What Is Gallbladder Cancer?
Anatomy of the gallbladder
The gallbladder is just below the liver. Bile is stored in the gallbladder and flows through the cystic duct and the common bile duct into the small intestine when food is being digested.
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.
Symptoms of Gallbladder Cancer
The symptoms of gallbladder cancer usually do not appear until the cancer has reached an advanced stage. Many symptoms are like those due to gallstones or gallbladder inflammation.
The following are typical symptoms of gallbladder cancer:
- Pain or discomfort in the right side of the upper abdomen
- A sense of fullness after eating even small amounts
- Heartburn
- Nausea and vomiting
- Poor appetite
- Loss of weight without trying
- Fever
- Yellowing of the skin (jaundice) or the white area of the eyes (scleral icterus)
- Severe itching
Diagnosing Gallbladder Cancer
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.
Procedures used to diagnose 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, The following tests and procedures may be used:
Physical exam history
Physical Exam and History
Physical exam and history is 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.
Please provide your medical records to us before your appointment. At the visit itself, the nurses and doctors will ask additional questions and carry out a detailed physical exam.
Ultrasound
Ultrasound
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.
CT scan
Computed Tomography Scan (CT Scan)
Computed tomography scan (CT or CAT scan) is a non-invasive diagnostic imaging procedure that uses a combination of special X-ray equipment and sophisticated computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. These cross-sectional images of the area being studied can then be examined on a computer monitor or printed.
CT scans are more detailed than general X-rays, showing detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans of internal organs, bone, soft tissue and blood vessels provide greater clarity and reveal more details than regular X-ray exams. CT scans also minimize exposure to radiation. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly.
In standard X-rays, a beam of energy is aimed at the body part being studied. A plate behind the body part captures the variations of the energy beam after it passes through skin, bone, muscle, and other tissue. While much information can be obtained from a standard X-ray, a lot of detail about internal organs and other structures is not available.
In computed tomography, the X-ray beam moves in a circle around the body. This allows many different views of the same organ or structure. The X-ray information is sent to a computer that interprets the X-ray data and displays it in a two-dimensional (2D) form on a monitor.
Using specialized equipment and expertise to create and interpret CT scans of the body, radiologists can more easily diagnose problems such as cancers, cardiovascular disease, infectious disease, trauma and musculoskeletal disorders.
CT scans of the chest can provide more detailed information about organs and structures inside the chest than standard X-rays of the chest, thus providing more information related to injuries and/or diseases of the chest (thoracic) organs.
Chest CT scans may also be used to visualize placement of needles during biopsies of thoracic organs or tumors, or during aspiration (withdrawal) of fluid from the chest. This is useful in monitoring tumors and other conditions of the chest before and after treatment.
While many images are taken during a CT scan, in some cases the patient receives the same or less radiation exposure than with a single standard X-ray.
CT scans may be done with or without “contrast.” Contrast refers to a substance taken by mouth or injected into an intravenous (IV) line that causes the particular organ or tissue under study to be seen more clearly. Contrast examinations may require you to fast for a certain period of time before the procedure. Your physician will notify you of this prior to the procedure.
Care agreement:
You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.
Related procedures
Other related procedures that may be used to assess the heart include:
- Resting or exercise electrocardiogram (ECG or EKG)
- Holter monitor
- Signal-averaged ECG
- Cardiac catheterization
- Chest X-ray
- Echocardiogram
- Electrophysiological studies
- Magnetic resonance imaging (MRI) of the heart
- Myocardial perfusion scans
- Radionuclide angiography
- Ultrafast CT scan
Blood chemistry studies
Blood Chemistry Study
A blood chemistry study is 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 makes it.
Liver Function Tests
Liver function tests are tests 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 assay
Carcinoembryonic Antigen (CEA) Assay
Carcinoembryonic antigen (CEA) assay is 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
The CA 19-9 assay test 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.
Chest X-ray
What Is a Chest X-Ray?
A chest X-ray is a type of diagnostic radiology procedure used to examine the chest and the organs and structures located in the chest. Chest X-rays may be used to assess the lungs, as well as the heart (either directly or indirectly) by looking at the heart itself. Certain conditions of the heart may cause changes in the lungs and/or the vessels of the lungs.
