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What is gall bladder cancer?

Gall bladder cancer occurs when cells in the gall bladder become abnormal and keep growing to form a mass or lump called a tumour. The tumour type is defined by the particular cells that are affected.  

The most common type is adenocarcinoma, which starts in epithelial cells (which release mucus) that line the inside of the gall bladder. These make up about 85% of all gall bladder cancers.  

Other types of gall bladder cancer include:  

  • squamous cell carcinoma, from squamous cells (skin-like cells)  
  • sarcoma, from connective tissue (which support and connect all the organs and structures of the body)  
  • lymphoma, from lymph tissue (part of the immune system which protects the body). 

Gall bladder cancer is rare. About 890 Australians are diagnosed with gall bladder or bile duct cancer each year. It is more likely to be diagnosed in women than men, and people aged over 65 years.  



Gall bladder cancer symptoms

Gall bladder cancer can be difficult to diagnose in its early stages as it doesn’t usually cause symptoms. Sometimes, gall bladder cancer is found when the gall bladder is removed for another reason, such as gallstones. But most people who have surgery for gallstones do not have gall bladder cancer. 

If symptoms do occur, they can include:  

  • abdominal pain, often on the upper right side

  • nausea (feeling sick) or vomiting

  • jaundice (yellowing of the skin and eyes), causing dark urine (wee), pale bowel movements (poo) and severe itching without any visible skin rash

  • a lump in the abdomen

  • general weakness or fatigue

  • unexplained weight loss

  • fever.



Causes of gall bladder cancer

The cause of gall bladder cancer is not known in most cases, but risk factors can include:  

  • having had gallstones or inflammation of the gall bladder (although the majority of people with gallstones will never develop gall bladder cancer) 

  • family history of gall bladder cancer can result in a small increase in risk (first-degree relative such as mother, father, sibling or child). The majority of people with gall bladder cancer, however, will not have a family history  

  • other gall bladder and bile duct conditions and abnormalities, such as gall bladder polyps, choledochal cysts (bile-filled cysts) and calcified gall bladder (also known as porcelain gall bladder).



Diagnosis of gall bladder cancer

If your doctor thinks that you may have gall bladder cancer, they will perform a physical examination and carry out certain tests.  

If the results suggest that you may have gall bladder cancer, your doctor will refer you to a specialist who will carry out more tests. These tests may include:  

Blood tests

Blood tests will include a full blood count to measure your white and red blood cells,, your platelets and chemicals produced by cancer cells (tumour markers).   

Ultrasound

Soundwaves are used to create pictures of the inside of your body. You will be asked to lie down and a gel will be spread over the affected part of your body and then a small device (transducer) is moved over the area. The ultrasound takes about 15 minutes and is painless.  

CT scan

Special machines are used to scan and create pictures of the inside of your body. You may have an injection of dye into your veins before the scan which makes the pictures clearer.  

During the scan you will lie on a table which moves in and out of the scanner.  A CT scan takes about 10-30 minutes.  

MRI

An MRI scan produces detailed cross-sectional pictures of your body and can show the extent of any tumours.  

You will lie on a table which slides into a large metal tube that is open at both ends. An MRI scan takes about 30-90 minutes.  

Diagnostic laparoscopy

A thin tube with a camera on the end (laparoscope) is inserted under into the abdomen so the doctor can view inside the cavity. You will have a laparoscopy under general anaesthetic. 

Cholangiography

An x-ray of the bile duct is taken to see if there is any narrowing or blockage and help plan surgery to remove the gall bladder.  

Biopsy

If your doctor sees any abnormal or unusual-looking areas they may remove a small sample of the tissue for closer examination. This is known as a biopsy. This can sometimes be done during a laparoscopy or cholangiography. A pathologist will then look at the sample under a microscope to check for signs of disease or cancer.  



Treatment for gall bladder cancer

Discussion with your doctor will help you decide on the best treatment for your cancer depending on the type of cancer you have; whether or not the cancer has spread (stage of disease); your age, fitness and general health and your preferences.  

The main treatments for gall bladder cancer include surgery, radiation therapy and chemotherapy. These can be given alone or in combination. 

Surgery

Surgery is the main treatment for gall bladder cancer, especially for people with early-stage disease where the gall bladder can be completely removed.  

Surgery to remove the gall bladder is called a cholecystectomy. Often surrounding tissue including lymph nodes, adjacent bile ducts and part of the liver will also be removed if gall bladder cancer is suspected. Surgery may be performed as either open surgery or keyhole (laparoscopic) surgery. 

If the cancer has spread and the tumour is pressing on, or blocking, the bile duct, you may need a stent (small tube made of either plastic or metal). This holds the bile duct open and allows bile to flow into the small bowel again. 

Radiation therapy (radiotherapy)

Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells, where the radiation comes from a machine outside the body. 

It is often given with chemotherapy in a treatment known as chemoradiation. It may be used for gall bladder cancer:  

  • after surgery, to destroy any remaining cancer cells and stop the cancer coming back  
  • if the cancer can’t be removed with surgery  
  • if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of symptoms such as pain). 

Chemotherapy

Chemotherapy is the use of drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug or be given a combination of drugs. 

Palliative care

In some cases of gall bladder cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.  

As well as slowing the spread of the cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.  

Treatment Team

Depending on your treatment, your treatment team may consist of a number of different health professionals, such as:
  • Cancer nurses- assist with treatment and provide information and support throughout your treatment.
  • Medical oncologist- prescribes and coordinates the course of chemotherapy.
  • Surgeon- surgically removes tumours and performs some biopsies.
  • Radiologist- interprets diagnostic scans (including CT, MRI and PET scans).
  • GP (General Practitioner)- looks after your general health and works with your specialists to coordinate treatment.
  • Radiation oncologist- prescribes and coordinates radiation therapy treatment.
  • Other allied health professionals- such as social workers, pharmacists and counsellors.
  • Dietitian- recommends an eating plan to follow while you are in treatment and recovery.
  • Gastroenterologist- specialises in diseases of the digestive system.
  • Pathologist- examines cells and tissues under a microscope.


Screening for gall bladder cancer

There is currently no national screening program for gall bladder cancer in Australia.  



Preventing gall bladder cancer

As the causes of gall bladder cancer are not understood there is no prevention advice specific to this disease.    



Prognosis of gall bladder cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis - the likely outcome of the disease - based on the test results, the rate of tumour growth, as well as your age, fitness and medical history.    



Sources

Understanding Gall Bladder Cancer. Cancer Council Australia © 2021. Last medical review of the source booklet: February 2021. 

Australian Institute of Health and Welfare (AIHW). Cancer in Australia 2019. Cancer series no.119. Cat. no. CAN 123. AIHW, Canberra, 2019. 

This web-based resource was made possible by the Cancer Australia Supporting people with cancer Grant initiative, funded by the Australian Government.