Risk Factors

When a person is diagnosed with gallbladder cancer, it's natural to wonder what may have caused the disease. Doctors can't always explain why one person gets gallbladder cancer and another doesn't.

However, certain risk factors may make a person more likely than others to develop gallbladder cancer. A risk factor is something that may increase the chance of getting a disease.

Having a risk factor does not mean that a person will have gallbladder cancer. Many people who get gallbladder cancer have none of these risk factors, and many people who have known risk factors never have cancer. A person with one or more of these risk factors should talk with his or her doctor about cancer risk.

Risk factors for gallbladder cancer include the following:

• Being female
• Being Native American

Symptoms

Gallbladder cancer may cause these common symptoms:

• Jaundice (yellowing of your skin or eyes)
• Pain above the stomach
• Fever
• Nausea and vomiting
• Bloating
• Lumps in the abdomen

Most often, these symptoms are not due to cancer. A person with these symptoms should tell his or her doctor so any health problems can be diagnosed and treated as early as possible.

Screening and Diagnosis

Gallbladder cancer is difficult to detect and diagnose:

• 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.

If symptoms suggest gallbladder cancer, the doctor will try to find out what's causing the problems. The doctor may order one or more of the following tests:

• Physical exam: The doctor feels the abdomen for fluid, swelling, or other changes. The doctor will also check for swollen lymph nodes.
• Ultrasound: This test uses high-energy sound waves to bounce off internal organs and tissues. The sound waves produce a pattern of echoes. A computer creates a picture from the echoes. Tumors may produce echoes that are different from the echoes made by healthy tissues.
• Liver function tests: The doctor sends blood to the lab 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 (CEA) assay: This test 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.
• CA 19-9 assay: This 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.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the body. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• Blood tests: The doctor sends blood to the lab to check the number of blood cells and to measure the amounts of certain substances released into the blood by organs and tissues in the body. A higher or lower than normal amount of a substance can be a sign of disease.
• Chest x-ray: An x-ray is taken of the organs and bones inside the chest.
• MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside the body. Sometimes contrast material is given by injection into a blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
• ERCP: The doctor uses an x-ray to see if there is any blockage in the gallbladder. Sometimes gallbladder cancer causes these ducts to narrow and block the flow of bile, causing jaundice. A thin lighted tube-like instrument (endoscope) is passed through the mouth, esophagus, and stomach into the small intestine. A smaller tube (catheter) is inserted through the endoscope into the pancreatic ducts. A dye is put into the catheter into the ducts and an x-ray is taken.
• Biopsy: The doctor removes cells or tissues from the gallbladder. Tissue samples may be taken during surgery. The tissue samples are sent to the lab and viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present. How much tissue is removed and how the biopsy is done depends on what part of the body is being tested for cancer. The doctor may obtain tissue in one of several ways:
  • A needle through the skin: The doctor inserts a thin needle into the gallbladder to remove a small amount of tissue. CT or ultrasound may be used to guide the needle.
  • Open surgery: The surgeon can remove tissue from the gallbladder through an incision.
• Laparoscopy: A surgeon makes an incision (cut) in the wall of the abdomen to check the inside of the abdomen for signs of disease. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.
• PTC: The doctor inserts a thin needle through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is left in the liver to drain bile into the small intestine or a collection bag outside the body.

Staging

If gallbladder cancer is diagnosed, the doctor needs to learn the extent (stage) of the disease to help choose the best treatment.

Staging is a careful attempt to find out the following:

• Whether the tumor has invaded the bile duct
• Whether the tumor has invaded nearby tissues
• Whether the cancer has spread, and if so, to what parts of the body

The doctor may order one or more of these staging tests:

• Physical exam: The doctor feels the abdomen for fluid, swelling, or other changes. The doctor will also check for swollen lymph nodes.
• Ultrasound: This test uses high-energy sound waves to bounce off internal organs and tissues. The sound waves produce a pattern of echoes. A computer creates a picture from the echoes. Tumors may produce echoes that are different from the echoes made by healthy tissues.
• Liver function tests: The doctor sends blood to the lab 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 bile duct cancer.
• Carcinoembryonic antigen (CEA) assay: This test 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.
• CA 19-9 assay: This 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.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of the inside of the body. The patient may receive contrast material by mouth or by injection into a blood vessel. The contrast material makes abnormal areas easier to see.
• Blood tests: The doctor sends blood to the lab to check the number of blood cells and to measure the amounts of certain substances released into the blood by organs and tissues in the body. A higher or lower than normal amount of a substance can be a sign of disease.
• Chest x-ray: An x-ray is taken of the organs and bones inside the chest.
• MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of areas inside the body. Sometimes contrast material is given by injection into a blood vessel. The contrast material makes abnormal areas show up more clearly on the picture.
• ERCP: The doctor uses an x-ray to see if there is any blockage in the bile ducts. Sometimes bile duct cancer causes these ducts to narrow and block the flow of bile, causing jaundice. A thin lighted tube-like instrument (endoscope) is passed through the mouth, esophagus, and stomach into the small intestine. A smaller tube (catheter) is inserted through the endoscope into the pancreatic ducts. A dye is put into the catheter into the ducts and an x-ray is taken.
• Biopsy: The doctor removes cells or tissues from the gallbladder. Tissue samples may be taken during surgery. The tissue samples are sent to the lab and viewed under a microscope to check for cancer cells. The removal of tissue to look for cancer cells is called a biopsy. In most cases, a biopsy is the only sure way to tell whether cancer is present. How much tissue is removed and how the biopsy is done depends on what part of the body is being tested for cancer. The doctor may obtain tissue in one of several ways:
  • A needle through the skin: The doctor inserts a thin needle into the gallbladder to remove a small amount of tissue. CT or ultrasound may be used to guide the needle.
  • Open surgery: The surgeon can remove tissue from the gallbladder through an incision.
• Laparoscopy: A surgeon makes an incision (cut) in the wall of the abdomen to check the areafor signs of disease. Sometimes organs are removed or tissue samples are taken and checked under a microscope for signs of disease.
• PTC: The doctor inserts a thin needle through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is left in the liver to drain bile into the small intestine or a collection bag outside the body.

