Gallbladder Cancer

Overview

Cancer of the gallbladder — the organ where bile is concentrated and stored to help the liver digest fats — is a very rare disease. Gallbladder cancer is difficult to detect in its early stages because symptoms typically don't develop until the cancer has grown significantly.

If you or a loved one has been diagnosed with gallbladder cancer, contact the experts here at City of Hope. Inroads are being made in the treatment of gallbladder cancer, and seeking medical care at a comprehensive cancer center provides the experience and options necessary to successfully attack this rare but serious disease.

Request a consultation

If you have been diagnosed with gallbladder cancer or are looking for a second opinion consultation about your treatment, request an appointment online or contact us at 800-826-HOPE. Please visit Making Your First Appointment for more information.

For over a decade, U.S. News & World Report has named City of Hope as one of the top cancer hospitals in the country. Patients who seek treatment or second opinions here will have the most experienced doctors and therapy options such as clinical trials of promising drugs or minimally invasive surgical techniques that can reduce side effects and recovery time. City of Hope brings together a broad array of cancer expertise from multiple disciplines, all under one roof.

Highlights of our Liver Program include:

  • State-of-the-art diagnostic imaging and mapping tools
  • Renowned surgeons with specialized gall bladder cancer expertise
  • Robotically assisted surgery using the da Vinci system
  • Minimally invasive laparoscopic procedures
  • Ultraprecise radiation therapy including helical TomoTherapy
  • Chemotherapy and targeted drug therapy
  • Pioneering drug research and clinical trials

NEWS & BREAKTHROUGHS

What is gallbladder cancer?

Your gallbladder is located just beneath the liver, to the right of the abdomen. This small, pear-shaped organ is responsible for storing bile, a digestive fluid produced by the liver.

It is hard to diagnose cancer of the gallbladder because early symptoms are difficult to recognize. Another challenge is the location of the gallbladder. Since it is deep inside the body, cancer can spread easily without detection.

What increases your risk of gallbladder cancer?

Age: Two-thirds of gallbladder cancers are diagnosed in people 65 or older.

Diseases and Conditions:

  • Choledochal Cysts: Cysts formed in the bile duct can cause precancerous changes to cells in the area, raising gallbladder cancer risk.
  • Gallbladder Polyps: Benign tumors in the gallbladder, particularly those larger than 1 centimeter in diameter, may later become malignant, elevating risk of developing gallbladder cancer.
  • Gallstones: Also known as choleithiasis, gallstones are the most common risk factor associated with gallbladder cancer; approximately 75 percent of gallstone cancer patients have gallstones upon diagnosis.
  • Obesity: Gallbladder is diagnosed more often in obese or overweight people. Obesity also increases the risk of gallstones, another risk factor for gallbladder cancer.
  • Porcelain Gallbladder: A condition in which the gallbladder becomes calcified due to long-term inflammation, it is linked to a higher risk of developing gallbladder cancer.
  • Primary Sclerosing Cholangitis: A condition that leads to inflammation and scarring of the bile duct tissue, this disease also raises gallbladder cancer risk.
  • Typhoid: Infection with salmonella (the bacteria responsible for typhoid) can elevate gallbladder cancer risk by inflaming the organ.

Ethnicity: In the United States, Hispanic Americans and Native Americans have the highest risk of getting gallbladder cancer. The risk is lower among African Americans.

Sex: Gallbladder cancer occurs twice as often in women.

If you suspect that you or a loved one may have an elevated risk of gallbladder cancer, please consult with a doctor on preventive and early detection measures that are available.

What are the symptoms of gallbladder cancer?

Symptoms of gallbladder cancer can go unnoticed until the late stages of the disease, but common symptoms are:

  • Jaundice (yellowing in the skin and whites of the eyes)
  • Discomfort or pain in the upper ride side of the abdomen
  • Lumps in the abdomen, due to cancer blocking the bile duct and causing the gallbladder to swell
  • Light-colored or greasy stools
  • Dark-colored urine
  • Persistent itching
  • Unexplained weight loss
  • Loss of appetite or feeling very full after a small meal
  • Nausea or frequent vomiting

Treatment options for gallbladder cancer

How is gallbladder cancer detected?

