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Gallbladder cancer

Gallbladder cancer is caused by an abnormal and uncontrolled growth of cells in the lining of your gallbladder.

Your gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy). It stores bile that is produced by your liver. Bile is a fluid that helps break down fatty food. It’s carried from your gallbladder to your bowel through a tube called the bile duct. Bile contains a substance called bilirubin that is yellow-green in colour – it’s produced when red blood cells are broken down in the liver. If bile isn't removed from your blood, it builds up and your skin will turn a yellow colour. This is known as jaundice.

Gallbladder cancer is rare in the UK – just under 800 people were diagnosed with it in 2011. It's more common in countries such as Chile, Japan and India than in European countries.

Gallbladder cancer mostly affects people over 65 but younger people can get it too. It’s more common in women – seven in every 10 people diagnosed with gallbladder cancer are women.

For the majority of people who develop gallbladder cancer, it starts in the cells in the lining of the gallbladder wall. This is called adenocarcinoma. The cancer may spread through the wall of your gallbladder.

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An image showing the location of the bile duct and surrounding structures
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How cancer develops
Cells begin to grow in an uncontrolled way

Details

  • Symptoms Symptoms of gallbladder cancer

    You may not have any symptoms during the early stages of gallbladder cancer. Some early-stage gallbladder cancers are found by chance – for example, if a doctor examines your gallbladder after it has been removed to treat gallstones.

    Later symptoms of gallbladder cancer can include the following.

    • Pain in your abdomen, especially in the upper right side.
    • Feeling sick and vomiting.
    • Unexplained weight loss.
    • Jaundice – this may cause your skin and the whites of your eyes to turn a yellow colour. You may also have darker urine, your faeces (stool) may become pale and your skin may feel itchy.

    These symptoms aren’t always caused by gallbladder cancer but if you have them, see your GP.

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  • Diagnosis Diagnosis of gallbladder cancer

    Your GP will ask you about your symptoms and examine you. He or she may also ask you about your medical history. Your GP may do a blood test to check your general health and how well your liver is working. He or she may then refer you to another doctor depending on the results and your symptoms. This may be to a gastroenterologist, a doctor who specialises in identifying and treating conditions that affect the digestive system. Alternatively you may be referred to a surgeon.

    You may then be offered further tests to find out whether your symptoms are caused by gallbladder cancer or something else. Some of these are explained below.

    • A scan, such as an ultrasound, CT or MRI, can produce images of your gallbladder and the surrounding tissues.
    • An endoscopic retrograde cholangio-pancreatography (ERCP) can check if there is a narrowing or blockage in your bile duct or pancreatic duct. In this test, your doctor will use a narrow, flexible, tube-like telescopic camera called an endoscope. This is passed into your mouth, through your stomach and down to reach into your bile duct. Before this is done you will have a local anaesthetic spray for your throat and a sedative to help you relax. This medicine will make you feel sleepy.
    • A fine needle aspiration biopsy. Your doctor will use a needle to suck out a small sample of cells for testing in a laboratory. Your doctor will use a CT or ultrasound scan to guide the needle to the right place.
    • In a laparoscopy (keyhole surgery), your surgeon will make a small cut in your abdomen to look at your gallbladder and the surrounding tissues. He or she will take small samples of tissue, which will be sent to a laboratory for testing. You will have a laparoscopy under general anaesthesia.

    If you're found to have cancer, other, more specific tests may be recommended to you to find out how advanced the cancer is. This process, known as staging, takes into account whether the cancer has spread and how big it is. You’re likely to be offered a CT scan to do this. This uses X-rays to produce three-dimensional pictures of the inside of your body. The test is painless and only takes a few minutes.

  • Treatment Treatment of gallbladder cancer

    The treatment you’re offered for gallbladder cancer will depend on how advanced your cancer is and your general health. Your doctor will discuss your treatment options with you.

    Surgery

    This is the main type of treatment for gallbladder cancer. If your cancer hasn't spread beyond the wall of your gallbladder, you may only need to have your gallbladder removed. This operation is called a cholecystectomy. However, if your cancer has spread to tissues beyond your gallbladder, you will be advised to have these removed with a bigger operation. Other parts of your body that may need to be removed include:

    • lymph nodes (part of your immune system that helps to fight infection)
    • parts of your liver
    • other organs, such as your pancreas or part of your bowel

    It’s possible that your cancer may have already spread too far to surrounding tissues for it to be possible to remove it with surgery. Instead, your surgeon will aim to relieve your symptoms and prevent jaundice. This is called palliative therapy.

