Gallbladder Cancer Treatment and Survival Rate

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

TAKEAWAYS:

• The care team will create a gallbladder cancer treatment plan based on factors such as the patient’s overall health, cancer stage and more.
• Patients may undergo just one treatment or a combination of several therapies.
• Survival rates for gallbladder cancer depend on how far the disease has spread.

The gallbladder cancer treatment option that may be appropriate for a particular patient depends on several factors, including the stage and extent of disease. The care team will recommend treatment options based on the patient’s unique diagnosis and needs.

Who Treats Gallbladder Cancer?

Gallbladder cancer is a rare disease and will be treated by experienced doctors and surgeons as part of the patient’s cancer care team. Throughout the process of gallbladder cancer treatment, the patient may encounter multiple types of doctors with different areas of expertise, including:

• Surgical oncologist, who treats cancer by performing surgery
• Radiation oncologist, who treats cancer using radiation therapy
• Medical oncologist, who treats cancer using drugs such as chemotherapy
• Gastroenterologist, who specializes in treating conditions and diseases that occur in the digestive tract

Together, these doctors make up what is called a “multidisciplinary team,” and they can recommend a well-rounded treatment plan. Throughout treatment, the patient may also be in the care of many other medical professionals, potentially including nurses, pharmacists, dietitians and social workers. The patient works closely with this team to make decisions about care.

Surgery

Surgery is a common treatment for gallbladder cancer. It may be performed to completely remove the tumor if the cancer is still localized, or to relieve symptoms or pain if the cancer is more widespread.

Staging laparoscopy: A staging laparoscopy is often performed before surgery, to allow the surgeon to get a closer look at the cancer and surrounding structures, and to determine the strategy for gallbladder cancer surgery. To do this, a long tube with a camera on the end is inserted into the abdomen through a small incision, and images are sent back that let the surgeon see where the cancer is, and how far it may have spread. Staging laparoscopy may be done for any gallbladder cancer stage, as the procedure itself is what helps determine the cancer’s stage.

Cholecystectomy: This is an operation to remove the gallbladder. A simple cholecystectomy in which only the gallbladder is removed is used most often for non-cancerous causes, such as when the gallbladder needs to be taken out because of gallstones. However, a more extensive, or radical, procedure is used most frequently if cancer is suspected. In an extended cholecystectomy, the surgeon removes the gallbladder along with a portion of the nearby liver, and the regional lymph nodes. Portions of other nearby organs may also be removed if the surgeon suspects the cancer has spread. This more extensive procedure can help to reduce the risk of the cancer coming back after gallbladder cancer surgery.

When possible, a cholecystectomy (either the simple or radical variation) is the most comprehensive means of treating gallbladder cancer. These surgeries may be an option for some instances of gallbladder cancer in stage 1, 2 and, less frequently, stage 3. However, the main factor in deciding whether or not these surgeries are an option isn’t the stage but whether the surgeon can safely and successfully remove the tumor. Gallbladder tumors that can be completely taken out by surgery are called “resectable,” while those that cannot are called “unresectable.” To be resectable, a gallbladder tumor can’t have grown into an important blood vessel.

Most gallbladder tumors are unresectable, possibly because they’re too large or located in a place that makes it impossible to remove all of the cancer safely. Surgery also may not be a feasible option if the patient’s health is too poor to withstand the surgery.

In some cases, patients with unresectable gallbladder cancers may undergo palliative surgery, to relieve symptoms rather than treat the cancer. For example, if a gallbladder tumor has grown large enough to press upon a bile duct, a stent (metal tube) may be surgically placed within the duct to keep it open and let bile pass through. When a bile duct is blocked, jaundice (a yellowing of the skin and eyes) may occur, and a stent placement may help treat this symptom.

