Screening and Diagnosis
Gallbladder Cancer Risk Factors
The cause of gallbladder cancer is unknown, but risk factors may include:
- Gallstones: Gallstones are the most common risk factor for gallbladder cancer. Three out of four patients with gallbladder cancer also experience gallstones and an inflamed gallbladder. If you have a large gallstone, rather than several small stones, cancer is more likely to develop. Experts believe this is because the gallstones irritate the gallbladder wall. However, gallstones are common and most people with gallstones do not develop cancer.
- Porcelain gallbladder: This condition occurs when the walls of the gallbladder are hardened by calcium buildup.
- Sex assigned at birth: In the U.S. gallbladder cancer affects people who are assigned female at birth twice as often as it affects people assigned male at birth.
- Age: Gallbladder cancer is more common in people over age 65.
- Ethnicity: Gallbladder cancer occurs most often in Hispanic people of Mexican descent and Native American people.
- Contact with carcinogens (substances that cause cancer): Toxins are filtered through the liver and excreted into bile, which flows through the gallbladder. Exposure to them can increase your risk of cancer.
- Weight: Research has indicated a link between obesity and developing gallbladder cancer. Obesity also increases the risk of gallstones.
- Gallbladder polyps (growths on the gallbladder wall): Polyps that are bigger than half an inch may be more likely to develop into cancer.
- Abnormalities in the bile duct: The bile duct carries bile from the liver to the gallbladder, then through the pancreas to the small intestine. If the bile duct is abnormal, bile may flow more slowly through the gallbladder. This condition may also allow pancreatic juices to reach the gallbladder.
Diagnosing Gallbladder Cancer
Your care team will use a variety of leading-edge methods to diagnose pancreatic cancer.
Tests and imaging to diagnose gallbladder cancer may include:
- Ultrasound or endoscopic ultrasound (EUS): This uses high-frequency sound waves to create an image of the internal organs to assess blood flow through various vessels. The ultrasound may be done with an external or internal device (endoscopic).
- Computed tomography scan (CT scan): This diagnostic imaging procedure uses a combination of X-rays and computer technology to produce images of the body. CT scans are more detailed than general X-rays.
- Magnetic resonance imaging (MRI): Using large magnets, radiofrequencies and a computer, an MRI produces detailed images of organs and structures in the body.
- Cholangiography: This procedure combines X-ray and an endoscope (a long, flexible, lighted tube guided through the digestive tract) to diagnose and treat problems in the liver, gallbladder, bile ducts and pancreas.
- Percutaneous transhepatic cholangiography (PTC): A needle is put through the skin and into the liver where the dye (contrast) is injected so that the bile duct structures can be seen by X-ray.
- Gallbladder biopsy: A sample of gallbladder tissue is removed, with a needle or during surgery, to be examined under a microscope for cancerous cells.
- Laparoscopic cholecystectomy: Minimally invasive surgical removal of the gallbladder.
- Special blood tests: Blood tests can show how your liver is functioning and if you have tumor markers that could indicate gallbladder cancer.
Stages of Gallbladder Cancer
“Staging” is the term oncologists use to define where gallbladder cancer is located and how much it has spread. After the stage of gallbladder cancer is determined, your physician can recommend a particular course of treatment.
Most cancer teams use the system developed by the American Joint Committee on Cancer, known as the TNM staging system.
T = Tumor
Where is the primary tumor and how large is it?
N = Nodes
Has the tumor spread to nearby lymph nodes (part of your immune system)?
M = Metastasis
Has cancer spread to other parts of the body?
For each letter, there are five numbered stages, from zero to four, depending on how much the cancer has spread. The lower the number, the more the cancer cells look like normal cells and the easier they are to treat and cure. A higher number means it has spread more deeply.
The place where cancer forms is called the primary site. Cancer can spread from the primary site to other parts of the body. Even if gallbladder cancer is found in other parts of your body, it’s still considered gallbladder cancer. For example, if gallbladder cancer has spread to the liver, it’s called metastatic gallbladder cancer, not liver cancer.
For treatment, physicians often use a simpler system of categorizing gallbladder cancer:
- Resectable cancer: These cancers can be surgically removed (resected).
- Borderline resectable cancer: These cancers can be surgically removed but are very close to major blood vessels or other important parts of your body.
- Locally advanced cancer: These cancers are still only in the area around the pancreas, but they cannot be removed completely with surgery, often because they are growing into nearby blood vessels. This category is also called unresectable because the cancer cannot be removed with surgery.
- Metastatic cancer: These cancers have spread to other parts of the body, so they cannot be removed completely with surgery (meaning they are also unresectable). Surgery may still be done, but it's used to relieve symptoms that the tumors in other areas of the body are causing.
Talk to your physician about your stage of cancer and how that will impact your treatment.