There are a few different ways your doctor can determine if you have developed gallbladder cancer.
Gallbladder cancer often doesn’t show signs or symptoms in its early stages, making diagnosis more challenging and treatment of utmost importance.
The OSUCCC – James team of gallbladder cancer experts uses the latest in medical technology to diagnose and stage gallbladder cancer. Innovations in diagnosis and treatment are also helping doctors find cancer earlier and work toward better outcomes.
Gallbladder and bile duct cancer risk factors
While doctors and cancer researchers aren’t certain what causes gallbladder and bile duct cancers, they do know that these cancers develop when abnormal cells grow and replicate out of control and form a tumor. There are certain risk factors that can increase the likelihood that this cancer may happen in some.
Specific risk factors for developing gallbladder and bile duct cancers include your age, sex, history of gallbladder-related conditions or diseases, and prior indications of gallstones. It’s important to remember that just because you may be at risk, it doesn’t mean you’ll develop the disease.
However, if you have any unusual symptoms, you should talk to your doctor.
Diagnosing gallbladder and bile duct cancers
Because gallbladder and bile duct cancers often don’t present symptoms in their early stages, doctors may reference your family history and your history of gallbladder-related conditions. However, if you’re at risk or suspected of having it, your doctors may use a variety of tests and screenings to rule out a cancer diagnosis.
Blood and laboratory tests for gallbladder cancer
Depending on your risk factors, preexisting conditions or genetic history, doctors may recommend one of two different tests for gallbladder cancer. These tests can help doctors understand more about your liver’s function and what may be causing symptoms, which is important as bile (a digestive fluid) is produced in the liver and stored in the gallbladder.
Liver function test
Using a blood sample, doctors use this test to measure substances in the blood released by your liver. If a higher-than-normal amount of a particular substance is detected, it may be a sign of liver disease caused by gallbladder cancer.
Blood chemistry analysis
Blood chemistry tests are done so that doctors can measure substances in your blood. In most cases, this will be a lab test to determine levels of bilirubin in the blood; higher levels of bilirubin may be an indication that the gallbladder isn’t functioning properly. Additionally, a higher or lower than normal amount of a substance could be a sign of disease in the organ or tissue that creates it.
Imaging exams for gallbladder cancer
Your doctor may use one of several different imaging tests to get detailed pictures of your gallbladder. These exams can be used to diagnose and determine the staging of gallbladder cancer.
Computed tomography (CT) scan
This imaging test uses X-ray technology to produce detailed images of the body. To help create the images, your doctor may administer a dye via injection or ask you to swallow a liquid mix that includes dye so that images of your abdominal organs and tissues appear clearly.
Ultrasound exam
Ultrasound imaging scans use sound waves rather than X-ray technology to help doctors examine areas inside the abdomen.
Endoscopic ultrasound
An endoscopic ultrasound uses ultrasound waves, which produce images of the organs and tissues inside your abdomen. Your doctor can also biopsy a tumor (to determine if it’s cancerous) with endoscopic ultrasound while using the endoscope.
Magnetic resonance imaging (MRI)
During an MRI screening, high-powered magnets and radio waves produce detailed images of the abdomen for your doctor.
Positron emission tomography (PET) scan
PET scans use a small amount of radioactive agent, along with a special imaging camera, to find areas of cancerous activity in your body (cancerous cells will appear brighter on PET imaging).
Cholangiography scan
Your doctor may order a cholangiogram to determine if your bile ducts are blocked, dilated or narrowed as a tumor may impact or block bile ducts. There are two different types of cholangiograms, known as PTCs and ERCPs.
Percutaneous transhepatic cholangiography (PTC): A PTC scan uses a special dye (administered via injection) to examine your liver and bile ducts. Your doctor may drain bile using a special stent if a blockage is discovered.
Endoscopic retrograde cholangiopancreatography (ERCP): Your doctor will use an endoscope to generate X-ray images of your pancreatic ducts to determine if they are narrowed or blocked. A stent may be placed in the ducts (while the endoscope is in use) to take tissue samples for biopsy.
