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This information is about gall bladder cancer.
The gall bladder is a small pouch that stores and concentrates bile. Bile is a fluid that helps us to digest food. Its main function is to break down fats in food. Bile is made by the liver and stored in the gall bladder. The gall bladder is connected to the small intestine and the liver by the bile ducts.
The gall bladder and the bile ducts are known as the biliary system.
We have separate information about cancer of the bile duct|.
Most cancers of the gall bladder are a type of cancer called adenocarcinoma. They start in the lining of the gall bladder.
It's a rare type of cancer with around 670 new cases in the UK each year. It's very rare in people under 50 and is most often seen in people over the age of 70. It's more common in women than men.
The cause of most gall bladder cancers is unknown. There are a number of risk factors that may increase your chances of developing this type of cancer. These include:
Gall bladder cancer is more likely to occur in people who have a history of gallstones or in people who have inflammation of the gall bladder (cholecystitis). However, most people who have gallstones or an inflamed gall bladder won't develop gall bladder cancer.
These are non-cancerous (benign) tumours of the gall bladder that increase the risk of developing gall bladder cancer.
Gall bladder cancer is slightly more common in people who are born with (congenital) abnormalities of the bile ducts.
People who have a condition called porcelain gall bladder, in which calcium forms in the wall of the gall bladder, also have a slightly increased risk of this type of cancer.
Some evidence suggests that people who smoke cigarettes are more likely to develop gall bladder cancer.
People who have a close relative (parent, brother or sister) with gall bladder cancer have a slightly higher risk of developing this type of cancer.
Being overweight increases your risk of developing gall bladder cancer.
Early gall bladder cancer often causes no symptoms and is usually discovered unexpectedly when someone has surgery to remove gallstones. About 1 in 5 gall bladder cancers are found in this way.
Most tumours are only discovered at an advanced stage. They can cause a variety of symptoms including sickness, high temperatures, weight loss and pain in the tummy (abdomen).
If the cancer blocks the bile duct, it may stop the flow of bile from the gall bladder into the small bowel. This causes bile to flow back into the blood and body tissues, and leads to the skin and whites of the eyes becoming yellow (known as jaundice).
The urine also becomes a dark yellow colour and stools (bowel motions) are pale. The skin may become itchy.
These symptoms may be caused by other problems such as gallstones or infection of the gall bladder, but it's important to get them checked by your doctor.
Usually you begin by seeing your GP who will examine you. They will refer you to a hospital specialist for any tests that may be necessary and for expert advice and treatment.
At the hospital, the doctor will ask you about your general health and any previous medical problems. They will then examine you and take blood samples to check your general health and that your liver is working properly. There are a number of commonly used tests to diagnose gall bladder cancer.
A CT scan takes a series of x-rays that build up a three-dimensional picture of the inside of the body. The scan is painless and takes 10–30 minutes. CT scans use small amounts of radiation, which are very unlikely to hurt you or anyone you come into contact with.
You will be asked not to eat or drink for at least four hours before the scan.
You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine or have asthma you could have a more serious reaction to the injection, so it's important to let your doctor know beforehand.
In this test, the x-ray machine rotates continuously around the body to make cross-sectional pictures of the body. Spiral CT scans are quite new, and if you need one, you may have to travel to a specialist hospital to have it.
This test is similar to a CT scan but uses magnetism instead of x-rays to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it’s safe for you to have an MRI scan.
Before having the scan, you’ll be asked to remove any metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly.
During the test you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It's painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It’s also noisy, but you’ll be given earplugs or headphones. You will be able to hear and speak to the person operating the scanner.
This may be used to take an x-ray picture of the pancreatic duct and bile duct. It can also be used to unblock the bile duct if necessary.
You'll be asked not to eat or drink anything for about six hours before the test so that the stomach and first part of the small bowel (the duodenum) are both empty. You'll be given a tablet or injection to make you relax (a sedative) and a local anaesthetic spray will be used to numb your throat. The doctor will then pass a thin, flexible tube called an endoscope through your mouth into your stomach and the small bowel just beyond it.
