Gall bladder cancer

Gall bladder cancer is a rare cancer of the digestive system. The gall bladder is a small pouch that stores bile. Bile is a fluid that helps us digest food. It helps to break down fats in food.

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

  • age
  • gallstones and inflammation
  • polyps (non-cancerous tumours of the gall bladder).

Early gall bladder cancer often does not cause any symptoms. It is often discovered when someone has surgery to remove gallstones. Later stages of gall bladder cancer may cause symptoms such as pain in the tummy (abdomen) or sickness. You may have scans, including an ultrasound, CT scan or MRI scan to diagnose gall bladder cancer that is causing symptoms.

The treatment you have depends on your general health, the position of the cancer, and whether it has spread to other areas of the body. Surgery, chemotherapy and radiotherapy may be used to treat gall bladder cancers.

You may be asked to take part in a clinical trial looking at new treatments for gall bladder cancers. Your doctor or specialist nurse can tell you about this.

What is gall bladder cancer?

Gall bladder cancer is rare. Just under 1000 people are diagnosed with it in the UK each year. It is rare in people under 50 and is most common in people over 75. It is 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 and break down fats. It is made by the liver and stored in the gall bladder. The gall bladder is connected to the small intestine and the liver by small tubes called the bile ducts.

The position of the gall bladder
The position of the gall bladder

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The gall bladder and the bile ducts together are called the biliary system. We have separate information about cancer that starts in the bile duct (cholangiocarcinoma).

Causes and risk factors of gall bladder cancer

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


Gall bladder cancer is more common in people over the age of 75.

Gallstones and inflammation

People with a history of gallstones or an inflamed gall bladder (cholecystitis) have a higher risk. But most people who have gallstones or an inflamed gall bladder do not develop gall bladder cancer.


These are non-cancerous (benign) tumours of the gall bladder. Having polyps increases the risk of developing gall bladder cancer.

Porcelain gall bladder

This is when calcium builds up in the wall of the gall bladder. People with this condition have a slightly increased risk.

Abnormal bile ducts

Gall bladder cancer is slightly more common in people born with abnormal bile ducts.


People who smoke cigarettes have a higher risk.


Being very overweight can also increase your risk.

Family history

Close relatives of people with gall bladder cancer have a slightly higher risk. A close relative is a parent, brother or sister.

Signs and symptoms of gall bladder cancer

Early gall bladder cancer does not usually cause symptoms. It is often found when someone has surgery to remove gallstones. But most people who have surgery for gallstones will not have gall bladder cancer.

Most gall bladder cancers are only found at an advanced stage. They can cause different 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)
  • 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 is important to get them checked by your doctor.

How gall bladder cancer is diagnosed

Gall bladder cancer may be diagnosed by chance during an operation to remove the gall bladder. This surgery is usually because of gallstones or inflammation.

Or you may be diagnosed after seeing your GP to have your symptoms checked. Your GP will then refer you to a hospital specialist. At the hospital, the specialist doctor will ask you about your general health and any previous medical problems. They will examine you and take blood samples. This is to check your general health and that your liver is working properly. They may also do the following tests:

Ultrasound scan

This uses soundwaves to build up a picture of the gall bladder and surrounding organs. You will usually be asked not to eat or drink anything for at least six hours before the scan. Once you are lying comfortably on your back, a gel is spread onto your tummy (abdomen). A small device that produces soundwaves is then passed over the area. The soundwaves produce a picture on a computer. The test is painless and only takes a few minutes.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional (3D) picture of the inside of the body. It is painless and takes 10 to 30 minutes. It uses a small amount of radiation, which is very unlikely to harm 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. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

MRI (magnetic resonance imaging) scan

This test is similar to a CT scan, but it 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 is safe for you to have an MRI scan.

Before the scan, you will 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. It can help the images from the scan show up more clearly. During the test, you will be asked to lie still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic during the scan. It is also noisy, but you will be given earplugs or headphones so you can listen to music. You will be able to hear and speak to the person operating the scanner.

An MRCP (magnetic resonance cholangiopancreatography) 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 uses x-rays to look at the gall bladder and bile ducts. Your doctor may also look at the ducts that connect the pancreas (see diagram above) to the small bowel.

You will be asked not to eat or drink anything for about six hours before the test. This is 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. Rarely, it may be done using a general anaesthetic.

The doctor will then pass a thin, flexible tube called an endoscope through your mouth. This goes 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 helps to show 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 other organs. It may also be used to take a sample of tissue (biopsy).

PTC (percutaneous transhepatic cholangiography)

This procedure can also be used to take an x-ray picture of the bile ducts. You will be asked not to eat or drink anything for about six hours before the test. You will be given a sedative in the same way as you would before an ERCP.

Your doctor will give you an injection of local anaesthetic to numb the area to the right of your tummy (abdomen). They carefully pass a thin needle through the skin. This goes into your liver and injects a dye which flows through the bile ducts. This helps shows any abnormality or blockages more clearly. You may feel some discomfort as the needle enters the liver.

You will be given antibiotics before and after the procedure to help prevent infection. You will need to stay in hospital for at least one night afterwards.