Exploratory surgery (laparoscopy)
Using a thin, illuminated tube inserted through a small incision in your abdomen, doctors can examine your abdomen on a monitor. The monitor will also guide your surgeon to the gallbladder (or other nearby organs) to take samples for biopsy or remove it all together if cancer is suspected.
Biopsy
Your doctor can examine tissue from the gallbladder and bile ducts to diagnose and determine the staging of your cancer. You may also receive a needle biopsy for tissue collection, which does not require anesthesia.
Tumor marker test
Substances produced by cancer cells, which can sometimes be found in the blood, are known as tumor markers. If you have gallbladder cancer, there may be a higher-than-normal level of CA 19-9 or CEA in your blood; while these markers are not specific to gallbladder cancer, higher levels of the marker may indicate an advanced stage of cancer.
CA 19-9 (or carbohydrate antigen 19-9) blood tests may offer doctors clues about the presence and development of cancer. Postdiagnosis, your doctor may conduct further tumor marker tests to see how the cancer is responding to treatment.
The stages of gallbladder cancer
Determining the stage of gallbladder cancer is an important step for your doctor. This will help you understand surgical and treatment options, as well as other therapies that may help control the spread of cancer.
Almost all gallbladder cancers develop in the inner wall of the gallbladder, known as the epithelium. Staging begins with stage 0 (early stage) up to stage IV (more advanced), with staging determined using the TNM system. The size of the tumor (T), whether it has spread to nearby lymph nodes (N) and metastasized/spread to other areas of the body (M) factor into how advanced your gallbladder cancer is.
Stage I gallbladder cancer
This indicates cancer has spread beyond the inner (mucosal) layer, typically to a layer with blood vessels or muscles.
Stage II gallbladder cancer
This stage of cancer means there is detected spread beyond the muscle layer of the gallbladder and into the surrounding connective tissue.
Stage IIIA gallbladder cancer
Stage III comprises two stages. In stage IIIA, cancer has spread to the thin tissue layers that cover the gallbladder and/or to one nearby organ or the liver. Nearby organs may include the stomach, small intestine, pancreas, colon or bile ducts outside of the liver.
Stage IIIB gallbladder cancer
This stage of gallbladder cancer indicates spread to nearby lymph nodes and at least one other area. Those areas may be:
- An area beyond the inner layer of the gallbladder to a layer with blood vessels or a muscle layer.
- Beyond the muscle layer to connective tissue around the muscle.
- Through the thin layers of tissue covering the gallbladder and/or to the liver or one nearby organ. Nearby organs include the stomach, small intestine, colon, pancreas or bile ducts outside the liver.
Stage IVA gallbladder cancer
There are two substages of stage IV gallbladder cancer. In stage IVA, cancer has metastasized (spread) to a main blood vessel of the liver, or to two or more nearby organs other than the liver. Cancer may also have spread to nearby lymph nodes.
Stage IVB gallbladder cancer
There are two ways doctors will determine if your gallbladder cancer has reached stage IVB, considered the most advanced stage.
Cancer is diagnosed as stage IVB if it has spread to:
- Lymph nodes along large arteries in the abdomen and/or near the lower part of the backbone.
- Or, to other organs or areas that are far from the gallbladder.
Doctors can also classify your gallbladder cancer based on how they plan to treat it, and if it can be surgically removed.
Localized gallbladder cancer
Localized gallbladder cancer is in its early stages, typically in stage I, and can be completely removed by surgery.
Unresectable, recurrent or metastatic gallbladder cancer
These types of gallbladder cancer are identified when they are in stages II, III or IV.
- Unresectable cancer makes up most bladder cancer diagnoses. This means that cancer cannot be removed by surgery.
- Recurrent cancer is cancer that has returned following treatment. Gallbladder cancer may come back in the gallbladder or other parts of your body.
- Metastatic cancer means cancer has spread from its original site (where it started) to other areas of the body. When gallbladder cancer becomes metastatic, it may spread to surrounding organs, tissues, throughout the abdominal cavity or to more distant parts of the body.
The stages of bile duct cancer
There are two areas in which bile duct cancer may form, determining how your doctor will diagnose and stage your cancer. The bile ducts are part of the biliary tract, which transports bile from the liver to the gallbladder and then to the small intestine during digestion.
