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The gallbladder is a pear-shaped organ located just under the liver. The gallbladder functions as storage place for bile, a fluid made by the liver that helps to digest fats. Bile is released from the gallbladder through the common bile duct and mixes in the stomach and intestines as food is broken down through digestion.
What is gallbladder cancer?
Gallbladder cancer occurs when cells in the gallbladder become abnormal and multiply without control.
What are the symptoms of gallbladder cancer?
Gallbladder cancer can sometimes be found on a scan that was performed for unrelated reasons. Other times, gallbladder cancers are found unexpectedly after removal of the gallbladder for other reasons, such as gallstones. Many people with gallbladder cancer do not have symptoms, however patients can present with symptoms that include:
- Jaundice (yellowing of the skin and whites of the eyes)
- Abdominal pain
- Nausea and vomiting
- Mass in the abdomen
Some of these symptoms are linked to many other diseases and may be nothing more harmful than stomach flu. See your physician if you have any of the above symptoms.
How is gallbladder cancer diagnosed?
Your physician will use several tests to determine if you have cancer and if the cancer has spread beyond the gallbladder. Your physician may order the following diagnostic tests:
- Blood tests. Blood tests may include a complete blood count, hematocrit, platelet count, liver function tests, CA-19-9 and bilirubin. Bilirubin is a chemical that may reach high levels in people with gallbladder cancer due to blockage of the common bile duct by a tumor.
- Abdominal Ultrasound. This test helps the doctor see a tumor.
- CT scan. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver.
- MRI scan. This test identifies the tumor(s) and pinpoints their size and location in the liver, as well as their relation to the vascular / biliary structures. It also helps the doctor to determine the overall health of the liver. A doctor will determine whether to do a CT scan, an MRI or both.
- Liver Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. The sample removed from the biopsy is analyzed by one of our expert pathologists. Depending on the size of the tumor or mass, your physician may recommend the biopsy can be taken one of several ways:
- By using a minimally invasive surgical technique known as laparoscopy.
- By fine needle or thick needle aspiration (a core biopsy), using a computed tomography (CT or CAT) scan or ultrasound to guide the needle placement.
- Through an endoscope (a thin, lighted, flexible tube) inserted in the mouth, passed through the stomach, and into the first part of the intestine. A tool can be passed from the endoscope through the intestinal wall to remove a sample of tissue.
- Endoscopic retrograde cholangiopancreatography (ERCP). This test is used so the physician can visually examine the ducts going into the gallbladder and the liver. You will be lightly sedated and your doctor will insert an endoscope through the mouth, down the esophagus, and into the stomach and small bowel. A smaller tube or catheter is passed through the endoscope and into the bile ducts. Dye is injected into the ducts, and the doctor takes X-rays that can show whether a tumor is present in the area around the gallbladder.
- Percutaneous cholangiography. In this procedure, a thin needle is inserted through the skin and into the bile ducts. A dye is injected through the needle so that a high-contrast image will show up on X-rays. By looking at the X-rays, the doctor may be able to see whether there is a tumor in the gallbladder. More commonly, a cholangiography provides images of the bile ducts and may not show a tumor in the gallbladder. However, it is excellent in detecting the site of a blocked bile duct.
- Laparoscopy. Laparoscopy uses an endoscope to look at the gallbladder and other internal organs. The tube is inserted through a small incision in the abdomen and the physician can visually examine the gallbladder and surrounding organs using the endoscope, camera and light.
What is the treatment for gallbladder cancer?
The treatment of gallbladder cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health.
Gallbladder cancer may be treated with one or more techniques including:
- Surgery to remove the tumor(s) in the gallbladder and sometimes part of the liver
- Radiation therapy
- Stent placement. A stent is a tube that allows the bile, which is made by the liver, to drain more easily into the intestine if a tumor is blocking the bile duct.
Surgery for gallbladder cancer
For most cases of gallbladder cancer, removal of the gallbladder and adjacent liver tissue is required. This procedure involves the removal of the gallbladder, a wedge-shaped section of the liver near the gallbladder, the common bile duct if involved with tumor, and the lymph nodes around the nearby blood vessels. Only very early gallbladder cancers are adequately treated with a simple cholecystectomy, or removal of the gallbladder. In those patients who had their gallbladder removed for gallstones and were later discovered to have gallbladder cancer, a repeat operation is often needed. The repeat operation usually involves removal of the liver tissue near where the gallbladder used to be located, as well as removal of the lymph nodes in the area.
What is the prognosis for gallbladder cancer?
If detected at an early stage, gallbladder cancer has a higher chance of being successfully treated. An individual treatment plan will be created for you by our experts at the Johns Hopkins Medicine Liver Tumor Center using our multidisciplinary approach.