Gallbladder Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Gallbladder Cancer

Gallbladder cancer is a rare type of cancer that starts in the tissues of the gallbladder.

Gallbladder cancer occurs when cells in the gallbladder start to grow out of control. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine.
Anatomy of the gallbladder. The gallbladder is just below the liver. Bile is stored in the gallbladder and flows through the cystic duct and the common bile duct into the small intestine when food is being digested.

The wall of the gallbladder has 4 main layers of tissue:

• mucosal (inner) layer
• muscle layer
• connective tissue layer
• serosal (outer) layer

Primary gallbladder cancer starts in the inner layer and spreads through the outer layers as it grows.

Signs and symptoms of gallbladder cancer include jaundice, fever, and pain.

These and other signs and symptoms may be caused by gallbladder cancer or by other conditions. Check with your doctor if you have any of the following:

• jaundice (yellowing of the skin and whites of the eyes)
• pain above the stomach
• fever
• nausea and vomiting
• bloating
• lumps in the abdomen

Gallbladder cancer is difficult to detect (find) and diagnose early.

Gallbladder cancer is difficult to detect and diagnose for the following reasons:

• People rarely have signs or symptoms in the early stages of 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. Although gallstones are the most common risk factor for developing gallbladder cancer, the overall risk is low. Most people with gallstones do not 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 staging.

To plan treatment, it is important to know if the gallbladder cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. In addition to asking about your personal and family health history and doing a physical exam, your doctor may perform the following tests and procedures:

• Liver function tests: A procedure in which a blood sample 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.
• 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.
• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
• Ultrasound exam: 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 abdominal ultrasound is done to diagnose gallbladder cancer.
• 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 drain bile into the small intestine or a collection bag outside the body.
• 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.
• MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Endoscopic ultrasound (EUS): A procedure in which an endoscope is inserted into the body, usually through the mouth or rectum. An endoscope is a thin, tube-like instrument with a light and a lens for viewing. A probe at the end of the endoscope is used to bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. This procedure is also called endosonography.
• 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. 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.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to 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.

Certain factors affect the prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on:

• 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 recurred (come back)

Treatment may also depend on the age and general health of the patient and whether the cancer is causing signs or symptoms.

Gallbladder cancer can be cured only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

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, diagnose, and stage gallbladder cancer.

There are three ways that cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.
• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.
• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if gallbladder cancer spreads to the liver, the cancer cells in the liver are actually gallbladder cancer cells. The disease is metastatic gallbladder cancer, not liver cancer.

The following stages are used for gallbladder cancer:

Stage 0 (Carcinoma in Situ)

In stage 0, abnormal cells are found in the mucosa (innermost layer) of the gallbladder wall. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.

Stage I

In stage I, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle layer of the gallbladder wall.

Stage II

Stage II is divided into stages IIA and IIB, depending on where the cancer has spread in the gallbladder.

• In stage IIA, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the side of the gallbladder that is not near the liver.
• In stage IIB, cancer has spread through the muscle layer to the connective tissue layer of the gallbladder wall on the same side as the liver. Cancer has not spread to the liver.

Stage III

Stage III is divided into stages IIIA and IIIB, depending on where the cancer has spread.

• In stage IIIA, cancer has spread through the connective tissue layer of the gallbladder wall and one or more of the following is true:
  • Cancer has spread to the serosa (layer of tissue that covers the gallbladder).
  • Cancer has spread to the liver.
  • Cancer has spread to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver).
• In stage IIIB, cancer has formed in the mucosa (innermost layer) of the gallbladder wall and may have spread to the muscle, connective tissue, or serosa (layer of tissue that covers the gallbladder) and may have also spread to the liver or to one nearby organ or structure (such as the stomach, small intestine, colon, pancreas, or the bile ducts outside the liver). Cancer has spread to one to three nearby lymph nodes.

Stage IV

Stage IV is divided into stages IVA and IVB.

• In stage IVA, cancer has spread to the portal vein or hepatic artery or to two or more organs or structures other than the liver. Cancer may have spread to one to three nearby lymph nodes.
• In stage IVB, cancer may have spread to nearby organs or structures. Cancer has spread:
  • to four or more nearby lymph nodes; or
  • to other parts of the body, such as the peritoneum and liver.

For gallbladder cancer, stages are also grouped according to how the cancer may be treated. There are two treatment groups:

Localized (Stage I)

Cancer is found in the wall of the gallbladder and can be completely removed by surgery.

Unresectable, recurrent, or metastatic (Stage II, Stage III, and Stage IV)

Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer have unresectable cancer.