    Your surgeon may recommend having a stent (a small, hollow tube) inserted to help bile drain properly into your bowel. Your surgeon may insert the stent through an endoscope or through your skin, passing through your liver.

    Alternatively, you may be offered a bypass operation to prevent your bile duct from becoming blocked. In this operation, your surgeon will cut your gallbladder or bile duct above where it’s blocked and reconnect it to your small bowel. This will allow bile to go around and bypass the cancer.

    Non-surgical treatments

    It’s possible that you will be offered chemotherapy or radiotherapy. Although neither of these can cure gallbladder cancer, they may help to relieve your symptoms.

    Chemotherapy

    Chemotherapy uses medicines to try to destroy cancer cells. If your surgeon can’t completely remove your cancer, you may be offered chemotherapy to try to shrink it and so reduce your symptoms. This is known as palliative care.

    A clinical trial is currently being carried out to test the effectiveness of using chemotherapy after surgery to prevent the cancer coming back. It’s hoped that this may increase the chance of curing gallbladder cancer.

    Radiotherapy

    Radiotherapy uses radiation to destroy cancer cells. A beam of radiation is targeted on the cancerous cells, which shrinks the tumour. However, it’s rarely used to treat gallbladder cancer except to try to reduce symptoms if your condition is advanced. You may be offered it in combination with chemotherapy.

    Photodynamic therapy

    Photodynamic therapy is a new treatment that is currently being tested. It involves using a light-sensitive medicine and a laser to destroy cancer cells. However, at the moment there isn’t enough evidence to say whether or not it’s effective at treating gallbladder cancer so it’s very rarely used.

    Clinical trials

    As well as the possible new treatments for gallbladder cancer that are mentioned here, many more are being tested in clinical trials. You may be able to take part in a clinical trial – ask your doctor for more information.

  • Gallstones and gallbladder disease treatment on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including gallstones and gallbladder treatment.

  • Causes Causes of gallbladder cancer

    The exact reasons why you may develop gallbladder cancer aren't fully understood at present. However, there are some things that may increase your risk of developing it, which are explained here.

    • Gallstones – these are hard, rock-like lumps that form in your gallbladder.
    • A condition called cholecystitis – this means you have inflammation of your gallbladder, which is often caused by gallstones.
    • Gallbladder polyps – these are non-cancerous lumps that grow on the lining of your gallbladder.
    • Inflamed or abnormal bile ducts.
    • A condition called ‘porcelain gallbladder’ – this is a build-up of calcium on the inside wall of your gallbladder.
    • Having a close relative (parent, brother or sister) who has had gallbladder cancer.
    • Smoking or if you have been exposed to some chemicals, such as those found in the oil, chemical, mining, textile and paper industries.
    • Being obese.
    • Having a diet that is low in fruit and vegetables and high in fat.
  • Help and support Help and support

    Being diagnosed with cancer can be distressing for you and your family. An important part of cancer treatment is having support to deal with the emotional aspects as well as the physical symptoms. Specialist cancer doctors and nurses are experts in providing the care and support you need, and may also visit you at home. If you have more advanced cancer, further care is available to you in hospices or at home.

  • FAQs FAQs

    Are there any side-effects from having a stent put in?

    Answer

    Having a stent put in is usually a safe procedure. The most likely side-effect is some skin soreness if you have it inserted through your skin (percutaneously). It’s also possible you may have some bleeding from your liver, or you may develop an infection.

    Explanation

    If you have a stent inserted through your skin, you may have some soreness for a few days where the needle went in.

    Your liver may bleed a little after the stent has been put in as it has a lot of blood flowing through it. If you have any unexpected pain, swelling or bruising, contact the hospital where you had the stent put in. You may have blood in your faeces, which could mean that blood from your liver has passed into your bowel. If this happens, you may need further treatment.

    Infection around the stent is another possible side-effect. Your doctor may give you antibiotics for a few days after your surgery to try to prevent this. However, in the longer term, you’re at higher risk of infection as bacteria from your gut can travel up the stent. If you have an infection, you may have abdominal (tummy) pain, a high temperature and shivers. Contact your GP straight away if you have these symptoms. You may need to go into hospital for antibiotic treatment.

    It’s possible for stents to become blocked and your surgeon may need to replace it after three to six months.

    If my gallbladder is removed, can I eat the same foods as I did before?

    Answer

    Yes, you can probably go back to eating your usual diet after you recover from your operation.

    Explanation

    You don't usually need to change your diet in the long term after your gallbladder has been removed. You may have gas or bloating after surgery for a few weeks, but this usually gets better over time.