Catching gallbladder cancer early — before it has a chance to grow and spread — is crucial to successful treatment. Although there are no screening guidelines for this cancer, it can be detected during a patient’s annual physical exam. If blood tests reveal abnormal liver enzymes, positive results on follow-up tests — and ruling out other diseases — may indicate gallbladder cancer.

How is gallbladder cancer diagnosed?

To diagnose gallbladder cancer, doctors first assess your complete medical history in addition to your risk factors and symptoms. You must also undergo a physical exam and one or more of the following tests:

Biopsy

Abnormal-looking cells are extracted from the gallbladder and checked by a pathologist for cancerous signs.

Blood tests

Blood tests may be performed to detect high bilirubin levels (the cause of jaundice) or other substances in the blood that may signal the presence of cancer. Additional blood tests may also be conducted to detect elevated levels of certain substances known as tumor markers.

Imaging Tests

Abdominal ultrasound: The initial imaging test a patient undergoes is usually an ultrasound. This type of test uses high frequency sound waves to create images of the gallbladder. Abdominal ultrasounds require no radiation and are noninvasive.

A doctor or ultrasound technician simply moves a wand-like instrument over your abdomen to capture the echoes that bounce off your internal organs. Those echoes are converted into images with the help of specialized computer programs.

Endoscopic or laparoscopic ultrasound: These ultrasounds provide more detailed images, as they allow for closer access to the gallbladder. Endoscopic and laparoscopic ultrasounds may be used to assist in removing tissue for a biopsy and determining if cancer has spread. During these procedures, a thin tube fitted with a light at the end is inserted through the mouth and down the throat, or through a small incision in the side of the body.

3D computed CT scan: Using advanced imaging technology and specialized techniques, radiologists at City of Hope can obtain highly clear and precise images of the gallbladder and liver. This allows the care team to better detect and locate tumors they can be targeted with minimal impact on surrounding normal tissues.

MRI scan: Similar to CT scans, MRI scans produce detailed images of soft tissues in the body using a powerful magnetic field and radio waves.

Staging Gallbladder Cancer

To properly plan for treatment, gallbladder cancer patients are staged in accordance to how advanced the disease is. This is primarily done by taking a number of factors into consideration, including:

  • Size of the tumor
  • Whether the cancer has grown into or through the multiple tissue layers of the gallbladder
  • If the tumor have grown into a blood vessel or adjacent organs, such as the liver or stomach
  •  Whether the cancer has spread to nearby lymph nodes and how many lymph nodes are affected
  •  Whether the cancer has metastasized to distant organs
  • If the cancer can be completely removed by surgery

Based on these factors, patients are staged according to their risk level, with higher risk patients typically requiring more intensive treatments. 

Every patient is different, with different needs. City of Hope treats you as a valued individual. Our entire team works together to bring you precise, state-of-the-art surgical, radiation, drug and other therapy options that will deliver the best outcome for you. We support you every step of the way, both during treatment and long after, helping you and your loved ones manage your recovery.

Highlights of City of Hope's gallbladder cancer treatment program include:

Surgery

Surgery is often the primary treatment for gallbladder cancer. It can be curative for early stage gallbladder cancer patients and can also improve survival outcomes and reduce discomfort for advanced gallbladder cancer patients. The procedure can involve removing the gallbladder (cholecystectomy) and surrounding cancerous tissue, if any, from the body.

If gallbladder cancer also obstructs the bile duct, surgery may be also be used to keep the bile duct open. This can be done by placing a stent or bypassing the blocked portion of the bile duct.

The expertise of City of Hope’s surgeons also means that they can treat gallbladder cancers that are considered inoperable elsewhere. This is done through advanced procedures that can navigate around sensitive areas (such as major blood vessels) and working with radiation and medical oncologists, who can shrink tumors down to an operable size and shape with radiation and drug therapies prior to surgery.

City of Hope’s surgeons specialize in minimally invasive and robotically-assisted surgical procedures for gallbladder cancer, which can remove cancerous tissue with less discomfort for the patient. By using smaller incisions compared to an open procedure, patients experience less pain, recover faster, have shorter hospital stays and are less likely to have post-surgical complications. 

Radiation Therapy

At City of Hope, we are experts in precise radiation deliveryUsing advanced imaging techniques, our radiation team can accurately locate and target a gallbladder tumor for treatment, ensuring maximum impact against cancer cells while minimizing exposure to surrounding normal tissues. At City of Hope, these techniques include respiratory gating and four-dimensional computed tomography.