Looking down the endoscope, the doctor can find the openings where the bile duct and the duct of the pancreas drain into the duodenum. A dye that can be seen on x-rays can be injected into these ducts so the doctor can see whether there are any abnormalities or blockages.
This scan is similar to an ERCP but involves an ultrasound probe being passed down the endoscope to take an ultrasound scan of the gall bladder and surrounding structures.
Angiograms are carried out in the x-ray department. A fine tube is put into a blood vessel (artery) in your groin. A dye is then injected up the tube. The dye circulates in the arteries so that they show up on x-ray.
This is a small operation that allows the doctors to look at the gall bladder, the liver and other internal organs in the area around the gall bladder. It is done under a general anaesthetic and will mean a short stay in hospital.
While you are under anaesthetic the doctor makes a small cut (incision) in your abdomen and inserts a thin flexible tube containing a light and camera (laparoscope). The doctor looks at the gall bladder and may take a small sample of tissue (biopsy) for examination under a microscope.
Sometimes the gall bladder can be removed during a laparoscopy to treat gallstones or chronic inflammation of the gall bladder. This operation is called a laparoscopic cholecystectomy.
If gall bladder cancer is found or suspected during this operation, the surgeon will change the operation to an open cholecystectomy. This is the removal of the gall bladder and surrounding tissues through a larger cut in the abdomen. This makes it easier to remove all of the cancer.
After the laparoscopy you will have one or two stitches in your abdomen. You may have uncomfortable wind and/or shoulder pains for several days after the operation. The pain can often be eased by walking or taking sips of peppermint water.
The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the particular type and the stage of the cancer helps the doctors to decide on the most appropriate treatment.
Cancer can spread in the body, either in the bloodstream or through the lymphatic system|. The lymphatic system is part of the body’s defence against infection and disease. The system is made up of a network of lymph nodes that are linked by fine tubes (lymph vessels). Doctors will usually look at the nearby lymph nodes to find the stage of the cancer.
There are four stages of cancer of the gall bladder.
The cancer affects only the wall of the gall bladder. Approximately 1 in 4 cancers are at this stage when they are diagnosed.
The cancer has spread through the full thickness of the wall of the gall bladder, but has not spread to nearby lymph nodes or surrounding organs.
The cancer has spread to lymph nodes close to the gall bladder or has spread to the liver, stomach, colon or the small bowel.
The cancer has spread very deeply into two or more organs close to the gall bladder or has spread to distant lymph nodes or organs, such the lungs. This is known as metastatic or secondary cancer.
A different system called the TNM staging system is sometimes used, in which:
This system is more complex and gives more precise information about the tumour stage.
If the cancer comes back after initial treatment it is known as recurrent cancer.
Grading refers to the appearance of cancer cells under a microscope and gives an idea of how quickly a cancer may develop.
Low-grade means the cancer cells look very much like normal cells; they are usually slow-growing and are less likely to spread. In high-grade tumours the cells look very abnormal, are likely to grow more quickly and are more likely to spread.
The treatment you have depends on a number of factors, including your general health, the position and size of the cancer in the gall bladder and whether the cancer has spread to other areas of the body.
Before you have any treatment, your doctor will give you full information about what it involves and explain its aims. They will usually ask you to sign a form saying that you give permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent.
Treatment can be given for different reasons and the potential benefits will vary for each person. If you've been offered treatment that aims to cure your cancer, deciding whether to have the treatment may not be difficult. However, if a cure is not possible and the treatment is to control the cancer for a period of time, it may be more difficult to decide whether or not to go ahead.
If you feel that you can't make a decision about treatment when it is first explained to you, you can always ask for more time to decide.
