Gallbladder Cancer

Definition

Cancer of the gallbladder is a disease in which 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.

Cholangiocarcinoma is an adenocarcinoma (carcinoma derived from glandular tissue or in which the tumor cells form recognizable glandular structures) arising from the epithelium (cellular lining) of the intrahepatic (within the liver) bile ducts.

Description

The majority of gallbladder tumors are found in glandular tissue within the gallbladder (adenocarcinoma). Others originate in the connective tissue (sarcoma) or other tissues (squamous carcinoma).

The management for all gallbladder cancer types is the same, always depending upon the extent of the tumor at the time of diagnosis.

Causes and Risk Factors

Cancer of the gallbladder is more common in women than in men. It also is more common in people who have had clusters of material in their gallbladder (gallstones).

Cancer of the gallbladder is hard to diagnose because the gallbladder is hidden behind other organs in the abdomen. Cancer of the gallbladder is sometimes found after the gallbladder is removed for other reasons.

Symptoms

The symptoms of gallbladder cancer may be simular to other diseases of the gallbladder, such as gallstones or infection. There may be no symptoms in the early stages.

You should see your doctor if you have pain above the stomach, lose weight without trying to, have a chronic fever, or if your skin or eyes turn yellow (jaundice).

Frequently, jaundice is a late development, after the other symptoms have been present for a long time. Itching may result from the buildup in the skin of a derivative of bile or bilirubin, which turns the skin yellow. This symptom usually reflects an advanced stage of the disease.

Diagnosis

Blood tests may be helpful, including serum bilirubin, alkaline phosphatase, and CA 19-9.

Diagnosis is often made unexpectedly at surgery done for other reasons.

Treatment

Treatment for cancer of the gallbladder depends on the stage of the disease and one's general health. Three major treatments may be considered:

1. Surgery: taking out the cancer or relieving symptoms of the cancer in an operation

2. Chemotherapy: using drugs to kill cancer

3. Radiation therapy: using high-dose X-rays to kill cancer cells

Surgery is a common treatment for cancer of the gallbladder if it has not spread to surrounding tissues. Your doctor may take out the gallbladder in an operation called a cholecystectomy. Part of the liver around the gallbladder and lymph nodes in the abdomen may also be removed.

If the cancer has spread and it cannot be removed, your doctor may perform surgery to relieve symptoms. If the cancer is blocking the bile ducts and bile builds up in the gallbladder, your doctor may do surgery to bypass the cancer. During this operation, the doctor will cut out the gallbladder or bile duct and sew it to the small intestine. This is called biliary bypass. Surgery or other procedures may also be done to put in a tube (catheter) to drain bile that has built up in the area.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy is called a systemic treatment because the drug enters the blood stream, travels through the body, and can kill cancer cells outside the gallbladder. Chemotherapy or other drugs may be given with radiation therapy to make cancer cells more sensitive to radiation (radiosensitizers).

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation for gallbladder cancer usually comes from a machine outside the body (external beam radiation therapy). Radiation may be used alone or in addition to surgery.

Questions to Ask Your Doctor

What tests need to be performed for a positive diagnosis of gallbladder cancer?

What are the surgical procedures to remove the gallbladder?

How much will be removed? What can be expected from this surgery?

Will the surgery reveal if the cancer has invaded surrounding tissue?

How successful is radiation alone in shrinking tumors? With surgery?

What are the side effects of radiation?

What measures can be taken to decrease the side effects of radiation?

Will chemotherapy be used?

What are the side effects of the particular chemotherapy drug you would be using?

What measures can be taken to control some of the side effects of the chemotherapy?

Is there a support group or person to help the family through this crisis?