Drug Therapy

Gallbladder cancer is often treated with chemotherapy (anti-cancer medicines that kill all fast-growing cells in the body). A new development in delivery chemotherapy to treat gallbladder cancer, Hepatic Arterial Infusion (HAI), uses a tiny pump implanted under the skin in the lower abdomen to deliver cancer-killing drugs directly into the main blood vessel entering the liver and surrounding organs, including the gallbladder. This direct method of chemotherapy delivery can be more effective against gallbladder cancer.

In addition to standard chemotherapy regimens, City of Hope patients can enroll in clinical trials testing new drugs (or new drug combinations) that may be more effective against the disease and/or less toxic to normal tissues.

 

 

City of Hope’s renowned physicians and researchers utilize the latest in technology and innovation to treat cancer, coupled with our enduring belief in providing unparalleled compassionate care.

Gastroenterology

Donald S. David, M.D., F.A.C.G.

Clinical Specialties

  • Gastroenterology

Medical Oncology

Vincent Chung, M.D., F.A.C.P.

Clinical Specialties

  • Medical Oncology
Marwan G. Fakih, M.D.

Clinical Specialties

  • Medical Oncology
Daneng Li, M.D.

Clinical Specialties

  • Medical Oncology
Dean W. Lim, M.D.

Clinical Specialties

  • Medical Oncology

Radiation Oncology

Yi-Jen Chen, M.D., Ph.D.

Clinical Specialties

  • Radiation Oncology

Surgical Oncology

Yuman Fong, M.D.

Clinical Specialties

  • Surgical Oncology
Lily Lau Lai, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
Laleh Melstrom, M.D., M.S., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
  • Hepato-Pancreato-Billiary (HPB) Surgery
Gagandeep Singh, M.D., F.A.C.S.

Clinical Specialties

  • Surgical Oncology
  • Liver and Pancreatic Surgery
  • Liver Cancers and Metastases
  • Biliary Tract Cancers
  • Gallbladder Cancer
  • Pancreas Cancer

Research and clinical trials for gallbladder cancer

At City of Hope, we offer access to numerous clinical trials aimed at improving survival rates and enhancing quality of life. Many of these new therapies are not always available elsewhere.

Some of our current research projects include:

  • Trametinib (Mekinist®) is a targeted therapy drug that can stop tumor development by removing enzymes necessary for gallbladder cancer cells to grow, and City of Hope is part of a Phase II trial to see if this drug is more effective than combination therapy for patients with advanced or recurrent gallbladder cancer. This trial will also evaluate the side effects differences between these two regimens to see which less toxic and easier to tolerate.
  • In many cases, combining chemotherapy and radiation (chemoradiation) can be more effective than either therapy alone, but it can also lead to more severe side effects as well. In a Phase I clinical trial, City of Hope researchers are seeing if combining the cancer drug gemcitabine (Gemzar®) with radiation therapy is well tolerated in gallbladder cancer patients and if so, determine the optimal dose for cancer-fighting effectiveness.
  • Overexpression of the CEA protein in some gallbladder cancers can be exploited for imaging purposes, since they will take in more of the drug M5A (which targets CEA-positive cancers) than normal tissues. Using this knowledge, researchers are investigating whether linking M5A to imaging agent 64Cu results in better visualization of tumors in a positron emission tomography (PET) scan. 

Learn more about our current clinical trials.

Living with gallbladder cancer

Your supportive care continues long after treatment is complete. At City of Hope we have an unmatched reputation for coordinated, compassionate care. Our specialists will help you adjust to post-treatment diet and lifestyle changes, and our unique family and survivorship programs will assist your loved ones.

When you come here, you automatically gain access to an unparalleled array of support services to help you and your family take each step in your gallbladder cancer journey. We can help with all of these concerns, and more:

  • Managing side effects
  • Pain management
  • Navigating the health care system
  • Your emotional, social and spiritual health
  • Staying healthy and active
  • Healthy cooking and eating
  • Healing arts
  • Caregiver skills
  • Dealing with family, school or work stress

Learn more about these resources at our Living with Cancer or Supportive Care Medicine sites.

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