You may be diagnosed with perihilar extrahepatic bile duct cancer or distal extrahepatic bile duct cancer based on where the cancer was first found.
Staging for perihilar extrahepatic bile duct cancer ranges from stage 0 (early stage) to stage IV (most advanced).
Stage 0 perihilar bile duct cancer
Stage 0 means that abnormal cells have been found in the innermost layer of tissue lining the perihilar bile duct, and these cells may become cancerous and spread. This stage is known as carcinoma in situ.
Stage I perihilar bile duct cancer
This stage indicates that cancer has been detected in the innermost layer of the wall of the perihilar bile duct and has spread to the muscle or fibrous tissue of the wall.
Stage II perihilar bile duct cancer
Stage II is an indication that cancer has spread through the wall of the perihilar bile duct and into nearby fatty tissue or the liver.
Stage III perihilar bile duct cancer
There are two substages of stage III, known as stage IIIA and stage IIIB.
Stage IIIA: The tumor has spread to one branch of the hepatic artery or portal vein.
Stage IIIB: Cancer has spread to nearby lymph nodes and into the wall of the perihilar bile duct; cancer may also have spread through the wall to nearby fatty tissue, the liver, or one branch of the hepatic artery or portal vein.
Stage IV perihilar bile duct cancer
Stage IV is also classified into two substages, known as stage IVA and IVB.
Stage IVA: Cancer may have spread to nearby lymph nodes and also spread to one or more of the main part of the portal vein or both branches of the portal vein, the hepatic artery, the right and left hepatic ducts, the right hepatic duct and the left branch of the hepatic artery or portal vein, or the left hepatic duct and right branch of the hepatic artery or portal vein.
Stage IVB: Cancer has spread to other distant organs or parts of the body including the liver.
Staging for distal extrahepatic bile duct cancer also ranges from stage 0 (early stage) to stage IV (most advanced).
Stage 0 distal bile duct cancer
Abnormal cells have been found in the innermost layer of tissue lining the distal bile duct and these cells may become cancerous and spread. This stage is also known as carcinoma in situ.
Stage I distal bile duct cancer
Stage I diagnosis means that cancer has formed and may be classified in one of two stages, stage IA or IB.
Stage IA: Cancer has been detected in only the distal bile duct.
Stage IB: Cancer has spread through the wall of the distal bile duct.
Stage II distal bile duct cancer
There are two substages that make up stage II, stage IIA and IIB.
Stage IIA: Cancer has spread from your distal bile duct to the gallbladder, pancreas, small intestine or other nearby organs.
Stage IIB: Cancer has spread from the distal bile duct to nearby lymph nodes. Stage IIB may also indicate that cancer has spread through the wall of the distal bile duct or to the gallbladder, pancreas, small intestine or other nearby organs.
Stage III distal bile duct cancer
Diagnosis of stage III indicates that cancer has spread to the larger vessels that carry blood to the organs in your abdomen or cancer has spread to nearby lymph nodes.
Stage IV distal bile duct cancer
Cancer has spread to other distant organs or parts of the body, including the liver or lungs.
Your doctor may also diagnose extrahepatic bile duct cancer based on how it will be treated, and there are two treatment groups: 1) localized and resectable and 2) unresectable, recurrent or metastatic.
Localized and resectable bile duct cancer
Your cancer has been found in an area where it can be completely removed by surgery. A small number of bile duct cancers are resectable.
Unresectable, recurrent or metastatic bile duct cancer
Unresectable cancer cannot be removed by surgery, and most people with extrahepatic bile duct cancer have unresectable cancer. Recurrent bile duct cancer has come back following treatment; extrahepatic bile duct cancer may return in the bile duct or other parts of the body.
Metastatic bile duct cancer has spread from where it started to other parts of the body. Cancer may have spread to nearby blood vessels or lymph nodes, the liver, common bile duct or other distant parts of the body.
If you have received a gallbladder or bile duct cancer diagnosis, or if you want a second opinion, the cancer experts at the OSUCCC – James are here to help you. Call 800-293-5066 to make an appointment.
Related Resources
Gallbladder Cancer Prevention and Risk Factors
Gallbladder Cancer Treatment
Gallbladder Cancer Treatment Team