Gallbladder Cancer Treatment (PDQ�)
General Information About Gallbladder Cancer
Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.
The wall of the gallbladder has 3 main layers of tissue.
Muscularis (middle, muscle) layer.
Serosal (outer) layer.
Between these layers is supporting
Being female can increase the risk of developing gallbladder cancer.
Anything that increases your chance of getting a disease is called a
Being Native American.
Possible signs of gallbladder cancer include jaundice, pain, and fever.
These and other
Jaundice(yellowing of the skin and whites of the eyes).
Pain above the stomach.
Fever. Nauseaand vomiting.
Lumps in the abdomen.
Gallbladder cancer is difficult to detect (find) and diagnose early.
Gallbladder cancer is difficult to detect and
There aren't any signs or symptoms that can be seen in the early
stagesof gallbladder cancer.
The symptoms of gallbladder cancer, when present, are like the symptoms of many other illnesses.
The gallbladder is hidden behind the liver.
Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.
Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.
Procedures that make pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the gallbladder is called
In order to plan treatment, it is important to know if the gallbladder cancer can be removed by
Physical examand history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient?s health habits and past illnesses and treatments will also be taken. Ultrasoundexam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. An abdominalultrasound is done to diagnose gallbladder cancer. Liver function tests: A procedure in which a bloodsample is checked to measure the amounts of certain substances released into the blood by the liver. A higher than normal amount of a substance can be a sign of liver disease that may be caused by gallbladder cancer. Carcinoembryonic antigen (CEA) assay: A test that measures the level of CEA in the blood. CEA is 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 or other conditions. CA 19-9 assay: A test that measures the level of CA 19-9 in the blood. CA 19-9 is 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 or other conditions. CT scan(CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-raymachine. A dyemay be injectedinto a veinor swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. Blood chemistry studies: A procedure in which 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. Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body. MRI(magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). A dye may be injectedinto the gallbladder area so the ducts(tubes) that carry bile from the liver to the gallbladder and from the gallbladder to the small intestine will show up better in the image. This procedure is called MRCP (magnetic resonance cholangiopancreatography). To create detailed pictures of blood vesselsnear the gallbladder, the dye is injected into a vein. This procedure is called MRA (magnetic resonance angiography). ERCP(endoscopic retrograde cholangiopancreatography): A procedure used to x-ray 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. An endoscope(a thin, lighted tube) is passed through the mouth, esophagus, and stomach into the first part of the small intestine. A catheter(a smaller tube) is then inserted through the endoscope into the bile ducts. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a fine tube may be inserted into the duct to unblock it. This tube (or stent) may be left in place to keep the duct open. Tissue samples may also be taken. Biopsy: The removal of cells or tissues so they can be viewed under a microscopeby a pathologistto 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. Laparoscopy: A surgical procedure to look at the organs inside the abdomen to check for signs of disease. Small incisions(cuts) 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 to find out if the cancer is within the gallbladder only or has spread to nearby tissues and if it can be removed by surgery. PTC(percutaneous transhepatic cholangiography): A procedure used to x-ray the liver and bile ducts. A thin needle is inserted through the skin below the ribs and into the liver. Dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, a thin, flexible tube called a stent is sometimes left in the liver to drainbile into the small intestine or a collection bag outside the body.
Certain factors affect the prognosis (chance of recovery) and treatment options.
The stage of the cancer (whether the cancer has spread from the gallbladder to other places in the body).
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
Treatment may also depend on the age and general health of the patient and whether the cancer is causing symptoms.
Gallbladder cancer can be
Taking part in one of the
Stages of Gallbladder Cancer
Tests and procedures to stage gallbladder cancer are usually done at the same time as diagnosis.
See the General Information section for a description of tests and procedures used to detect,
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
tissue. Cancer invadesthe surrounding normal tissue.
lymph system. Cancer invades the lymph system and travels through the lymph vesselsto other places in the body.
blood. Cancer invades the veinsand capillariesand travels through the blood to other places in the body.
The following stages are used for gallbladder cancer:
Stage 0 (Carcinoma in Situ)
In stage I,
In stage II,
In stage IIIA,
In stage IIIB,
beyond the inner layer of the
gallbladderto a layer of tissuewith blood vesselsor to the muscle layer; or
beyond the muscle layer to the connective tissue around the muscle; or
through the thin layers of
tissuethat cover the gallbladderand/or to the liverand/or to one nearby organ(such as the stomach, small intestine, colon, pancreas, or bile ductsoutside the liver).
In stage IV,
In stage IVB,
lymph nodesalong large arteriesin the abdomenand/or near the lower part of the backbone; or
organsor areas far away from the gallbladder.
For gallbladder cancer, stages are also grouped according to how the cancer may be treated. There are two treatment groups:
Localized (Stage I)
Unresectable, recurrent, or metastatic (Stage II, Stage III, and Stage IV)
Treatment Option Overview
There are different types of treatment for patients with gallbladder cancer.
Different types of treatments are available for patients with
Three types of standard treatment are used:
Gallbladder cancer may be treated with a cholecystectomy,
If the cancer has spread and cannot be removed, the following types of
biliary bypass: If the tumoris blocking the small intestineand bileis building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile ductwill be cut and sewn to the small intestine to create a new pathway around the blocked area. Endoscopic stentplacement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drainbile that has built up in the area. The stent may be placed through a catheterthat drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine. Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An x-rayof the liverand bile ducts is done to locate the blockage. Images made by ultrasoundare used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundicebefore surgery.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Clinical trials are studying ways to improve the effect of radiation therapy on tumor cells, including the following:
Hyperthermia therapy: A treatment in which body tissue is exposed to high temperatures to damage and kill cancer cells or to make cancer cells more sensitive to the effects of radiation therapy and certain anticancer drugs. Radiosensitizers: Drugs that make tumor cells more sensitive to radiation therapy. Giving radiation therapy together with radiosensitizers may kill more tumor cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from
Follow-up tests may be needed.
Some of the tests that were done to
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has
Treatment Options for Gallbladder Cancer
A link to a list of current
Localized Gallbladder Cancer
Surgeryto remove the gallbladderand some of the tissuearound it. Part of the liverand nearby lymph nodesmay also be removed. Radiation therapywith or without chemotherapymay follow surgery.
Radiation therapy with or without chemotherapy.
clinical trialof radiation therapy with radiosensitizers.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized gallbladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Unresectable, Recurrent, or Metastatic Gallbladder Cancer
Percutaneous transhepatic biliary drainageor the placement of stentsto relieve symptomscaused by blocked bile ducts. This may be followed by radiation therapyas palliative treatment. Surgeryas palliative treatment to relieve symptomscaused by blocked bile ducts. Chemotherapy.
clinical trialof new ways to give palliative radiation therapy, such as giving it together with hyperthermia therapy, radiosensitizers, or chemotherapy.
A clinical trial of new
drugsand drug combinations.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with unresectable gallbladder cancer, recurrent gallbladder cancer and metastatic gallbladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
To Learn More About Gallbladder Cancer
For more information from the
What You Need to Know About? Cancer
Understanding Cancer Series: Cancer
Chemotherapy and You: Support for People With Cancer
Radiation Therapy and You: Support for People With Cancer
Coping with Cancer: Supportive and Palliative Care
Information For Survivors/Caregivers/Advocates
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Changes to This Summary (12/23/2011)
Changes were made to this summary to match those made to the health professional version.
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