What Is Gallbladder Cancer?

Overview

Gallbladder carcinoma, also known as gallbladder cancer, is a type of cancer that is found anywhere in the gallbladder. The gallbladder is a small, pear-shaped organ that lies underneath the right side of your liver, in the upper abdomen. The gallbladder concentrates and stores bile, a fluid made in the liver, which helps you break down fats from food. This cancer is quite rare with only around 1100 diagnosed each year in the UK. The severity of gallbladder cancer depends on where it is located,the size, if it has spread, and your general health.¹

This article will explore the causes, symptoms, and diagnosis of gallbladder carcinoma as well as the possible options for treatment and management.

Causes of gallbladder cancer

Anyone can get gallbladder cancer and often, there is no clear cause. However, there are certain risk factors that can increase your risk of developing it. Also, like other cancer types, gallbladder cancer can be linked to your lifestyle. 

Age and sex

Your risk for gallbladder cancer increases as you age. Most people who develop it are over the age of 75. Also, gallbladder is more common in women than men with 71% of people diagnosed being women.^{1 2}

Medical conditions

Certain medical conditions increase your risk for gallbladder cancer. For example, inflammation of the gallbladder and gallstones are the most common risk factors for gallbladder cancer. Gallstones are hard, rock-like lumps that form in the gallbladder. They are mainly made of cholesterol, mixed with other substances found in bile. People with a history of gallbladder conditions such as gallstones have a five times higher risk for gallbladder cancer than those who do not. However, because it is very rare, most people who have these medical conditions do not get gallbladder cancer.^{1 2}

Family history

If you have a family member with gallbladder cancer, you are five times more likely to develop gallbladder cancer compared to those without a family history of this type of cancer.¹

Ethnicity

The risk for gallbladder cancer varies for people living in different parts of the world and different racial groups. This is mainly due to the factors affecting these populations such as gallstones, infection, inflammation, or diet. For example, Asia and Latin America are parts of the world where gallbladder cancer is significantly high. In comparison, western countries such as the UK, US, Canada, Australia, and New Zealand as well as Mediterranean and Western European countries have low rates of gallbladder cancer.¹

Obesity and Diabetes

Being overweight or obese can increase your risk for many different types of cancer, including gallbladder cancer. Being overweight can trigger changes in hormones in the body, especially for women, which can increase your risk for gallbladder cancer. Also, overweight or obese people are more likely to develop gallstones which increase  the risk of gallbladder cancer.

In addition, people with diabetes have an increased risk of gallbladder or bile duct cancer.¹

Smoking and alcohol

Smoking and drinking alcohol can increase the risk of gallbladder cancer as well as other cancer types. Heavy drinkers have a higher risk of developing gallbladder cancer than moderate drinkers. In general, the less you drink, the lower your chance of developing gallbladder cancer.¹

Signs and symptoms of gallbladder cancer

The symptoms of gallbladder cancer are usually unclear or hard to identify, especially in the early stages. These symptoms usually appear at the later stages.

Cancer Research UK states that the possible symptoms of gallbladder cancer are:¹

• Abdominal pain – an aching feeling on the right side of your abdominal, often described as a dragging feeling. You can also experience a sharper pain if gallstones block the bile duct.
• Jaundice – your skin or the whites of your eyes turn yellow, severe itching, dark urine, pale coloured stool
• Gallbladder enlargement – if your bile duct is blocked, your gallbladder will enlarge as it fills up with bile
• Feeling or being sick
• Loss of appetite or losing weight unexpectedly
• A high temperature
• A lump in your abdomen or a swollen abdomen

These symptoms usually appear at the later stages of gallbladder cancer. In addition, many of these symptoms are common and overlap with other medical conditions. So, having these symptoms may not mean you have gallbladder cancer but it is advised you get checked by your GP as a precaution. This is because, if it is cancer, the earlier it is found, the more treatable it is.²

Management and treatment for gallbladder cancer

Although gallbladder cancer is often treatable, it is difficult to treat. This is because treatment often depends on:²

• The size and type of gallbladder cancer
• Where it is located
• If the cancer has spread
• Your general health and well-being

Cancer treatment options include surgery, radiotherapy, and chemotherapy. You will have regular check-ups during and after any treatments and may also have tests and scans.²

Surgery to remove gallbladder cancer

Surgery to remove gallbladder cancer is a treatment option if it is detected early and has not spread (early gallbladder cancer). This often involves removing all of the gallbladder as well as lymph nodes around it. If the cancer has spread into a nearby organ, a surgeon can also remove part or all of that organ.³

