Most gall bladder cancers start in the glandular cells in the gall bladder. They are called adenocarcinomas.

Gall bladder cancer is rare. Around 900 people are diagnosed with it in the UK each year. It's very rare in people under 50 and is most often seen in people over 70. It's more common in women than men.

We hope this information answers your questions. If you have any further questions, you can ask your doctor or nurse at the hospital where you are having treatment.

The gall bladder

The gall bladder is a small pouch that stores bile. Bile is a fluid that helps us digest food. It helps 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 together are known as the biliary system. We have separate information about cancer of the bile duct.

We don’t know what causes most gall bladder cancers but there are a number of factors that may increase your risk of developing it. These include: 

Age

Gall bladder cancer is more common in people over the age of 70.

Gallstones and inflammation 

Gall bladder cancer is more likely to occur in people who have a history of gallstones or inflammation of the gall bladder (cholecystitis). But most people who have gallstones or an inflamed gall bladder won't develop gall bladder cancer. 

Polyps 

These are non-cancerous (benign) tumours of the gall bladder that increase the risk of developing gall bladder cancer. 

Porcelain gall bladder 

This condition causes calcium to form in the wall of the gall bladder. People with this condition have a slightly increased risk of developing gall bladder cancer. 

Abnormal bile ducts 

Gall bladder cancer is slightly more common in people who are born with congenital abnormalities of the bile ducts. 

Smoking 

Some evidence suggests that people who smoke cigarettes are more likely to develop gall bladder cancer. 

Obesity 

Being very overweight increases the risk of developing gall bladder cancer. 

Family history 

If you have a close relative with gall bladder cancer, you have a slightly higher risk of developing it. A close relative is a parent, brother or sister.

Early gall bladder cancer often causes no symptoms. It is usually discovered when someone has surgery to remove gallstones. About 1 in 5 gall bladder cancers (20%) are found this way. 

Most gall bladder cancers are only found at an advanced stage. They can cause a variety of symptoms, including: 

• sickness
• high temperatures (fevers)
• weight loss 
• 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. This can lead to:

• the skin and whites of the eyes becoming yellow (jaundice) 
• the urine becoming a dark yellow colour 
• pale stools (bowel motions) 
• itchy skin. 

These symptoms may be caused by other problems, such as gallstones or an infection of the gall bladder. But it's important to get them checked by your doctor. 

You usually begin by seeing your GP, who will examine you and refer you to a hospital specialist.

At the hospital, the doctor will ask you about your general health and any previous medical problems. They will examine you and take blood samples to check your general health and that your liver is working properly. They may also do the following tests:

Ultrasound scan

This uses sound waves to build up a picture of the gall bladder and surrounding organs. Once you are lying comfortably on your back, a gel is spread onto your tummy (abdomen). A small device that produces sound waves is then passed over the area. The sound waves are made into a picture on a computer. The test is painless and only takes a few minutes. You may be asked not to eat or drink before the scan. Your doctor or nurse can tell you more about what you need to do before the ultrasound scan.

CT scan

A CT (computerised tomography) scan uses x-rays to build a three-dimensional (3D) picture of the inside of the body. You may be given either a drink or injection of dye. This is to make certain areas of the body show up more clearly. This scan takes about 30 minutes and is painless. We have more detailed information about having a CT scan.

MRI (magnetic resonance imaging) scan

This scan uses magnetism to build up a detailed picture of areas of your body. You may be given an injection of dye, into a vein, to improve the images from the scan. We have more detailed information about having an MRI scan.

An MRCP (Magnetic Resonance Cholangio-Pancreatography) is a special type of MRI scan that may be used. It is not widely available. If you are having this scan, your doctors will tell you more about it.

ERCP (endoscopic retrograde cholangio-pancreatography)

This test 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 the stomach and first part of the small bowel (the duodenum) are both empty. The doctor will give you a tablet or injection to make you relax (a sedative). They will use a local anaesthetic spray to numb your throat. The doctor will then pass a thin, flexible tube called an endoscope through your mouth, into your stomach and into the small bowel just beyond it.

The doctor will look down the endoscope to find the openings where the bile duct and the duct of the pancreas drain into the duodenum. They can inject a dye that can be seen on x-rays into these ducts. This means they can see whether there are any abnormalities or blockages.

EUS (endoscopic ultrasound)

This scan is similar to an ERCP, but an ultrasound probe is attached to the endoscope. This takes an ultrasound scan of the gall bladder and surrounding structures.

Angiogram

This is a test to look at your blood vessels. The bile duct is very close to the large blood vessels that carry blood to and from your liver. An angiogram may be used to check whether any of these blood vessels are affected by the cancer.

Angiograms are done in the x-ray department. A thin tube is put into a blood vessel (artery) in your groin. A dye is then injected up the tube. The dye travels around the arteries so they show up on an x-ray.

Laparoscopy

This is a small operation that allows the doctors to look at your gall bladder, liver and other internal organs in the area around the gall bladder. It’s done under a general anaesthetic and you will have a short stay in hospital.

