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Gallbladder cancer

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From MayoClinic.com

When to seek medical advice

Check with your doctor if you develop any of the signs or symptoms of biliary tract problems, such as:

Although these signs and symptoms are usually not related to cancer, they may indicate other conditions that require medical care.

Screening and diagnosis

Many gallbladder cancers are discovered when a pathologist examines a gallbladder that has been removed for symptoms of gallstones. But many gallbladder and most bile duct cancers are found only after related signs and symptoms appear.

If you develop any of the symptoms of biliary tract cancer, your doctor will talk with you about your medical history and conduct a thorough physical exam. You'll also likely have one or more of the following tests:

  • Blood tests. Your doctor may order tests to check for elevated levels of bilirubin or the enzyme alkaline phosphatase. You might also have tests to measure certain substances (markers) in your blood that sometimes indicate the presence of a tumor. People with bile duct cancer tend to have high levels of the marker CA 19-9. But CA 19-9 levels can be elevated in people with other types of cancer as well as in people who are cancer-free. For that reason, this isn't considered a definitive test.

  • Ultrasound. This test uses high-energy sound waves to produce images of your internal organs, including your gallbladder. It has no side effects, is not invasive and generally takes less than 30 minutes. While you lie on a bed or table, a wand-shaped device (transducer) is placed on your body. It emits high-frequency (nonaudible) sound waves that are reflected from your gallbladder back to the transducer and then translated into a moving image. Ultrasound is usually one of the first tests done in the evaluation of patients with jaundice and is especially good at diagnosing the presence of gallstones and obstructed bile ducts. It can also show the presence and extent of tumors. Endoscopic ultrasound is a technique that can sometimes provide even better images. In this test, an ultrasound transducer is attached to the end of a flexible, lighted viewing tube known as an endoscope. The endoscope is gently passed down your throat into your stomach and duodenum, and from there into the common bile duct.

  • Computerized tomography (CT) scan. This is essentially a highly detailed X-ray that allows your doctor to see your gallbladder in two-dimensional "slices." Split-second computer processing creates these images while a series of thin X-ray beams pass through your body. In most cases, you will have a dye (contrast medium) injected into a vein before the test. By helping to produce clearer images, the dye makes it easier to distinguish a tumor from normal tissue. A CT scan can also help determine if cancerous cells have spread to the common bile duct, lymph nodes or liver.

  • Magnetic resonance imaging (MRI). Instead of X-rays, this test uses a powerful magnetic field and radio waves to create images. Used in combination with cholangiography — a test in which a small amount of dye is used to highlight the biliary tract — it can help determine whether the flow of bile is blocked or a tumor has invaded the liver. During the test, you're encased in a cylindrical tube that can seem quite confining to some people. The machine also makes a loud thumping noise you might find disturbing. In most cases you'll be given headphones for the noise. If you're claustrophobic, ask your doctor whether another scanner or some mild sedation may be an option for you. 

  • Endoscopic retrograde cholangiopancreatiography (ERCP). In this procedure, an endoscope is gently passed down your throat, through your stomach and into the upper part of your small intestine. Air is used to inflate your intestinal tract so that your doctor can more easily see the openings of the bile and pancreatic ducts. A dye is then injected into these ducts via a catheter that's passed through the endoscope. Finally, X-rays are taken of the ducts. Your throat may be sore for a time after the procedure, and you may feel bloated from the air introduced into your intestine. Major complications are rare and include infection and bleeding. This test is most sensitive for detecting an obstruction of the bile ducts and its cause, and can also be used in preparation for surgery. ERCP can also allow a biopsy to be performed, confirming a diagnosis.

  • Laparoscopy. A somewhat more invasive procedure than ERCP, laparoscopy also uses a small, lighted instrument (laparoscope) to view your gallbladder, liver and surrounding tissue. But in this case, the instrument is attached to a television camera and inserted through a small incision in your abdomen. During this procedure, your surgeon can also take tissue samples to help confirm the diagnosis of cancer. Laparoscopy is often used to confirm how far the cancer has spread.

  • Angiography. In this test, a small tube (catheter) is inserted into a blood vessel — usually in your groin — and gently threaded to the area to be studied. A dye is then inserted into the catheter and X-rays track the dye as it flows through your blood vessels. This test is sometimes performed to show surgeons the exact location of blood vessels near a bile duct cancer.

  • Biopsy. In this procedure, a small sample of tissue is removed and examined for malignant cells under a microscope. It's the only way to make a definitive diagnosis of cancer. Biopsies of the gallbladder and bile ducts can be obtained in several ways. Your doctor may take tissue samples during laparoscopy. Or he or she may choose to perform a fine-needle aspiration (FNA) — a procedure in which a very thin needle is inserted through your skin and into your gallbladder. An ultrasound or CT scan is often used to guide the needle's placement. When the needle has reached the tumor, cells are withdrawn and sent to a lab for further study. Tissue samples can also be removed during or after gallbladder surgery. Bile duct cells and tiny fragments of duct tissue can be obtained through a procedure known as biliary brushing. As in ERCP, an endoscope is inserted into the bile duct where it empties into your small intestine. But instead of injecting dye and taking X-rays, your surgeon uses a small brush placed in the endoscope to scrape cells and bits of tissue from the lining of the bile duct.

Staging biliary tract cancers

Staging tests help determine the size and location of cancer and whether it has spread. This helps your doctor determine the best treatment for you.

Doctors stage biliary tract cancers in several ways. One method of classifying stages is as follows:

  • Resectable. This is cancer found only in the tissues that make up the walls of the gallbladder or bile ducts. The cancer can be entirely removed during an operation. The term resectable refers to a cancer that can be removed.

  • Unresectable. At this stage, the cancer has spread to nearby lymph nodes or organs such as the liver, pancreas, stomach or intestines. All the cancer cannot be removed during an operation.

  • Recurrent. This refers to cancer that returns after it has been treated. It may recur in the gallbladder or bile duct or in some other part of the body.


A tumor that blocks the bile duct can cause pain, jaundice, nausea and vomiting. Tumors located where the pancreatic duct enters the small intestine may block the small intestine, preventing normal passage of food. Or tumors may make it difficult to digest and absorb nutrients from the food you eat by blocking the flow of pancreatic enzymes.

The most serious complication of biliary tract cancer is metastasis. Your gallbladder and bile ducts are surrounded by a number of vital organs, including your liver, stomach, pancreas and intestines. Because biliary tract cancers are rarely discovered in the early stages, they often have time to spread to these organs or to nearby lymph nodes.

Gallbladder cancer > 1 > 2 > 3 > 4

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