An extended cholecystectomy may involve removing the gallbladder, a small portion of liver tissue and the regional lymph nodes. But depending on the cancer and where it’s spread, it may involve removing much more than that, including a more significant portion of the liver, the common bile duct, the pancreas and other organs or tissues. As a result, the risks of gallbladder surgery vary widely depending on the extent of the surgery performed.

In general, surgery comes with a risk of blood clots, excessive bleeding, infection and reactions to anesthesia. An extended cholecystectomy may also cause complications such as bile leakage and liver failure.

Gallbladder cancer surgeries may require a prolonged recovery, during which the patient may experience difficulties getting proper nutrition due to the digestive system being affected by surgery.

Chemotherapy

Chemotherapy for gallbladder cancer may be prescribed in addition to surgery to help prevent recurrence. The potential side effects of chemotherapy may include:

• Nausea and vomiting
• Hair loss
• Mouth sores

Prior to receiving chemotherapy for gallbladder cancer, the patient may receive pre-medications to help make side effects more tolerable. The patient’s care team will offer a variety of techniques designed to help reduce or manage chemotherapy-related symptoms. For example, our naturopathic providers may suggest supplements to reduce nausea, and a mind-body provider may recommend techniques to help the patient relax and feel less anxious during his or her gallbladder cancer chemotherapy treatments.

Chemotherapy may be used after surgery to help treat early-stage gallbladder cancers that are resectable. In this case, chemotherapy aims to lower the chances that any cancer is left behind after surgery. When used for this purpose, chemotherapy is usually combined with radiation therapy.

For advanced-stage, unresectable gallbladder tumors, chemotherapy may be used as the primary treatment. This option is a way to potentially extend a patient’s life. Chemotherapy may also function as a palliative treatment and potentially relieve symptoms such as pain caused by a large tumor.

Chemotherapy drugs may be delivered through an intravenous (IV) line. A new development is treating gallbladder cancer by delivering chemotherapy differently: using hepatic arterial infusion (HAI). This 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. It may be more effective against gallbladder cancer to reach the tumor directly.

Radiation Therapy

Radiation therapy for gallbladder cancer may be used to shrink the size of a tumor or to help kill cancer cells that may be left after surgery. Radiation therapy requires accuracy and precision. With targeted radiation therapy delivery systems, our radiation oncologists are better able to zero in on difficult-to-reach tumors in the gallbladder. Our radiation oncologists may also use technologies designed to direct higher radiation doses at gallbladder cancer cells, while reducing exposure to normal, healthy tissue.

Similar to chemotherapy, radiation therapy may be an option to help treat resectable, early-stage gallbladder tumors after surgery. Patients who are ineligible for surgery but whose cancer is limited to the gallbladder or the surrounding area may undergo radiation therapy as their main treatment to help shrink the tumor and slow its spread.

Radiation therapy may also be used to treat symptoms by attacking a tumor that is causing pain or other problems.

When radiation therapy is used to treat gallbladder cancer, side effects may include:

• Skin changes in the treatment area, including redness and blisters
• Stomach upset
• Diarrhea
• Fatigue
• Damage to the liver

Immunotherapy

Immunotherapy is a cancer treatment that helps strengthen the immune system’s ability to find and attack cancer cells.

Immunotherapy drugs may be recommended to help treat gallbladder cancers that cannot be removed by surgery or that have spread widely within the body (metastasized).

Some gallbladder tumors have specific mutations in their DNA that make them more treatable with certain immunotherapy drugs. Two types of immunotherapy, Keytruda^® (pembrolizumab) and Opdivo^® (nivolumab), are approved to treat gallbladder tumors with a certain genetic marker called MSI. This genetic marker often causes cancer cells to incur a high number of mutations, and immunotherapy drugs may help the immune system find and attack these cells.

The potential side effects of immunotherapy may vary depending on the type. However, some general side effects include:

• Skin changes
• Symptoms that resemble the flu
• Diarrhea
• Weight changes (gain or loss)

Targeted Therapy

Targeted therapies utilize certain substances or drugs to target and destroy cancer cells. It’s called “targeted” because the drugs or substances target mutations that make the cancer cells different from healthy cells, often resulting in less damage to healthy cells than with other cancer treatments.

