Symptoms, Risk and Diagnosis of Gallbladder Cancer

The gallbladder has the function of storing bile made by the liver to help our bodies digest fat. Gallbladder cancer is a rare disease in which cancer cells are found in the tissues of the gallbladder or main bile ducts. The wall of the gallbladder has 3 main layers of tissue: the mucosal (inner) layer, the muscle layer and the serosal outer layer, separated by supporting connective tissue. Primary gallbladder cancer starts in the inner layer and spreads through the outer layers and into the bile duct as it grows.

The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Symptoms of Gallbladder and Bile Duct Cancer

There are no signs or symptoms in the early stages of gallbladder cancer. When symptoms are present, they are similar to symptoms of many other illnesses. Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.

As the tumor grows, you may experience some of the following:

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

Risk Factors

For gallbladder cancer:

• Being female
• Being Native American

For bile duct cancer, there are additional risk factors:

• Primary sclerosing cholangitis: inflammation causing scars in the bile duct
• Chronic ulcerative colitis
• Choledochal cysts or congenital cystic dilatation of bile ducts
• Infection with a Chinese liver fluke parasite

Procedures that make pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. Staging the cancer helps to plan treatment. Clinicians need to determine the stage to know if the gallbladder cancer can be removed by surgery. Making a diagnosis of gallbladder and bile duct cancer may involve different approaches. The following tests and procedures may be used:

1. Physical exam and history: This basic exam looks at the patient’s past illnesses and treatments, and any signs of disease, or abnormalities.
2. Liver function tests: By testing a blood sample for higher than normal amounts of different substances released by the liver, your doctor can detect possible liver disease caused by gallbladder cancer.
3. Carcinoembryonic antigen (CEA) and CA 19-9 assays: These tests measure the level of CEA and CA 19-9 in the blood, substances released into the bloodstream from both cancer cells and normal cells. When found in higher than normal amounts, it can be a sign of gallbladder cancer.
4. Blood Chemistry Studies: A blood sample is checked 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 makes it.
5. PTC (percutaneous transhepatic cholangiography): this x-ray of the liver and bile ducts requires inserting a thin needle through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts before the 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.
6. Endoscopic retrograde cholangiopancreatography (ERCP): This procedure uses x-ray of the ducts (tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine. Sometimes gallbladder cancer causes these ducts to narrow and block or slow the flow of bile, causing jaundice. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it and be left in place to keep the duct open. Tissue samples may also be taken and checked under a microscope for signs of cancer.
7. Laparoscopy: Small incisions are made in the wall of the abdomen and a laparoscope (a thin, lighted tube) is inserted into one of the incisions. Other instruments may be inserted through the same or other incisions to perform procedures such as removing organs or taking tissue samples for biopsy. The laparoscopy helps determine if the cancer is within the gallbladder only or has spread to nearby tissues; and if it can be removed by surgery. Any tissue taken at the time can be biopsied and viewed under a microscope by a pathologist to check for signs of cancer. The biopsy may be done after surgery to remove the tumor. If the tumor clearly cannot be removed by surgery, the biopsy may be done using a fine needle to remove cells from the tumor.
8. Abdominal CT Scan: Detailed pictures inside the body and organs can identify some problems
9. Ultrasound: This type of imaging uses sound waves instead of radiation to identify abnormal areas in the gallbladder or nearby organs.

Staging of Gallbladder Cancer

Staging for gallbladder cancer is ranked 0 through IV and recurrent, meaning the cancer comes back after treatment. Most staging is done during diagnosis. For treatment, these cancers are divided into two groups:

• Localized (stage I)
• Unresectable, recurrent or metastatic (Stages II – IV)

Staging for primary bile duct cancer has two staging systems, depending on where the tumor is:

• Perihilar bile duct tumors form in the area where the bile duct leaves the liver. This type of tumor is also called a Klatskin tumor. It is staged 0 – IV, depending on the extent and aggressiveness of the tumor
• Distal bile duct tumors form in the area where the bile duct empties into the small intestine. This is also staged 0 – IV.

As with gallbladder tumors, for treatment, they are divided into localized and unresectable.

Prognosis

The prognosis (chance of recovery) depends on the following:

• The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body)
• If in the bile duct, whether it is in the upper or lower part of the duct
• Whether the cancer can be completely removed by surgery
• The type of gallbladder cancer (how the cancer cell looks under a microscope)
• Whether the cancer has just been diagnosed or has recurred (come back)
• The age and general health of the patient
• Whether the cancer is causing signs or symptoms