Your gallbladder is a small sac located just under your liver on the right side of your abdomen. It stores and releases bile, which aids in food digestion.

Gallbladder cancer occurs when cancerous cells develop in the wall of the gallbladder. This disease is uncommon, with just 5,000 to 6,000 diagnoses in the U.S. each year. Gallbladder disease is aggressive and is often diagnosed at an advanced stage, making it difficult to treat.

To learn more about gallbladder cancer, we spoke with gastrointestinal medical oncologist Milind Javle, M.D., who specializes in treating cancers of the bile duct and gallbladder.

What are the symptoms of gallbladder cancer?

Symptoms of gallbladder cancer can include:

• abdominal pain or discomfort
• jaundice
• rapid weight loss

Gallbladder cancer symptoms often don’t appear in the early stages of the disease. And symptoms often mimic those of other conditions, like gallstones. It’s important to see your doctor if you experience any of the above symptoms.

What are the risk factors for developing gallbladder cancer?

Factors that may increase your chance of gallbladder cancer are:

• Ethnicity: In the U.S., it’s seen more in Hispanic Americans and Native Americans. Globally, it’s seen more in South Asians, East Asians and Latin Americans.
• Sex: It’s more likely to occur in females than males.
• Obesity: It’s more common in people with a higher body mass (obese).  
• Inflammatory bowel disease: Having ulcerative colitis or Crohn’s disease can increase your risk for gallbladder cancer.
• Gallstones: Multiple and/or large gallstones are often associated with gallbladder cancer. However, gallstones are very common, and gallbladder cancer is rare. Very few people with gallstones will actually develop gallbladder cancer.

How is gallbladder cancer diagnosed?

Typically, we’ll start with an abdominal ultrasound. This will show us if there’s any abnormal thickening of the gallbladder wall.

We may also do blood tests to see if there’s any elevation in blood count and to check liver function.

This can be followed by a CT scan to get a better picture of the tumor, its relationship to the liver, involvement of lymph nodes and so on.   

Gallbladder cancer is often misdiagnosed as bile duct cancer or liver cancer. So, it’s particularly important to see your doctor if you develop any symptoms and are at high risk.

How is gallbladder cancer staged?

Determining the stage of cancer helps your doctors plan the right course of treatment. Gallbladder cancer is staged using the TNM system, which stands for Tumor, Node, Metastasis. Under this system:

• T refers to the size of the tumor and how deep it has penetrated the gallbladder wall.
• N refers to whether the cancer has spread to the lymph nodes and if so, how many.
• M refers to whether the cancer has metastasized, or spread to other parts of the body.

Tumors are classified as T1 through T4. T1 and T2 are considered early-stage where cancer is confined to the gallbladder. T3 means the cancer is locally or regionally advanced, having spread to only nearby organs. T4 is metastatic, meaning the cancer has usually spread to distant places in the body.

Where does gallbladder cancer usually spread first?

The two most common places to which gallbladder cancer spreads are:

• the liver and lymph nodes, which are next to the gallbladder, and
• the peritoneum, which is the lining of the abdomen. This can cause distention and fluid in the belly.

Advanced gallbladder cancer can spread to other organs like the bones and lungs.

How is gallbladder cancer treated?

Surgery is used to treat early-stage gallbladder cancer. This is more involved than a simple cholecystectomy. It’s a complex procedure where we remove the gallbladder and surrounding structures, including part of the liver and lymph nodes. Following surgery, patients may receive chemotherapy and sometimes radiation to help prevent local and distant recurrence.

When gallbladder cancer is more advanced, like stages III or IV, we usually treat the patient with a combination of chemotherapy and immunotherapy. Sometimes, we’re able to do targeted therapy as well.

We do genetic profiling of gallbladder tumors, either at the time of surgery or at diagnosis for metastatic cancer. We look at the genetics of the tumor, not inherited genes from parents. About 20% of the time, we identify a gene we can target with a specific therapy.

What is the outlook for patients with gallbladder cancer?

Gallbladder cancer can be cured if it’s caught and treated very early. If it’s found before it spreads, it’s considered resectable and can be removed by surgery.

If gallbladder cancer is detected in its later stages, sometimes even stage II when surgery is performed, recurrence rates are high. Up to 40% to 50% of these patients will have a recurrence in the first two years. The prognosis is poor for patients diagnosed with advanced disease; the average rate of survival is less than a year.

What research is being done to advance gallbladder cancer treatment?

MD Anderson is at the forefront of developing targeted therapies for gallbladder cancer. From genetic profiling, we know that about 15% of gallbladder tumors have the HER2 gene, which is also seen in some types of breast cancer. We have several clinical trials targeting the HER2 gene in gallbladder cancer treatment.

We also have clinical trials studying targeted therapies and immunotherapies for other genetic alterations seen in gallbladder cancer. We see a lot of promising results coming from these studies that will allow us to offer more treatment options for gallbladder cancer.

What else should we know about gallbladder cancer?

MD Anderson used to see 30 to 40 patients a year with bile duct or gallbladder cancer. Today, that number is close to 400. While the gallbladder and bile duct are somewhat connected anatomically, gallbladder cancer and bile duct cancer are two different diseases. It’s important to seek care at a place like MD Anderson that specializes in diagnosing and treating gallbladder cancer.