Recurrent cancer is cancer that has recurred (come back) after it has been treated. Gallbladder cancer may come back in the gallbladder or in other parts of the body.

Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic gallbladder cancer may spread to surrounding tissues, organs, throughout the abdominal cavity, or to distant parts of the body.

Treatment Option Overview

There are different types of treatment for patients with gallbladder cancer.

Different types of treatments are available for patients with gallbladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

The following types of treatment are used:

Surgery

Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.

If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:

• Biliary bypass: If the tumor is blocking the bile duct and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the doctor will cut the gallbladder or bile duct in the area before the blockage and sew it to the small intestine to create a new pathway around the blocked area.
• Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin tube) to drain bile that has built up in the area. The doctor may place the stent through a catheter that drains the bile into a bag on 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-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are 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 jaundice before surgery.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward area of the body with cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic therapy).

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 website.

Radiation sensitizers

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.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells. The following targeted therapies are being studied in patients with gallbladder cancer that is locally advanced and cannot be removed by surgery or has spread to other parts of the body:

• Ivosidenib is a type of targeted therapy that blocks a specific mutation in a gene called IDH1. It works by slowing or stopping the growth of cancer cells.
• Pemigatinib is a type of targeted therapy that blocks specific changes in a gene called FGFR2. This may help keep cancer cells from growing and may kill them.

Immunotherapy

Immunotherapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

Immune checkpoint inhibitor therapy is a type of immunotherapy that may be used to treat gallbladder cancer.

• PD-1 and PD-L1 inhibitor therapy: PD-1 is a protein on the surface of T cells that helps keep the body's immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells.
  • Pembrolizumab is a type of PD-1 inhibitor that may be used in patients whose cancer is locally advanced and cannot be removed by surgery or has spread to other parts of the body.
  • Durvalumab is a type of PD-L1 inhibitor that is being studied in combination with chemotherapy in previously untreated patients whose cancer is locally advanced, recurrent, or has spread to other parts of the body.

Immune checkpoint inhibitor. Checkpoint proteins, such as PD-L1 on tumor cells and PD-1 on T cells, help keep immune responses in check. The binding of PD-L1 to PD-1 keeps T cells from killing tumor cells in the body (left panel). Blocking the binding of PD-L1 to PD-1 with an immune checkpoint inhibitor (anti-PD-L1 or anti-PD-1) allows the T cells to kill tumor cells (right panel).

Treatment for gallbladder cancer may cause side effects.

For information about side effects caused by treatment for cancer, visit our Side Effects page.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

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 recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI's clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

As you go through treatment, you will have follow-up tests or check-ups. Some tests that were done to diagnose or stage the cancer may be repeated to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

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 recurred (come back).

Treatment of Localized and Locally Advanced Gallbladder Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of localized and locally advanced gallbladder cancer may include:

• Surgery to remove the gallbladder and some of the tissue around it. Part of the liver and nearby lymph nodes may also be removed. Radiation therapy with or without chemotherapy may follow surgery.
• Radiation therapy with or without chemotherapy.
• A clinical trial of radiation therapy with radiosensitizers.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Treatment of unresectable, metastatic, or recurrent gallbladder cancer is usually within a clinical trial. Treatment may include:

• Percutaneous transhepatic biliary drainage or the placement of stents to relieve symptoms caused by blocked bile ducts. This may be followed by radiation therapy as palliative treatment.
• Surgery as palliative treatment to relieve symptoms caused by blocked bile ducts.
• Chemotherapy.
• A clinical trial of new ways to give palliative radiation therapy, such as giving it together with hyperthermia therapy, radiosensitizers, or chemotherapy.
• A clinical trial of targeted therapy or immunotherapy for patients with mutations (changes) in certain genes.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Gallbladder Cancer

For more information from the National Cancer Institute about gallbladder cancer, see the Gallbladder Cancer Home Page.

For general cancer information and other resources from the National Cancer Institute, visit:

• About Cancer
• Staging
• Chemotherapy and You: Support for People With Cancer
• Radiation Therapy and You: Support for People With Cancer
• Coping with Cancer
• Questions to Ask Your Doctor about Cancer
• For Survivors and Caregivers

About This PDQ Summary

About PDQ

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This PDQ cancer information summary has current information about the treatment of gallbladder cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

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Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

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A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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PDQ® Adult Treatment Editorial Board. PDQ Gallbladder Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/gallbladder/patient/gallbladder-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389400]

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Last Revised: 2024-01-18

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