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

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

After a laparoscopy, you will have one or two stitches in your tummy. You may have uncomfortable wind or shoulder pains for several days after the operation. You can often ease the pain by walking or taking sips of peppermint water.

Someone having a CT scan

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Having a CT scan

A radiographer explains how a CT scan works, and Jyoti talks about her experience.

About our cancer information videos

Staging and grading of gall bladder cancer


The stage of a cancer describes its size and whether it has spread from where it started. Knowing the stage of the cancer helps 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.

Stage 2

The cancer has spread through the wall of the gall bladder, but not 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 as 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).

If the cancer comes back after it was first treated, it is known as recurrent cancer.


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 similar to 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.

Treatment for gall bladder cancer

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.


You will be referred to a surgeon who is a specialist in gall bladder cancer. If the cancer is found at an early stage, the aim of treatment is usually to cure the cancer. If it is not possible to remove all the cancer, the surgeon removes as much as possible to help control the cancer and improve symptoms.

Sometimes doctors find the cancer by chance when they are doing keyhole surgery to remove the gall bladder (laparoscopic cholecystectomy). If this happens, they change the operation to open surgery. They remove the gall bladder and surrounding tissues through a larger cut in the tummy. This makes it easier to remove all the cancer.

A cancer may also be found after surgery for gallstones when doctors examine the gall bladder. If this happens, you may need further surgery to try to make sure all the cancer is removed. 

If the cancer has spread outside the gall bladder, you may have a larger operation called a radical cholecystectomy to remove:

  • the gall bladder
  • the surrounding tissues
  • the lymph nodes and parts of other organs.

After your operation, you will 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 operation.

Some people may have problems with bloating, wind or diarrhoea after their gall bladder has been removed. These problems usually improve within a few weeks. Tell your doctor or nurse if you have any of these problems. They can give you advice and medicines to help.


Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy the cancer cells.

Chemotherapy may be used after surgery if the surgeon cannot remove all the cancer. It may also be used if surgery is not possible or if the cancer has come back after surgery.

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 gemcitabine (Gemzar®) and cisplatin.

Side effects of chemotherapy

The side effects depend on the drug or combination of drugs you are given. Your doctor or nurse will tell you the drugs you are going to have and the likely side effects.

Chemotherapy drugs can reduce the number of white cells in your blood during treatment. This will make you more likely to get an infection. It is very important to contact the hospital straight away if you have any signs of infection. Your doctor or nurse will give you advice about what to do if this happens.

Chemotherapy can also cause other side effects, such as:

Let your doctor or nurse know about any side effects during treatment. They can give you advice and help to reduce these.

We have more information about coping with the side effects of chemotherapy and about different chemotherapy drugs.


Radiotherapy uses high-energy x-rays to destroy the cancer cells, while doing as little harm as possible to normal cells. It may be used to relieve symptoms if gall bladder cancer has spread. You may only need a few treatments and the side effects are usually mild. We can send you more information about radiotherapy.

Blockages and stents

If the cancer is blocking your bile duct, this can often be treated with a flexible plastic or metal tube called a stent. The stent holds the duct open, so it is no longer blocked.

Bile duct stents are usually put in using an ERCP. The doctor can see the narrowing caused by the blockage in the bile duct by looking at x-rays. They stretch the narrowing using dilators (small inflatable balloons). They then insert the stent through the endoscope so the bile can drain. If you have any discomfort while this is being done, it is important to let your doctor know.

If a stent can’t be passed into the bile duct during an ERCP, the doctor may do a PTC instead. This involves inserting the stent through the skin (percutaneous) and liver (transhepatic) into the top of the bile duct, using a needle and tube.

The doctor injects some local anaesthetic into the skin to numb it. They then insert a long, thin, flexible needle through the skin into the liver. The doctor looks at x-ray images on a screen to help them guide the needle to the bile duct and inject a dye.

You may feel warm all over when the dye is injected. This is normal and the feeling wears off quickly.

The dye flows through the ducts, showing the area that is blocked. The doctor passes a fine guide wire along the needle into the blockage in the bile duct. A stent is then passed along this wire. The stent holds open the bile duct where it has narrowed, allowing fluid to flow through it again. You may feel some pushing when the wire and stent are being put in. If this is uncomfortable or painful, let the doctor know so that you can be given painkillers.

To help prevent infection, you will be given antibiotics before and after the procedure. You will probably need to stay in hospital for a few days.

Sometimes a stent needs to be replaced if it becomes blocked or gets infected. If a plastic stent has been in place for a long time, it may need to be replaced with a new one.

Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. You may be asked to take part in a clinical trial. Your doctor will discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. Our information about clinical trials may help you decide.


After your treatment, you will have regular check-ups and possibly scans or x-rays. These may continue for several years. Let your doctor know as soon as possible if you have any problems or notice new symptoms between these times.

Your feelings

You may have many different emotions, including anxiety, anger and fear. These are all normal reactions. They are part of the process that many people experience 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. Others may 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 and other organisations, like the NET Patient Foundation, can give you information about counselling in your area.