Like immunotherapy, targeted therapy may be used to treat gallbladder tumors that cannot be successfully removed by surgery, have spread widely within the body, or have certain genetic mutations that make them targetable. Some examples of targeted therapies that may be used in these cases include:

• Tibsovo® (ivosidenib), which targets a specific mutation in the IDH1 gene. By blocking the action of this mutation, ivosidenib may help prevent cancer from growing.
• Pemazyre^® (pemigatinib), which targets certain mutations in the FGFR2 gene, helping to block the growth of cancer cells and sometimes kill them.

More types of targeted therapies and other new treatments are constantly being studied in clinical trials.

While side effects may vary depending on the type of targeted therapy used, diarrhea and liver problems are among the most common.

Treating Recurrent Gallbladder Cancer

Sometimes, cancer recurs after treatment has ended. Gallbladder cancer, like other cancers, may come back in the gallbladder or nearby (local recurrence), or it may return in a distant part of the body (distant recurrence). When cancer recurs, a new round of testing typically needs to be done to figure out the cancer’s location.

Treatment options for recurrent gallbladder cancer depend on factors such as what was used the first time around, where the cancer is located, and whether or not the patient is healthy enough to withstand surgery.

If gallbladder cancer comes back in the gallbladder and is limited to that area, surgery followed by chemotherapy or radiation therapy may be used. However, most of the time, when gallbladder cancer recurs, it cannot be successfully removed by surgery and is deemed unresectable. In this case, treatment options may include chemotherapy, targeted therapy or immunotherapy. Oftentimes, recurrent gallbladder cancer is treated in a clinical trial.

Clinical Trials

As gallbladder cancer is a rare cancer, treating it can be challenging. As a result, new treatments for gallbladder cancer are being studied through clinical trials.

Clinical trials may be particularly beneficial for patients with gallbladder cancer that cannot be successfully removed by surgery or for those with recurrent gallbladder cancer. Clinical trials may even be one of the primary treatment options for these types of gallbladder cancer. The National Cancer Institute lists clinical trials of targeted therapies or immunotherapies as one of the main options for patients with unresectable, metastatic or recurrent gallbladder cancer.

City of Hope^® may have clinical trials available for eligible patients with gallbladder cancer. It’s always a good idea to discuss the possibility of enrolling in a clinical trial with the care team to find out if it may be a good option.

Gallbladder Cancer Survival Rate

Identifying the stage of cancer not only helps the care team determine a treatment plan, it also helps predict a potential prognosis. This is achieved by calculating the percentage of people with gallbladder cancer who survive at least five years after diagnosis compared to people who don’t have that type of cancer. It’s important to remember that this is only a statistic based on all people with gallbladder cancer several years in the past, so individual patient experiences may vary.

The American Cancer Society (ACS) shares gallbladder cancer survival rates from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program. The survival rate for gallbladder cancer is based on where the cancer started and how far the cancer has spread, as indicated below.

Localized: The cancer has not spread outside the gallbladder. The five-year relative survival rate for localized gallbladder cancer is about 69 percent.

Regional: The cancer has spread to nearby tissues or lymph nodes. The five-year relative survival rate for regional gallbladder cancer is about 28 percent.

Distant: The cancer has spread to farther reaches of the body. The five-year relative survival rate for distant gallbladder cancer is about 3 percent.

The overall five-year relative survival rate for gallbladder cancer is 20 percent, according to the ACS.

Keep in mind that the survival rate for gallbladder cancer depends on a variety of factors, including the patient’s age, overall health and the extent of the disease, so always talk to the care team about the patient’s individual prognosis.

Gallbladder Cancer Treatment at City of Hope

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.

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.

City of Hope’s radiation team uses advanced imaging techniques to 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.