Stages of gallbladder cancer

Stage 0: Cancer cells are found in the innermost layer of the gallbladder.

Stage I: The cancer is found in the innermost layer of the gallbladder, the connective tissues and/or the muscle layer.

Stage II: The cancer has spread to the 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). Cancer may also have spread to nearby lymph nodes.

Stage III: The cancer has spread to a main blood vessel in the liver or to nearby organs. Cancer may also have spread to nearby lymph nodes.

Stage IV: The cancer has spread to nearby lymph nodes and/or to organs far away from the gallbladder.

Stages may also be grouped according to how the cancer may be treated:

Localized (Stage I): The cancer is found in the wall of the gallbladder and can be completely removed by surgery (resectable).

Unresectable (Stage II, Stage III, and Stage IV): The cancer has spread through the wall of the gallbladder to surrounding tissues or organs or throughout the abdominal cavity. Except in patients whose cancer has spread only to lymph nodes, the cancer cannot be completely removed by surgery (unresectable).

Treatment

At Huntsman Cancer Institute, gallbladder cancer is treated by a team of specialists, including surgeons, medical oncologists (doctors who treat cancer with medicine, radiation oncologists (doctors who treat cancer with radiation), gastroenterologists (doctors who treat diseases of the digestive system), nurses, dietitians, and social workers.

Common treatment options for gallbladder cancer include the following:

• Surgery
• Radiation therapy
• Chemotherapy
• Clinical trials

A patient may have a combination of treatments. The treatment that's right for each patient depends on many factors:

• The location of the cancer
• Whether the cancer is removable by surgery
• The patient's overall health
• Side effects of the treatment

The health care team can describe all of the treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Side effects may not be the same for each person, and they may even change from one treatment session to the next.

Surgery

Common types of surgery for gallbladder cancer include the following:

• Cholecystectomy: The doctor removes the gallbladder and some of the tissues around it. Nearby lymph nodes may also be removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

• Surgical biliary bypass: If a tumor cannot be removed, but is blocking the small intestine and causing bile build up in the gallbladder, a biliary bypass may be done. A surgeon will cut out the gallbladder or bile duct and sew it to the small intestine to create a new pathway around the blocked area. This surgery helps relieve jaundice caused by the buildup of bile.
• Endoscopic stent placement: If a tumor cannot be removed, but is blocking the bile duct and causing bile build up in the gallbladder, the doctor places a stent either through a catheter or around the blocked area to drain the bile to the outside of the body.
• Percutaneous transhepatic biliary drainage: If there is blockage and an endoscopic stent placement is not possible, the doctor will take an x-ray of the liver and bile ducts to locate the blockage. Images are used to place a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside of the body. This procedure may be done to relieve jaundice before surgery.

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. Radiation therapy only affects cells in the treated area.

There are two types of radiation therapy that doctors may use to treat gallbladder cancer:

• External radiation: The radiation comes from a large machine outside the body. The machine aims beams of radiation at the cancer. Patients go to a hospital or clinic for treatment. This type of treatment uses computers to closely target the cancer, which protects healthy tissue near the gallbladder.
• Internal radiation therapy (brachytherapy): The radiation comes from radioactive material usually contained in very small implants called seeds. The seeds are put near or directly into the cancer, using thin plastic tubes.

Chemotherapy

Chemotherapy uses drugs to kill and control cancer cells. It may be used to treat gallbladder cancer before or after surgery. The patient may receive chemotherapy in different ways:

• By mouth: Some drugs are pills that can be swallowed. They may be given before or after surgery.
• Into a vein: For cancer that has spread, drugs are usually given by vein (intravenous). The drugs enter the bloodstream and travel throughout the body. Chemotherapy may be given before or after surgery.

Learn more about this treatment in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, work, or normal daily life.

There are several places you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and over 3,000 books, DVDs, and CDs available for checkout. Talk one-on-one with trained and caring staff, or send an e-mail for answers to your cancer questions.
• Our Patient and Family Support Services offer emotional support and resources for coping with cancer and its impact on daily life to Huntsman Cancer Institute (HCI) patients and their families.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers many programs to increase the quality of life and well-being of HCI patients and their families.