While you are under anaesthetic, the doctor will make a small cut (incision) in your tummy (abdomen) and insert a thin, flexible tube that has a light and camera (laparoscope). They will look at your gall bladder. They may take a small sample of tissue (biopsy) to look at under a microscope.

Sometimes they remove the gall bladder during a laparoscopy, to treat gallstones or chronic inflammation of the gall bladder. This operation is called a laparoscopic cholecystectomy.

If the surgeon finds or suspects gall bladder cancer during this operation, they will change the operation to an open cholecystectomy. This is when they remove the gall bladder and surrounding tissues through a larger cut in the tummy. This makes it easier to remove all of the cancer.

After a 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. You can often ease the pain by walking or taking sips of peppermint water. Your doctor may also give you painkillers.

Laparotomy

If none of these tests have been able to diagnose the cause of your symptoms, you may have an operation called a laparotomy. This is done under a general anaesthetic.

The surgeon makes a cut (incision) in your tummy, so they can look at the gall bladder and the tissue around it. If they find a cancer that has not spread to surrounding tissues, they may be able to remove it. Or they may be able to clear any blockages that cancer might be causing.

Staging

The stage of a cancer describes its size and whether it has spread beyond its original site. Knowing the stage of the cancer helps the doctors decide on the best treatment for you.

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. It 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 gall bladder cancer:

Stage 1

The cancer affects only the wall of the gall bladder. Approximately 1 in 4 cancers (25%) are at this stage when they are diagnosed.

Stage 2

The cancer has spread through the full thickness of the wall of the gall bladder, but it has not spread to nearby lymph nodes or surrounding organs.

Stage 3

The cancer has spread to lymph nodes close to the gall bladder or has spread to the liver, stomach, colon or small bowel.

Stage 4

The cancer has spread very deeply into two or more organs close to the gall bladder, or it 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:

• T describes the size of the tumour.
• N describes whether the cancer has spread to the lymph nodes.
• M describes whether the cancer has spread to another part of the body, such as the liver (secondary or metastatic cancer).

This system is more complex. It gives more precise information about the tumour stage.

If the cancer comes back after initial treatment, it is known as recurrent cancer.

Grading

Grading means the way cancer cells look under a microscope. It gives an idea of how quickly a cancer may develop.

In low-grade tumours, 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. They 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
• whether it has spread to other areas of the body.

Surgery

Whether or not surgery is possible depends on the results of the tests described above. You may be referred to a surgeon who is a specialist in gall bladder cancer.

If you have early gall bladder cancer, you will have an operation to remove your gallbladder. This is called an open cholecystectomy. It may also be removed during a laparotomy, when the surgeon looks at the gall bladder and surrounding tissue through a cut in your tummy. If it is possible to remove all of the cancer with surgery, the aim of the treatment is usually to cure the cancer.

If the cancer has spread beyond the gall bladder, you may be offered a radical cholecystectomy. This is a major operation that removes the gall bladder, the surrounding tissues, the 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 it isn’t possible to cure the cancer, surgery may be used to help improve symptoms. This is done by removing as much of the cancer as possible.

Radiotherapy

Radiotherapy treats cancer by using high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It can either be given externally from a radiotherapy machine or internally by placing radioactive material close to the tumour (brachytherapy).

Radiotherapy is sometimes used to treat gall bladder cancer. You may have radiotherapy after surgery. Radiotherapy may also be given to help relieve symptoms if the cancer is advanced.

Chemotherapy

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 surgery. It may also be used if surgery isn't possible or if the cancer has come back after initial treatment. The aim of chemotherapy is to shrink or slow down the growth of the cancer and relieve symptoms. The chemotherapy drugs most commonly used are cisplatin and gemcitabine (Gemzar®).

Stent insertion

If the cancer is causing a blockage in the bile duct, it may be possible for the doctor to insert a small tube (stent) during an ERCP (endoscopic retrograde cholangio-pancreatography). This can help relieve jaundice without surgery.

The preparation and procedure for this is the same as for an ERCP (described above). The doctor will be able to see the narrowing in the bile duct by looking at the x-ray image. They can stretch the narrowing using inflatable balloons (dilators). Then they can insert the stent through the endoscope so the bile can drain.

The stent usually needs to be replaced every 3–4 months, to stop it becoming blocked. If it does become blocked, you may become jaundiced and have high temperatures. It's important to tell your specialist as soon as possible if you have these symptoms. You may need antibiotics, and your specialist might advise that they should swap the stent for a new one. For most people, this procedure can be done quite easily.

Clinical trials

Research is being done into possible new treatments for gall bladder cancer. Your doctor may invite you to take part in a clinical trial. Cancer doctors use clinical trials to assess new treatments.

Having tests and treatment for cancer can be very stressful. You may have many different emotions, including anxiety, anger and fear. These are all normal reactions that many people go through when dealing with cancer.

Everyone has their own way of coping with difficult situations. Some people find it helpful to talk to family or friends, while others prefer to seek help from people outside their situation. Some people prefer to keep their feelings to themselves. There is no right or wrong way to cope, but help is there if you need it. Our cancer support specialists can give you information about counselling in your area.