Source: Cancer Resource Room

What is Gallbladder Cancer?
Gallbladder cancer is a rare type of cancer. There are fewer than 3000 new cases in the US each year. Like all cancers, it is a disease caused by a group of abnormal cells that grow and multiply without stopping. As these cells grow and multiply, they form a tumor. The tumor cells crowd out the normal cells of an organ, and take up space inside the organ. When normal cells get crowded out, there are fewer healthy cells left to do the job of that organ. Tumor cells can travel through the blood and lymph to other parts of the body and form more tumors. These are called metastases. Gallbladder cancer starts in the cells that line the inside of the gallbladder. As the cancer cells grow, they can take up space that is needed for the flow and storage of bile. The cancer cells can also invade the other layers of the gallbladder and grow into nearby tissues.

What is the gallbladder? What does the gallbladder do?
The gallbladder is a sack-like, hollow organ located under the right lobe of the liver. It is shaped like a small pear and made of several layers.

The layers of the gallbladder, starting from the inside are: the mucosa, lamina propria, muscle layer, and the serosa. Gallbladder cancer starts in the mucosa and can grow through the outer layers.

The liver produces bile that flows through a series of tubes called bile ducts and collects in the gallbladder. The gallbladder concentrates and stores the bile made by the liver. Bile is used by the body to digest fats. When bile is needed by the digestive system, the gallbladder squeezes it out through the Common Bile Duct into the duodenum (first part of the small intestine). Gallstones are a common problem of the gallbladder. They form from things in the bile and can cause blockage of the bile ducts. Many people (75 to 98%) who get gallbladder cancer also have gallstones. Cancer of the gallbladder can block the bile ducts causing a back-up of bile. Also, cancer can start in the gallbladder and spread into the liver and bile ducts.

What are the symptoms of gallbladder cancer?
Symptoms — What the patient feels or notices:
People with gallbladder disease often have pain in the right upper part of the abdomen. This pain is the same as pain caused by gallstones. This makes it difficult to tell gallbladder cancer from gallstone disease (cholecystitis).

When gallbladder cancer causes symptoms, they include:

• pain in the right upper part of the abdomen
• poor appetite
• weight loss (without dieting)
• a lump in the right upper part of the abdomen
• fatigue from anemia (low blood count)
• yellow color of the skin and eyes from jaundice

Some or all of these symptoms can happen with more common illnesses. They should be checked by a doctor.

Learning about the patient—Medical history and physical exam:
A patient’s medical history and physical exam are the first steps in making a diagnosis of any disease. In the case of gallbladder cancer, the patient’s history may include information about inflammatory bowel disease, chronic typhoid infection, gallstones, and medical problems of the gallbladder, liver, or pancreas.

The physical exam focuses on the abdomen, looking for areas of tenderness, a lump (mass) in the right upper abdomen, or swelling from fluid in the abdomen. The fluid is called ascites and can be detected by pushing back and forth on the sides of the belly. The doctor also checks for signs of weight loss or muscle wasting. The skin and eyes are checked for the yellow color caused by jaundice.
Blood tests and a chest x-ray check a patient’s general health. There is no single blood test that can find gallbladder cancer. However, some routine blood tests are helpful in finding problems with the gall bladder.

How is gallbladder cancer diagnosed?
Gallbladder cancer is diagnosed by the patient’s symptoms, medical history, physical exam, blood tests, and xrays. Sometimes gallbladder cancer is discovered by chance, or during surgery for common gallstone disease. The patient may be examined for some other problem and a tumor (or mass) is found on an x-ray, ultrasound, or CT scan of the liver or abdomen. Some blood tests may be abnormal when the gallbladder is irritated or blocked up by tumor. Some blood tests that are useful in diagnosing gallbladder cancer are:

• CBC—complete blood count to check for anemia
• LFT’s—liver function tests
• CEA and CA 19-9—tumor markers associated with several cancers

Xrays and other imaging tests:
Regular xrays rarely show any changes from gallbladder cancer. The tests that are used to diagnose gallbladder cancer and to see how far it has spread include:

