How Can You Tell If You Have Gallbladder Cancer?

The gallbladder is a small, pear-shaped organ on the right side of the abdomen and just beneath the liver. This organ holds the digestive fluid known as bile. Bile is released into the small intestine from the gall bladder. Nearly all gallbladder cancers start in the epithelium (the inner wall of the gallbladder). Over time they grow through the various layers toward the outside of the gallbladder.

Gallbladder cancer is uncommon but when the cancer is discovered and treated early, the chances of complete recovery are high. This may be difficult because gallbladder cancer may not be discovered until it is advanced.

The stage of cancer describes how much cancer is in the body. It helps determine how serious the cancer is and the best way to treat it. Although each person’s cancer experience is unique, cancers with similar stages tend to have a similar outlook and are often treated in the same way.

The staging system most often used for gallbladder cancer is the TNM  (tumor, nodes, metastasis) system of the American Joint Committee on Cancer (AJCC), which is based on three main key features:

• The extent (size) of the tumor (T): Identifying if cancer has grown into the wall of the gallbladder or has extended to nearby organs. The depth that a tumor grows from the inside (epithelium layer) through the other outer layers is a key part of staging.
• The spread to nearby lymph nodes (N): Identifying if cancer has spread to nearby lymph nodes.
• The spread (metastasis) to distant sites (M): Identifying if cancer has spread to the distant organs, such as the liver, the peritoneum (the lining of the abdominal cavity), or the lungs.

Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage. The stages are:

• Stage 0: Describes that the cancer is in situ (within the gallbladder).
• Stage I: The tumor is only in the gallbladder and has not spread.
• Stage II: The tumor has extended to the perimuscular connective tissue but has not spread elsewhere.
• Stage IIIA: The tumor has spread beyond the gallbladder but not to nearby arteries or veins. It has not spread to any lymph nodes or other parts of the body.
• Stage IIIB: The tumor of any size has spread to nearby lymph nodes but not to the nearby arteries and/or veins or other parts of the body.
• Stage IVA: The tumor has spread to the nearby arteries, veins, and/or nearby lymph nodes, but it has not spread to other parts of the body.
• Stage IVB: Describes that the tumor has spread to other parts of the body or distant lymph nodes.

Gallbladder cancer forms when healthy gallbladder cells develop changes (mutations) in their deoxyribonucleic acid (DNA). A cell's DNA contains the instructions that control the cell machinery. The mutations cause the cells to grow out of control and continue living when other cells would normally die. The accumulating cells form a tumor. This tumor can grow beyond the gallbladder and spread to other areas of the body.

Factors that can increase the risk of gallbladder cancer include:

• Female sex: Gallbladder cancer is more common in women.
• Age: The risk of gallbladder cancer increases with age.
• A history of gallstones: Gallbladder cancer is most common in people who have gallstones or have had gallstones in the past. Larger gallstones may carry a larger risk.
• Other gallbladder diseases and conditions: Polyps, chronic inflammation, and infection.
• Inflammation of the bile ducts: Primary sclerosing cholangitis causes inflammation of the ducts that drain bile from the gallbladder and liver, which increases the risk of gallbladder cancer.

In addition to physical examination, the following tests may be used to diagnose gallbladder cancer:

• Biopsy
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Percutaneous cholangiography
• Ultrasound
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Endoscopic ultrasonography
• Positron emission tomography (PET) or PET-CT scan.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. The types of treatments include:

• Surgery, namely cholecystectomy, radical gallbladder resection, and palliative surgery
• Radiation therapy
• Chemotherapy
• Immunotherapy