Gallbladder Cancer: Symptoms, Risk Factors & Treatment

Gallbladder cancer is a malignant tumor that starts in the cells of the gallbladder, a small organ in the digestive system that stores bile. Bile is produced by the liver and helps digest fats from food.

This type of cancer is rare and usually does not cause symptoms in its early stages. Because of this, it is often diagnosed later, when it has already affected nearby organs such as the liver and may cause symptoms such as abdominal pain, abdominal swelling, or yellowing of the skin and eyes.

Treatment for gallbladder cancer should be planned and supervised by an oncologist. It may involve surgery to remove the gallbladder, chemotherapy, radiation therapy, or a combination of these to target cancer cells and help prevent the cancer from spreading to other organs.

Main symptoms

The main symptoms of gallbladder cancer are:

• Persistent right-sided abdominal pain

• Abdominal swelling

• Frequent nausea and vomiting

• Yellowing of the skin and eyes (jaundice)

• Decreased appetite

• Weight loss

• Persistent fever above 100.4ºF (38ºC)

• Chills

According to the National Cancer Institute, gallbladder cancer is difficult to detect early because people rarely have signs or symptoms in the early stages, and when symptoms are present, they can resemble those of many other conditions.

Confirming a diagnosis

Gallbladder cancer is usually diagnosed by a gastroenterologist using imaging tests, such as an abdominal ultrasound, computed tomography (CT) scan, or magnetic resonance imaging (MRI), to identify cancer in the gallbladder.

In addition, the doctor may order blood tests to check tumor markers such as CA 19-9 and CA-125. However, these markers are not specific to gallbladder cancer and may also be elevated in other cancers or noncancerous conditions.

Once gallbladder cancer is confirmed, the gastroenterologist should refer the person to an oncologist for treatment.

Risk factors

The exact cause of gallbladder cancer is unknown, but certain factors can increase your risk, including:

• Age over 75

• Gallstones

• Gallbladder polyps

• Gallbladder infection

• Chronic inflammation of the gallbladder

• Diabetes

• Abnormal bile ducts

In addition, gallbladder cancer is more common in women, in people with obesity, and in people with a family history of this type of cancer.

Treatment options

Treatment for gallbladder cancer should be guided by an oncologist and usually includes:

1. Surgery

Surgery is the main treatment for gallbladder cancer and is usually done to remove as much of the tumor as possible. It can be performed in two ways:

• Cholecystectomy: done to completely remove the gallbladder when the cancer has not spread beyond the gallbladder and its ducts

• Partial hepatectomy: used when the cancer is close to the liver, in which case it is recommended to remove the gallbladder along with a small portion of the liver

In some cases, when gallbladder cancer is small, found early, and completely removed with a cholecystectomy, no additional treatment may be needed.

However, if surgery cannot completely remove the tumor or if the cancer is more advanced, the doctor may also recommend radiation therapy or chemotherapy to try to destroy the remaining cancer cells.

2. Chemotherapy

Chemotherapy may be given before surgery to reduce the number of cancer cells and make the tumor easier to remove, or after surgery to destroy any remaining tumor cells.

This type of treatment may be given through medications injected into a vein, such as cisplatin, fluorouracil, or gemcitabine. In some cases, it may also be given as oral medication, such as capecitabine.

Chemotherapy works by preventing cancer cells from dividing and multiplying. However, it can also affect normal cells that divide quickly in the body, such as hair follicle cells and blood cells, which may cause side effects such as hair loss or a weakened immune system that increases the risk of infection.

3. Radiation therapy

Radiation therapy for gallbladder cancer is usually used in more advanced cases, when it is not possible to remove the tumor with surgery. According to the National Cancer Institute, radiation therapy is often given with other cancer treatments, such as chemotherapy, and may also be used when the goal is to ease symptoms.

This treatment uses a machine placed near the affected area that emits radiation capable of destroying tumor cells. Several sessions are usually needed, and treatment may cause side effects such as itching, irritation, or skin burns.

Cancer staging

Gallbladder cancer is staged based on a biopsy of tissue removed during gallbladder surgery. The report may describe:

• Stage I: the cancer is limited to the inner layers of the gallbladder

• Stage II: the tumor affects all layers of the gallbladder and may spread to the bile ducts

• Stage III: the cancer affects the gallbladder and one or more nearby organs, such as the liver, small intestine, or stomach

• Stage IV: large tumors are present in the gallbladder and in multiple organs in more distant parts of the body

The more advanced the stage of gallbladder cancer, the more difficult treatment becomes, and the harder it is to achieve a complete cure.

Can gallbladder cancer be cured?

Gallbladder cancer can sometimes be cured when it is found early and treatment starts promptly.

However, in more advanced stages, when the cancer has already spread to other organs, a cure is much less likely. In these situations, the oncologist may recommend palliative care, which focuses on keeping the person as comfortable and pain-free as possible.