Stents and bypass surgery

You may need to have surgery to control some of the symptoms of gallbladder cancer if it has spread too far and cannot be removed. This can include surgery to unblock the bile duct or stop it from getting blocked which can help with jaundice. This involves a tube called a stent which holds the duct open so it is no longer blocked.³

If the surgery is unsuccessful or not possible, your doctor may suggest surgery to bypass the blockage. This involves the surgeon making a cut in the bile duct or sometimes the gallbladder just above the blockage. The surgeon will then reconnect the cut to the small bowel which bypasses the blocked part of the bile duct so the bile can flow from the liver to the bowel. This reduces the symptoms of jaundice and helps with feeling or being sick.⁴

Chemotherapy

Another cancer treatment option is chemotherapy which uses anti-cancer (cytotoxic) drugs that work to destroy cancer cells. These drugs do not cure cancer but can help prevent the growth of cancer or shrink the cancer. You may have chemotherapy:²

• Before surgery – to shrink the cancer
• After surgery – to prevent the cancer from coming back or to get rid of any remaining cancer
• If surgery is not possible – to shrink the cancer and control and improve symptoms

Radiotherapy

Radiotherapy uses high-energy rays of radiation to target the tumour and kill cancer cells. This treatment can be used to help control and improve symptoms if gallbladder cancer has spread.²

FAQs

How is gallbladder cancer diagnosed

Gallbladder cancer is often diagnosed by chance during an operation to remove the gallbladder, usually due to gallstones or inflammation. However, you may undergo tests and scans if you have the symptoms of gallbladder cancer.

These tests and scans include:²

• A blood test
• Scans – e.g. ultrasound scan, CT scan, PET scan, MRI scan, X-ray scan (cholangiography)
• A biopsy – a collection of small sample cells from the gallbladder to check for cancer
• Laparoscopy – a small operation which uses a thin tube with a camera on the end to look at your gallbladder, liver and other surrounding organs
• Endoscopic retrograde cholangio pancreatography (ERCP)

How can I prevent gallbladder cancer

There is no sure way of preventing gallbladder cancer as most of the risk factors are out of our control. However, there are a few ways to lower your risk of developing it.

The American Cancer Society states that you can lower your risk by:⁵

• Maintaining a healthy weight
• Keeping physically active
• Following a healthy diet – plenty of fruits, vegetables, and wholegrains and limiting red and processed meats, sugary drinks, and highly processed food
• Avoiding or limiting alcohol intake
• Avoiding smoking

What are the stages of gallbladder cancer

Similar to other cancer types, stages of gallbladder cancer describe its size and whether it has spread from where it started. This can help your doctor decide on the best treatment for you.

The four stages of gallbladder cancer are:³

1. The cancer is only affecting the wall of the gallbladder (early gallbladder cancer)
2. The cancer has spread through the muscle layer of the gallbladder wall into the connective tissue underneath but has not spread outside the gallbladder
3. The cancer has spread to the nearby lymph nodes or the liver, colon, stomach, or small bowel
4. The cancer has spread deeply into two or more surrounding organs or has spread to distant lymph nodes or organs such as the lungs

Doctors also often use the TNM staging system. 

Who are at risk of gallbladder cancer

You are most at risk of gallbladder cancer if you:^1,2

• Are over the age of 75
• Are a woman
• Have certain medical conditions – gallstones, inflamed gallbladder, porcelain gallbladder, abnormal bile duct, diabetes
• Are overweight or obese
• Smoke or heavily drink alcohol
• Have a family history of gallbladder cancer
• Have Latin American or Asian heritage 

How common is gallbladder cancer

Gallbladder cancer is quite rare with around 1100 people diagnosed in the UK each year.¹

When should I see a doctor

It is important to get any possible symptoms of gallbladder cancer checked as soon as possible. This is because early gallbladder cancer is easier to treat than advanced gallbladder cancer.

Summary

In summary, gallbladder carcinoma is a rare cancer that is found anywhere in the gallbladder. There is no clear cause of gallbladder cancer but risk factors include certain medical conditions, age and sex, family history of gallbladder cancer, ethnicity, smoking, and drinking alcohol. There are usually no apparent  symptoms and these symptoms often overlap with other medical conditions and include abdominal pain, jaundice, gallbladder enlargement, and feeling or being sick. Like other cancer types, gallbladder cancer treatment depends on the size of the cancer, where it is located, if it has spread and the general well-being  of the patient. Treatment includes surgery, chemotherapy, and radiotherapy. There are many tests and scans that can be used to diagnose gallbladder cancer such as a blood test, CT scan, ultrasound scan, biopsy, and laparoscopy. If you feel you have any symptoms of gallbladder cancer it is important to contact your GP as the earlier the cancer is detected, the more treatable it is.