to some other cancers. Several factors influence the rate of spread:
- Tumor grade: Higher-grade tumors (more abnormal-looking cells) tend to grow and spread more quickly than lower-grade tumors.
- Lymphatic invasion: If the cancer has already spread to nearby lymph nodes, it is more likely to spread to other parts of the body.
- Vascular invasion: If the cancer has invaded blood vessels, it can spread more easily to distant organs.
Because gallbladder cancer is often diagnosed at a later stage, it's difficult to pinpoint exactly how long it takes to spread from its earliest stages. However, the tendency for late diagnosis underscores its potential for rapid progression and spread.
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