What is Gallbladder Cancer?

What is Gallbladder Cancer?

Gallbladder cancer begins when abnormal cells grow in the gallbladder—a small, pear-shaped organ located beneath the liver on the right side of the abdomen. This organ plays a key role in digestion by storing bile, a fluid produced by the liver to help break down food.

Although gallbladder cancer is relatively rare, early detection significantly improves the chances of successful treatment. Unfortunately, most cases are diagnosed at a later stage, after the cancer has spread beyond the gallbladder, which often leads to a poor prognosis.

One of the challenges in identifying gallbladder cancer early is that it typically causes no noticeable symptoms in its initial stages. When symptoms do appear, they often resemble those of more common digestive issues. Additionally, because the gallbladder is tucked deep within the body, tumors can grow undetected for some time.

The cure rate for gallbladder cancer is excellent if it’s in the early stages when it can removed with surgery. Unfortunately, most people don’t receive a diagnosis until the cancer has spread beyond their gallbladder.

Types of gallbladder cancer

Gallbladder cancer is classified based on the type of cell where it originates. Pathologists determine the cancer type by examining tumor cells under a microscope.

Gallbladder Adenocarcinoma:

Adenocarcinoma accounts for about 90% of gallbladder cancer cases. It begins in the gland-like cells lining the gallbladder. There are three subtypes:

• Nonpapillary adenocarcinoma – the most common form.
• Papillary adenocarcinoma – rare and less likely to spread, offering a better prognosis.
• Mucinous adenocarcinoma – extremely rare, arising from mucin-producing cells.

Other Rare Types

Less common forms of gallbladder cancer include:

• Adenosquamous carcinoma
• Squamous cell carcinoma
• Carcinosarcoma

These types are uncommon but important to recognize for accurate diagnosis and treatment planning.

Stages of Gall Bladder cancer

Gallbladder cancer is classified by type and stage, which helps guide treatment decisions. Staging reflects how far the cancer has progressed, based on tumor size, location, and spread.

Cancer Stages

• Stage I: Cancer is limited to the inner lining of the gallbladder.
• Stage II: Cancer has grown into the outer layers of the gallbladder.
• Stage III: Cancer has spread to nearby organs (like the liver or stomach) and possibly lymph nodes.
• Stage IV: The most advanced stage, involving multiple organs or distant metastasis.

Treatment Groups

• Localized (Stage I): Cancer is confined and may be treated with surgery.
• Unresectable, Recurrent, or Metastatic (Stages II–IV): Cancer has spread and may require a combination of therapies such as chemotherapy, radiation, or palliative care.

Understanding the stage helps doctors tailor a treatment plan to each patient’s unique needs.

Causes of Gall Bladder

Gallbladder cancer is rare, and its exact causes are not fully understood. However, several risk factors have been identified that may increase the likelihood of developing this disease.

Key Risk Factors

• Age & Gender: Most cases occur in people aged 85–89. Women are more affected than men, accounting for 71% of diagnoses.
• Gallstones & Inflammation: Chronic gallbladder conditions, especially gallstones and cholecystitis, significantly raise the risk.
• Family History: Having close relatives with gallbladder cancer increases your risk, though the overall likelihood remains low.
• Porcelain Gallbladder: A rare condition caused by repeated inflammation, leading to calcium buildup in the gallbladder wall.
• Primary Sclerosing Cholangitis (PSC): A rare bile duct inflammation linked to a slightly increased risk.
• Smoking
• Obesity: Excess weight can alter hormone levels and increase the chance of gallstones, both of which raise cancer risk.
• Pancreas & Bile Duct Abnormalities: Rare congenital conditions like choledochal cysts and pancreaticobiliary maljunction may contribute.
• Gallbladder Polyps: Larger polyps (over 1 cm) have a higher chance of becoming cancerous.
• Diabetes: May elevate the risk of gallbladder and bile duct cancers.
• Alcohol Consumption: Heavy drinking increases risk; moderation lowers it.
• Ionising Radiation: Exposure from medical scans like X-rays and CTs carries a small risk but is carefully managed by healthcare providers.

