A National Cancer Institute-designated Comprehensive Cancer Center

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Gallbladder Cancer

Gallbladder Cancer
At City of Hope, aggressive treatment programs using emerging therapies and the most advanced technologies available combine to give gallbladder cancer patients the most positive outcomes possible.
 
Through our active clinical trials research program – one of the most extensive in the nation – we can often provide patients with access to promising new anticancer drugs and technologies not available elsewhere.
 
About Gallbladder Cancer
 
Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.
 
Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.
 
The wall of the gallbladder has 3 main layers of tissue.
 
  • Mucosal (innermost) layer.
  • Muscularis (middle, muscle) layer.
  • Serosal (outer) layer.

Between these layers is supporting connective tissue. Primary gallbladder cancer starts in the innermost layer and spreads through the outer layers as it grows.
 
Recurrent Gallbladder Cancer
Recurrent gallbladder cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the gallbladder or in other parts of the body.
 
Gallbladder Cancer Symptoms
 
Possible signs of gallbladder cancer include jaundice, pain, and fever.

These and other symptoms may be caused by gallbladder cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

  • Jaundice (yellowing of the skin and whites of the eyes).
  • Pain above the stomach.
  • Fever.
  • Nausea and vomiting.
  • Bloating.
  • Lumps in the abdomen.

Gallbladder cancer is difficult to detect and diagnose early for the following reasons:
 
  • There aren't any noticeable signs or symptoms in the early stages of gallbladder cancer.
  • The symptoms of gallbladder cancer, when present, are like the symptoms of many other illnesses.
  • The gallbladder is hidden behind the liver.

Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.
 

How We Diagnose Gallbladder Cancer

Gallbladder cancer is difficult to diagnose because the gallbladder is hidden behind other organs in the abdomen. Symptoms of gallbladder cancer may resemble other gallbladder diseases such as gallstones or infection, which in some cases may result in no symptoms in the early stages.

Diagnostic tests are needed to determine whether symptoms are, in fact, gallbladder cancer. If cancer is found, additional tests may be used to assess the stage of the disease, specifically, how advanced the cancer is, and whether it has metastasized (spread outside the esophagus ).
 
  • A biopsy— taking a small sample of tissue for examination under a microscope —may also be required to confirm a diagnosis of cancer.
 
  • Ultrasound exam: High-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes that form a picture of body tissues called a sonogram. An abdominal ultrasound is done to diagnose gallbladder cancer.
 
  • Liver function tests: Blood samples are analyzed to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer.
 
  • Blood chemistry studies: A blood sample is analyzed to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that produces it.
 
  • CT or CAT (computerized axial tomography) scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
 
  • PTC (percutaneous transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drain bile into the small intestine or a collection bag outside the body.
     
  • Laparoscopy: This surgical staging procedure is used to examine internal organs. An incision is made in the abdominal wall and a thin, lighted tube called a laparoscope is inserted into the abdomen. Tissue samples and lymph nodes may be removed for biopsy.
 
  • PET (positron emission tomography) scan: PET is used to identify malignant cells. First, a small amount of radionuclide glucose (sugar) is injected into a vein, and then the scan begins. Cancer cells take up more glucose than normal cells and appear brighter in the scan.

Gallbladder Cancer Treatment Approaches

Gallbladder cancer is often in an advanced stage when it is diagnosed, requiring rapid intervention by a group of specialists experienced in treating the disease. The multidisciplinary team at City of Hope includes medical experts from the departments of Surgical Oncology, Medical Oncology and Radiation Oncology.
 

Surgery is an important treatment for localized tumors. When applicable, our specialists utilize minimally invasive surgery (MIS) with advanced technologies such as laparoscopy and the new da Vinci robotic surgery system that allows for greater precision. These surgeries feature small incisions and potentially:
 
  • less blood loss, pain and visible incisions
 
  • shorter hospital stay and recovery time
 
  • fewer complications and quicker return to normal activities
 
Often gallbladder cancer is treated with a cholecystectomy – the surgical removal of the gallbladder and some of the tissues around it. Nearby lymph nodes are also removed. If the cancer involves or is adjacent to the liver, a portion of the liver may need to be removed at the time of surgery.
 
If the cancer has spread and cannot be removed, the following types of palliative procedures may relieve symptoms:
 
  • Surgical biliary bypass: If the tumor is blocking the bile duct and bile is building up in the liver, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.
 
  • Endoscopic stent placement:  If the tumor is blocking the bile duct, nonsurgical techniques can be used to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go through the blocked area and drain the bile into the small intestine.
 
  • Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An X-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery.
 
 
 
Radiation therapy uses energy beams to kill cancer cells. Specialists in the Department of Radiation Oncology have developed highly accurate new approaches that maximize the delivery of radiation to malignant cells while minimizing unnecessary exposure of healthy tissues. Therapeutic procedures include:
 
 
 
 
 
Chemotherapy

Chemotherapy – the use of anticancer medicines – includes a wide range of drugs and treatment strategies to treat primary and metastatic gallbladder cancer. City of Hope provides both standard chemotherapies as well as access to newly developed drugs through an extensive program of clinical trials.
 
As part of the treatment team, a medical oncologist will evaluate the best options, so that a course of chemotherapy, if appropriate, can be tailored to the patient.

Resources

All of our patients have access to the  Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the Federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.

Gallbladder Cancer Research/Clinical Trials

City of Hope has long been a leader in cancer research. As an organization specializing in treating cancer patients, our doctors, nurses and other medical professionals have the in-depth experience that makes a difference in cancer diagnosis and care. We also work to bring the latest scientific findings into clinical practice as quickly as possible. With our extensive program of clinical trials, patients at City of Hope have access to new treatments that are not yet available elsewhere.
 
To learn more about our clinical trials program and specifically about trials for gallbladder cancer, click here.

Gallbladder Cancer Team

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Joe Komsky
Senior Director
Phone: 213-241-7293
Email: jkomsky@coh.org

 
 
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Physicians in the United States and throughout the world are welcome to refer patients to City of Hope.

There are a number of options you can choose from to refer a patient:

  • Call 800-826-HOPE (4673) to speak with a patient referral specialist.
  • Fax the patient face sheet to 626-301-8432
  • Complete an online callback request form
 
Your insurance company/medical group will tell you if you need any authorizations. You can also find out what, if any, co-payments and deductibles will be your responsibility.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
City of Hope is one of only 41 Comprehensive Cancer Centers in the country, the highest designation awarded by the National Cancer Institute to institutions that lead the way in cancer research, treatment, prevention and professional education.
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