You are free to choose not to have the treatment and the staff can explain what may happen if you do not have it. You don't have to give a reason for not wanting treatment, but it can be helpful to let the staff know your concerns so that they can give you the best advice.
Surgery| is the main treatment for gall bladder cancer. If you have early gall bladder cancer, it may be removed using an open cholecystectomy or a laparotomy.
If the cancer has spread beyond the gall bladder, a radical choleycystectomy may be done. This is a major operation that removes the gall bladder, the surrounding tissues, lymph nodes and parts of other organs that may be affected by cancer.
After your operation you may stay in an intensive care ward for the first couple of days. You will then be moved to a general ward until you recover. Most people need to be in hospital for about two weeks after this type of operation.
If a cure isn't possible, surgery may still be used to help improve a person's symptoms by removing as much of the cancer as possible.
Whether surgery is possible or not depends on the results of the investigations described above. You may be referred to a surgeon who is a specialist in this rare cancer.
Radiotherapy| treats cancer by using high-energy x-rays that destroy the cancer cells while doing as little harm as possible to normal cells. It is occasionally used for cancer of the gall bladder.
It can either be given externally from a radiotherapy machine or internally by placing radioactive material close to the tumour (brachytherapy).
Chemotherapy| is the use of anti-cancer (cytotoxic) drugs to destroy the cancer cells. Chemotherapy may occasionally be used after surgery if all the cancer couldn't be removed by the operation. It may also be used if an operation isn't possible or the cancer has come back (recurred) after initial treatment. The aim of chemotherapy treatment is to try to shrink or slow down the growth of the cancer and to relieve symptoms. The drugs cisplatin and gemcitabine (Gemzar®)| can be used in combination to treat gall bladder cancer.
If cancer in the gall bladder is causing a blockage in the bile duct, it may be possible for the doctor to insert a small tube (stent) during the ERCP. This can help to relieve jaundice without a surgical operation.
The stent is about 5–10cm long and is as thick as a ballpoint pen refill. The stent clears a passage through the bile duct to allow the bile to drain away. The preparation and procedure is the same as for an ERCP. By looking at the x-ray image the doctor will be able to see the narrowing in the bile duct. The narrowing can be stretched using inflatable balloons (dilators), and the stent can be inserted through the endoscope to enable the bile to drain.
The stent usually needs to be replaced every 3–4 months to prevent it becoming blocked. If it does become blocked, you may become jaundiced and have high temperatures. It's important to tell your specialist about these symptoms as early as possible. You may need antibiotics and your specialist might advise that the stent be exchanged for a new one. For most people this procedure can be done quite easily.
PDT| uses a combination of laser light and a light-sensitive drug to destroy cancer cells. In gall bladder cancer it can be used to help relieve symptoms.
The light-sensitive drug is injected into a vein. It circulates in the bloodstream and enters cells throughout the body. The drug enters more cancer cells than healthy cells.
It doesn't do anything until it is exposed to laser light of a particular wavelength.
About two days after the injection you have an endoscopy. The doctor uses an endoscopy tube like the one used in an ERCP, to shine the laser light on to the cancer. This activates the drug and destroys the cancer cells.
You may be sensitive to light for a few days after the injection. You’ll be told what precautions you need to take until this effect wears off. Other possible side effects include pain|, inflammation and nausea|.
Cancer doctors use clinical trials| to assess new treatments. Research is being done into possible new treatments for gall bladder cancer. These include:
Having investigations and treatment for cancer can be a very stressful experience. You may have many emotions| including anxiety, anger and fear. These are all normal reactions and are part of the process that many people go through when trying to come to terms with their condition.
Many people find it helpful to talk things over with their doctor or nurse, or with one of our cancer support specialists|. Close friends and family can also offer support.
This section has been compiled using information from a number of reliable sources including:
For answers, support or just a chat, call the Macmillan Support Line free (Monday to Friday, 9am-8pm)
If you have any questions about cancer, need support or just want someone to talk to, ask Macmillan.