• Abdominal ultrasound—Ultrasound imaging uses a probe on the skin of the abdomen. The probe transmits sound waves into the abdomen that are reflected back from the organs, vessels, and other tissues. Ultrasound makes a picture of the gallbladder to show its size, shape, thickness, and whether or not it contains gallstones or a tumor. The test is painless and quick.
• Chest x-ray—This test may show cancer spread to the lungs, fluid in the lungs, or an abnormal shape of the diaphragm (thin muscle separating the chest from the abdomen).
• CT scan—A series of xrays are taken in thin cross-sections across the abdomen. The xrays create pictures of the liver, gallbladder, and other organs in layers. This is an excellent way to find a tumor, to see what size it is, and to see whether or not it has spread to nearby lymph nodes or other tissues. An abdominal CT scan shows the stomach, lymph nodes, liver, gallbladder and bile ducts, pancreas, small and large intestines, kidneys, major blood vessels, and part of the spine. The patient may need to drink a contrast solution to help outline the digestive organs. An IV is used to give the patient contrast “dye” that travels through the blood. Contrast dye in the blood makes a person feel very warm for a brief time, and causes the sensation of needing to pee urgently. Both feelings pass quickly. CT scans are not painful but do require lying on a table for about 30 minutes.
• MRI—Magnetic Resonance Imaging is like CT scans, but it uses strong magnets instead of xrays to make the pictures of the organs. Usually, a CT scan is all that is needed for gallbladder cancer. If an MRI is done, the process is nearly the same as a CT scan.
• MRCP—Magnetic Resonance CholangioPancreatogram is a special MRI that takes thin cross-section pictures across the abdomen. It can show details of cancer in the gallbladder, liver, pancreas, bile ducts, large blood vessels, and lymph nodes. These images are used for diagnosis, finding spread of disease, and planning surgery. MRI and MRCP require that you lie on your back for about 45 minutes in a tunnel-like space. It is a closed space, and the equipment is noisy but painless. An IV is used to put some dye in the blood system. The dye outlines blood vessels and bile ducts. The MRCP has replaced a test called a cholangiogram, which requires putting a catheter (tube) into the bile ducts. That test is good for making a diagnosis of gallbladder cancer, but the catheter can cause an infection or bleeding. Putting it into the right place can be painful.

What is a biopsy?
A biopsy involves taking a small piece of tissue suspected of being abnormal and looking at that tissue under a microscope. Usually a biopsy is not needed. The patient’s history, physical exam, imaging tests and blood tests are enough to diagnose gallbladder cancer. If a patient can be treated by surgery, a biopsy will not add anything to the planning. However, if the patient is not going to be treated with surgery, sometimes a biopsy is done just to prove what the disease is.

What is the “stage” of gallbladder cancer?
Stage describes:

• how much the tumor has grown through the layers of the gallbladder
• if it has spread to the liver, bile ducts, blood vessels, and/or lymph nodes around the area of the gallbladder
• spread to lymph nodes and to other parts of the body such as the lungs, bones, or brain.

In general, the stages are grouped as follows:

• Stage 1—tumor has not grown further than the muscle layer of the gallbladder. No tumor has spread to lymph nodes or any other part of the body
• Stage 2—tumor has grown as far as the outer covering layer of the gallbladder, but has not gone through the covering layer of tissue. No tumor has spread to lymph nodes or any other part of the body.
• Stage 3—may be one of the following: a) tumor may have grown up to, but not through, the covering layer of the gallbladder, and spread to nearby lymph nodes, b) tumor has grown through the covering layer and into a nearby organ, but not into any lymph nodes.
• Stage 4A—tumor has grown through all layers of the gallbladder and into the liver or other nearby organs. Tumor may or may not have spread to lymph nodes.
• Stage 4B—tumor has spread to the liver and /or other nearby organs, to lymph nodes near or distant from the liver, and tumor may have spread to other parts of the body.

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