Gallbladder Cancer: Symptoms
What are the symptoms of gallbladder cancer?
The symptoms of gallbladder cancer usually don’t occur until the cancer is at an advanced stage. The symptoms of gallbladder cancer may include:
Pain or discomfort in the right side of the upper abdomen
Lumps in the belly (abdomen)
A sense of fullness after eating even small amounts
Nausea and vomiting
Loss of weight without trying
Yellowing of the skin (jaundice) or the white area of the eyes (scleral icterus)
When to see your healthcare provider
Many of these symptoms can also be caused by other health problems. Some of these symptoms are like those due to gallstones or gallbladder inflammation. But it is important to see your healthcare provider if you have these symptoms. Only a healthcare provider can tell if you have cancer.
Gallbladder Cancer: Diagnosis
How is gallbladder cancer diagnosed?
Gallbladder cancer is often hard to find. That’s partly due to where the gallbladder is in the body. And many people don’t have symptoms in the early stages of the disease.
If your healthcare provider thinks you might have gallbladder cancer, you will need certain exams and tests to be sure. Diagnosing gallbladder cancer starts with your healthcare provider asking you questions. He or she will ask you about your health history, your symptoms, risk factors, and family history of disease. Your healthcare provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
Endoscopic ultrasound (EUS)
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Liver function blood tests
Tumor marker blood tests
Ultrasound. This test uses sound waves and a computer to create images of the inside of the body. The sound waves bounce off parts of the body and send signals to the computer. A computer then receives the signals and creates images.
Endoscopic ultrasound (EUS). This test combines ultrasound with a tool called an endoscope. It’s a long bendable tube with a light and camera. It’s placed into the mouth or the rectum to reach the digestive tract. EUS creates images of the digestive tract and nearby tissue and organs. A small ultrasound tool is put on the end of the endoscope. It lets the doctor see high-quality images of your organs. An EUS may help your doctor tell the difference between a tumor that’s cancer (malignant) or not cancer (benign). During EUS, a small piece of tissue can also be taken to check for cancer under a microscope.
Computed tomography (CT) scan. A CT scanner takes many X-rays as it rotates around you. A computer combines these images to create detailed images. A CT scan can help show a gallbladder tumor or tell if the cancer has spread.
Magnetic resonance imaging (MRI) scan. An MRI scan uses radio waves and strong magnets to create detailed images of the inside of your body. Your doctor may use an MRI scan to look at organs, blood vessels, and lymph nodes.
Cholangiography. This test uses X-rays and a dye injected into the bile ducts to see if they are blocked or narrowed. These tests can also be used to get samples of cells or fluid to look for cancer, or to place a stent (small tube) inside a duct to keep it open. The kinds of this test are:
Magnetic resonance cholangiopancreatography (MRCP). This is a non-invasive way to take images of the bile ducts. It uses the same type of machine used for MRI scans. It doesn’t need a contrast agent. And it’s not invasive like other types of cholangiograms. A doctor may use MRCP just to image the bile ducts. But this test can’t be used to get biopsy samples or to place small tubes (stents) in the ducts to keep them open.
Endoscopic retrograde cholangiopancreatography (ERCP). The ducts are reached by passing an endoscope down the throat and into the small intestine.
Percutaneous transhepatic cholangiography (PTC). The ducts are reached by passing a needle through the skin and into the liver.
Laparoscopic cholecystectomy. This is a surgery to take out the gallbladder. It uses a tool called a laparoscope. This thin, lighted tube lets a doctor see your gallbladder and nearby organs. The doctor makes a small cut just above your belly button to insert the tube. Tools are then passed through other cuts in the skin to take out the gallbladder. In many cases, gallbladder cancer is found by chance when surgery is done for a problem such as gallstones. A pathologist checks the gallbladder when it’s taken out with surgery. This is a doctor who specializes in looking at cells under a microscope to check for problems, including cancer. This type of surgery is not done if a healthcare provider thinks you have gallbladder cancer. In that case, a larger surgery will be needed.