    If you have had other organs removed to treat the cancer, in particular, your pancreas, you will need to adjust your diet. This is because your pancreas produces insulin (which regulates your blood sugar level) and digestive juices (chemicals that break down food). You may find it helps to eat smaller meals more frequently rather than having three large meals a day. You may need to take medicines to replace other substances that your body is no longer producing, such as the chemicals that usually break down food. Ask your doctor or a dietitian for advice.

    Will I need an artificial gallbladder to replace the one that may be removed?

    Answer

    No, you won't need an artificial gallbladder if you have your gallbladder removed.

    Explanation

    An operation to remove your gallbladder is called a cholecystectomy. If your gallbladder is removed, bile will be able to drain from your liver directly into your small bowel.

    A possible side-effect of this procedure is diarrhoea – this happens to about one in 10 people who have their gallbladder removed. If you do get diarrhoea, your doctor may give you medicines to control it, such as cholestyramine. You might also find it helps to limit caffeinated drinks and dairy products as these can cause diarrhoea. Ask your doctor for more advice.

  • Resources Resources

    Further information

    Sources

    • Kumar P, Clark M. Clinical medicine. 8th ed. Edinburgh: Saunders; 2012
    • Postcholecystectomy syndrome. The Merck Manuals. www.merckmanuals.com, published November 2013
    • Zhua AX, Honga TS, Hezelb AF, et al. Current management of gallbladder carcinoma. Oncologist 2010; 15:168–81. doi:10.1634/theoncologist.2009-0302
    • Dutta U. Gallbladder cancer: can newer insights improve the outcome? J Gastroenterol Hepatol 2012; 27:642–53. doi:10.1111/j.1440-1746.2011.07048.x
    • What are the risk factors for gallbladder cancer? American Cancer Society. www.cancer.org, published 6 December 2013
    • Gallbladder cancer. Medscape. www.emedicine.medscape.com, published 26 August 2013
    • Gallbladder cancer. American Society of Clinical Oncology. www.cancer.net, published March 2013
    • General information about gallbladder cancer. National Cancer Institute. www.cancer.gov, published 25 October 2013
    • Evidence-based indications for the use of PET-CT in the UK 2013. Royal College of Physicians, Royal College of Radiologists, 2013. www.rcr.ac.uk
    • Eckel F, Brunner T, Jelic S. Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. Ann Oncol 2011; 22(supplement 6):40–44. doi:10.1093/annonc/mdr375
    • Unresectable, recurrent, or metastatic gallbladder cancer. National Cancer Institute. www.cancer.gov, published 24 May 2013
    • Farahmandfar M, Chabok M, Alade M, et al. Post cholecystectomy diarrhoea – a systematic review. Surgical Science 2012; 3(332–38). doi:10.4236/ss.2012.36065
    • Danley T, St Anna L. Postcholecystectomy diarrhea: what relieves it? J Fam Pract 2011; 60(10):635–36. www.jfponline.com
    • Stents and surgery for advanced gallbladder cancer. Cancer Research UK. www.cancerresearchuk.org, published 24 August 2012
    • Dumonceau J-M, Tringali A, Blero D, et al. Biliary stenting: indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44:277–98. www.esge.com
    • Pfau PR, Pleskow DK, Banerjee S, et al. Pancreatic and biliary stents, status evaluation report. Gastrointest Endosc 2013; 77(3):319–27. doi:10.1016/j.gie.2012.09.026
    • Biliary stenting. Medscape. www.emedicine.medscape.com, published 12 November 2013
    • Cancer statistics: gallbladder. World Cancer Research Fund. www.wcrf-uk.org, reviewed July 2013
    • Cholecystitis – acute. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2012
    • A randomised clinical trial evaluating adjuvant chemotherapy with capecitabine compared to expectant treatment alone (observation), following surgical resection of a biliary tumour. UK Clinical Trials Gateway. www.ukctg.nihr.ac.uk, accessed 27 March 2014
    • A trial looking at capecitabine after surgery for cancer of the bile duct or gallbladder (BILCAP). Cancer Research UK. www.cancerresearchuk.org, published 17 October 2013
    • Photodynamic therapy in treating patients with cancer of the bile duct, gallbladder or pancreas. ClinicalTrials.gov. www.clinicaltrials.gov, published March 2013
    • Pancreatic Section of the British Society of Gastroenterology, Pancreatic Society of Great Britain and Ireland, Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, Royal College of Pathologists, Special Interest Group for Gastro-Intestinal Radiology. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut 2005; 54(5):1–16. doi:10.1136/gut.2004.057059
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    Reviewed by Polly Kerr, Bupa Heath Information Team, March 2014.

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