Symptoms of gallbladder cancer

Most of the gallbladder cancers are detected during diagnosis or treatment of other problems of the gallbladder or the liver. These cancers do not show any signs in the beginning and the symptoms do not appear until the advanced stages. Following are the most common symptoms of gallbladder cancer that a patient might experience:

Screening & Diagnosis

Gallbladder cancer is hard to find in its early stages, the organ is located deep in the body and tumours cannot be seen or felt during routine examinations. Gallbladder cancer has no reliable screening tests to detect the cancer early and so these are usually detected after the tumour has grown enough to show symptoms. The few cases that are detected early are due to other conditions related to the gallbladder such as gallstones or inflammation. There are no early signs of gallbladder cancer noticeable other than the above-mentioned conditions.

To diagnose gallbladder cancer and determine how far it has spread (a process called staging), doctors use a combination of imaging tests, lab studies, and procedures. These help assess whether the cancer can be surgically removed and guide treatment planning.

Common Diagnostic Tests and Procedures

• Liver Function & Blood Chemistry Tests: Measure substances in the blood to detect liver issues or other abnormalities.
• CT Scan: Produces detailed cross-sectional images of the chest, abdomen, and pelvis to locate tumors.
• Ultrasound: Uses sound waves to create images of the gallbladder and nearby organs.
• PTC (Percutaneous Transhepatic Cholangography): X-rays the liver and bile ducts using injected dye to detect blockages.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Examines bile ducts via an endoscope and may include stent placement or tissue sampling.
• MRI with Gadolinium: Offers high-resolution images enhanced by contrast dye to highlight cancer cells.
• Endoscopic Ultrasound (EUS): Combines endoscopy and ultrasound to visualize internal tissues and guide biopsies.
• Laparoscopy: A minimally invasive surgery to inspect abdominal organs and determine cancer spread.
• Biopsy: Removes tissue samples for microscopic examination to confirm cancer diagnosis.

Treatment

Gallbladder cancer treatment depends on the stage and whether the cancer can be surgically removed. Common approaches include surgery, radiation, chemotherapy, and emerging therapies.

Surgery

• Cholecystectomy: Removal of the gallbladder and surrounding tissues, often guided by laparoscope.
• Palliative Surgery: Used when cancer cannot be removed, to relieve symptoms:
  • Biliary bypass: Creates a new bile flow path around a blockage.
  • Endoscopic stent placement: Inserts a tube to drain bile.
  • Percutaneous transhepatic biliary drainage: Uses imaging to place a stent for bile drainage.

Radiation Therapy

Uses high-energy rays to destroy or slow the growth of cancer cells. Typically delivered externally.

Chemotherapy

Uses drugs to kill or stop the division of cancer cells. Administered orally or via injection to reach cancer cells throughout the body.

Targeted Therapy

• Ivosidenib: Targets IDH1 gene mutations to slow cancer growth.
• Pemigatinib: Blocks FGFR2 gene changes to inhibit cancer cell development.

Immunotherapy

Boosts the body’s immune system to fight cancer.

• PD-1/PD-L1 Inhibitors: Help immune cells recognize and destroy cancer cells.
• Pembrolizumab: A PD-1 inhibitor for advanced or metastatic cases.
• Durvalumab: A PD-L1 inhibitor under study with chemotherapy for advanced or recurrent cancer.

Survival rate

Gall bladder cancer remains a highly lethal disease, with only 10% of all patients are upfront resectable. People diagnosed with early GBC typically have a 5-year survival rate of 30%-40%, whereas individuals with locally advanced lesions have a one-year survival rate of around 10%.

The 5-year relative survival rate for gallbladder cancer was generally higher in Asian populations than in other regions. Survival rates were more favorable in younger individuals, with no differences in survival observed between the sexes.