A biopsy is when a small amount of tissue is removed to be checked for cancer. A biopsy may be taken during a laparoscopy. Or a fine needle biopsy may be done. A fine needle biopsy is usually done with the aid of a CT scan to help locate the tumor. This is called a CT scan-guided biopsy. Or an ultrasound can be used to find the tumor instead of a CT scan. Once the tumor is located, the doctor inserts a needle using the images as a guide and extracts a tissue sample. A specialized doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.
Liver function. These are blood tests that help show how well the liver is working. They can help diagnose liver and bile duct diseases. The gallbladder is just under the liver and is part of the liver and bile duct system. Gallbladder cancer can affect liver function. The most common liver function tests are:
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (AP)
Gamma glutamyl transpeptidase (GGT)
Prothrombin time (PT)
Tumor markers. This is another type of blood test. These tests look for increases in certain substances called tumor markers. Some cancers make these substances. If you have bile duct cancer, two markers may be increased. They are carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9). If your tumor markers are high, it may mean that you have cancer or another disease. A normal level of tumor markers doesn’t always mean there is no cancer. Your doctor may repeat this test during your treatment to see how your treatment is working.
Getting your test results
When your healthcare provider has the results of your tests, your provider will contact you of the results. Your healthcare provider will talk with you about other tests that may be needed if gallbladder cancer is found. Make sure you understand the results and what follow up is needed.
Gallbladder Cancer: Treatment Choices
There are many treatment choices for gallbladder cancer. Which may work best for you? It depends on a number of factors. These include the location and stage of the cancer. Other things to think about are your age, overall health, the goal of treatment, and what side effects you’ll find acceptable.
Learning about your treatment options
You may have questions and concerns about your treatment options. You may also want to know how you’ll feel and function after treatment, and if you’ll have to change your normal activities.
Your healthcare provider is the best person to answer your questions. He or she can tell you what your treatment choices are, what outcomes you might expect, and what the risks and side effects are. Your healthcare provider may advise a specific treatment. Or he or she may offer more than one, and ask you to decide which one you’d like to use. It can be hard to make this decision. It is important to take the time you need to make the best choice for you. You may also want to talk with another healthcare provider to get a second opinion about treatment options.
Types of treatment for gallbladder cancer
These are the main kinds of treatment for gallbladder cancer:
Local treatments. These remove, destroy, or control cancer cells in one part area of the body. Surgery and radiation are local treatments.
Systemic treatments. These kill control cancer cells throughout the whole body. Chemotherapy is a systemic treatment.
Palliative treatments. These treatments help to ease the problems cancer is causing, but they don't treat the cancer itself. This includes things like surgery or stents to open blocked ducts.
You may have just one treatment or a combination of treatments.
Goals of treatment for gallbladder cancer
Each treatment has a different goal. Your healthcare provider will explain the benefits and side effects of each option. Discuss any concerns you have before making a decision. The treatments for gallbladder cancer include:
The goal of surgery is to take out all or as much of the tumor as possible. The whole gallbladder may need to be removed. This is called a simple cholecystectomy. Nearby tissues may also need to be taken out. This is called an extended or radical cholecystectomy. That may include some of the liver, the bile duct, and lymph nodes. If the whole tumor can’t be removed, surgery may also be done to ease symptoms.
Radiation uses X-rays to kill cancer cells in a specific area. This treatment may be used after surgery to try to get rid of any cancer cells that are left in the body. It can also be used to treat cancer that can’t be removed with surgery. Or it may be used to help relieve symptoms from advanced cancer. It’s often used along with chemotherapy in these cases.
The goal of this treatment is to reduce the chance that the cancer will spread to other parts of your body. It is also used to kill cancer cells that may have already spread beyond the gallbladder. Chemotherapy is usually given along with surgery or radiation. Low doses of chemotherapy may given with radiation. This can help the radiation work better. Chemotherapy may be given by itself if the cancer has spread from the gallbladder and can’t be fully removed with surgery.
Asking about clinical trials
New ways to treat gallbladder cancer are being tested in clinical trials. Before starting treatment, ask your healthcare provider if there are any clinical trials you should consider.