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JAMA Patient Page
September 25, 2018

Gallbladder Cancer

JAMA. 2018;320(12):1294. doi:10.1001/jama.2018.11815

Gallbladder cancer is an uncommon disease that is associated with gallstones and chronic gallbladder inflammation.

Gallbladder cancer is more common in women, older patients, and Native Americans. Although most people with gallbladder cancer have gallstones, only 1 in 200 people with gallstones develop gallbladder cancer. As the tumors grow, they obstruct the flow of bile from the gallbladder and liver to the intestine. This causes backup of bile into the liver and eventually into the bloodstream, causing jaundice, a condition in which the skin turns yellow.

Symptoms and Diagnosis

Gallbladder cancer is dangerous because it is often diagnosed late in its course, when the tumors are already large enough to cause blockage and invade nearby structures. Most of the time it is found only when a patient is having surgery for gallstones. The cancer can also present with subtle, vague symptoms like loss of appetite, chronic abdominal discomfort, weight loss, itching (pruritus), yellowing of the whites of the eyes (scleral icterus), and jaundice. The last 3 signs are caused by high levels of bile in the blood that deposit into tissues. Unlike certain other cancers, there are no tests or procedures that are used routinely for early detection or prevention of gallbladder cancer.

The diagnosis is made based on a combination of history and physical examination, laboratory tests, radiologic imaging (ultrasound, computed tomography, magnetic resonance imaging, and/or positron emission tomography), and biopsy. Often, a procedure called endoscopic retrograde cholangiopancreatography (ERCP) is used to temporarily relieve the obstruction caused by the tumor. In some cases, endoscopic ultrasound (EUS) is used to obtain a biopsy for diagnosis.

Treatment

The first step after diagnosing gallbladder cancer is to determine if it is limited to the gallbladder and ducts (localized) or if it spread to other organs in the body (metastatic). If the disease is localized, surgery is the only treatment that offers a possibility of cure. If the tumor is too large, sometimes chemotherapy can be used to shrink it so that surgery can be easier and safer. The operation can be involved and requires a prolonged recovery time. Typically, a radical cholecystectomy is performed; this involves removing the gallbladder along with a small amount of adjacent liver and lymph nodes. Very rarely, a more extensive operation is needed to remove parts of the small bowel and the pancreas (Whipple procedure). If the cancer was found while performing a cholecystectomy, a second operation to remove parts of the liver and lymph nodes may be necessary.

Some patients may need chemotherapy after surgery. If the disease is metastatic at the time of diagnosis, usually surgery is not indicated and chemotherapy is the first choice of treatment.

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Article Information

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Sources: Downing SR, Cadogan K, Ortega G, et al. Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection. Arch Surg. 2011;146(6):734-738.

Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;6:99-109.

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