Chest X-rays are used to assess the lungs and heart including enlargement, masses, spots, or to help show whether cancer has spread into the lungs. A chest X-ray can see changes in the normal structure of the heart, lungs, and/or lung vessels like extra blood flow, which may indicate disease or other conditions.
Chest X-rays use invisible X-ray beams to produce images that provide important information regarding the size, shape, contour, and anatomic location of the heart, lungs, bronchi, great vessels (aorta, aortic arch, pulmonary arteries), mediastinum (an area in the middle of the chest separating the lungs), and the bones (cervical and dorsal spine, clavicles, shoulder girdle, and ribs).
Depending on the results of the chest X-ray, additional tests or procedures may be requested by your physician for further diagnostic information.
Other related procedures that may be used to diagnose problems of the chest and respiratory tract include:
- Chest fluoroscopy
- Chest ultrasound
- Computed tomography (CT scan) of the chest
- Lung biopsy
- Lung scans
- Mediastinoscopy
- Positron emission tomography (PET scan) of the chest
- Pleural biopsy
- Thoracentesis
- Sinus X-rays
- Pulmonary angiogram
- Bronchoscopy
- Bronchography
MRI
MRI (Magnetic Resonance Imaging)
This scan is 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).
Endoscopic retrograde cholangiopancreatography
Endoscopic Retrograde Cholangiopancreatography (ERCP)
An endoscopic retrograde cholangiopancreatography is a procedure that allows the doctor to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas.
This procedure uses X-rays to look at 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. This allows the doctor to examine the inside of these organs and detect any abnormalities. 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
Biopsy
A biopsy is 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
Laparoscopy
A laparoscopy is a surgical procedure used 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.
Percutaneous transhepatic cholangiography
Percutaneous Transhepatic Cholangiography (PTC)
A percutaneous transhepatic cholangiography (PTC) is an X-ray examination of the bile ducts through an IV. A needle is introduced through the skin into the liver, depositing the dye (contrast). The bile duct structure is then viewable via the X-ray.
Gallbladder Cancer Staging
What staging means
Stage is the word doctors use to describe the size of a cancerous tumor as well as to describe whether or not it has spread to other organs. The first place cancer is found in your body is called the primary site or primary tumor. When a cancer spreads, it’s said to have metastasized.
The TNM system
TNM Staging System
The TNM System is a standard system for describing the extent of a cancer’s growth. This system was developed by the American Joint Committee on Cancer (AJCC) and is the most common system used to stage anal cancer. Here’s what the letters stand for in the TNM System.
- T (tumor) refers to the size of the original tumor and whether or not it has invaded nearby organs.
- N (node) refers to whether the lymph nodes in the area of the original tumor have become cancerous.
- M (metastasis) refers to whether the cancer has spread to other, distant organs in the body, such as your bones, liver, or lungs.
Stages of gallbladder cancer
Stages of Gallbladder Cancer
Your oncologist assigns numerical values from 0 to 4 to your T, N, and M stages. These letter and number combinations are called stage groupings. They’re used to determine your overall disease stage. Stage is expressed in Roman numerals from I (the earliest) to IV (the most advanced). The lower the number, the less the cancer has spread. The higher the number, the more the cancer has spread.
Stage 0 (carcinoma in situ)
In stage 0, abnormal cells are found in the innermost (mucosal) layer of the gallbladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed. Stage I is divided into stage IA and stage IB.
- Stage IA: Cancer has spread beyond the innermost (mucosal) layer to the connective tissue or to the muscle (muscularis) layer.
- Stage IB: Cancer has spread beyond the muscle layer to the connective tissue around the muscle.
Stage II
Stage II is divided into stage IIA and stage IIB.
- Stage IIA: Cancer has spread beyond the visceral peritoneum (tissue that covers the gallbladder) and/or to the liver and/or one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).
- Stage IIB: Cancer has spread:
- Beyond the innermost layer to the connective tissue and to nearby lymph nodes; or
- To the muscle layer and nearby lymph nodes; or
- Beyond the muscle layer to the connective tissue around the muscle and to nearby lymph nodes; or
- Through the visceral peritoneum (tissue that covers the gallbladder) and/or to the liver and/or to one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver), and to nearby lymph nodes.
Stage III
In stage III, cancer has spread to a main blood vessel in the liver or to nearby organs and may have spread to nearby lymph nodes.
Stage IV
In stage IV, cancer has spread to nearby lymph nodes and/or to organs far away from the gallbladder.
