Some gallbladder cancers are found after a gallbladder has been removed from a patient for treatment of gallstones or chronic (long-term) gallbladder inflammation. Gallbladders removed for those reasons are always examined by a pathologist (a doctor specializing in laboratory tests for diagnosing disease) to see if they contain cancerous cells.

Most gallbladder cancers, though, are found when patients go to a doctor with some of the signs or symptoms listed in the section, "Can Gallbladder Cancer Be Found Early?" Doctors may use a combination of several of the methods described below to find out whether the disease is present.

Signs and Symptoms of Gallbladder Cancer

Although signs and symptoms are usually not present until the later stages of gallbladder cancer, in some cases they may lead to an early diagnosis. If you have any of the following problems, see a doctor right away:

Abdominal pain: More than half of all people with gallbladder cancer have abdominal (stomach area) pain at the time of diagnosis. Most often this is in the upper right part of the abdomen.

Nausea and/or vomiting: At the time of their diagnosis, more than half of all people with gallbladder cancer report vomiting as a symptom.

Jaundice: Jaundice is a condition that gives a yellowish color to the skin, the white part of the eyes, and tissues of the body. One fourth to one half of all patients with gallbladder cancer have jaundice when they are diagnosed.

Gallbladder enlargement: Sometimes bile duct blockage causes bile to accumulate in the gallbladder, causing it to become larger than usual. This enlargement can sometimes be felt by the doctor during a physical exam and can also be detected by imaging studies such as ultrasound.

Other symptoms: Less common symptoms include loss of appetite, weight loss, abdominal swelling, severe itching, and black, tarry stools.

Although these are symptoms and signs of gallbladder cancer, it is important to remember that they may also be caused by non-cancerous diseases. In fact, hepatitis (infection of the liver by a virus) is a much more common cause of jaundice and there are many causes of abdominal pain that are far more common than gallbladder cancer. Nonetheless, people with these signs and symptoms should check with their doctor so that any health problems can be diagnosed as soon as possible, when treatment is likely to be most successful.

History and physical exam: To begin, a complete medical history (medical interview) will be taken to check for risk factors and symptoms. A physical exam is done to provide other information about signs of gallbladder cancer and other health problems.

If gallbladder cancer is suspected, the physical exam will focus mostly on the abdomen to check for any masses or fluid accumulation. The skin and the white part of the eyes will be checked for jaundice (yellow discoloration). Sometimes, cancer of the gallbladder spreads to lymph nodes, producing an enlargement that can be felt beneath the skin surface. Lymph nodes above the collarbone and lymph nodes in several other locations will be examined carefully to look for swelling that might indicate the spread of cancer.

Blood tests: Doctors may order lab tests to determine how much bilirubin is in the blood. Bilirubin is what gives the bile its color, and too much bilirubin in the blood is what is responsible for the yellow color of skin and the whites of the eyes when jaundice occurs. A high bilirubin count tells the doctor that there may be either gallbladder or liver problems.

The medical team may also order tests for levels of two enzymes, alkaline phosphatase and aspartate aminotransferase, that can also be an indication of gallbladder disease. Other tests are CEA and CA 19-9. These are tumor markers (proteins that circulate in the blood when certain cancers are present). Usually the blood levels of these markers are high only when the cancer is in an advanced stage.

Imaging Tests

Ultrasonography (ultrasound): Ultrasound can identify about one half of gallbladder cancers. This test uses sound waves to produce images of internal organs. A transducer emits sound waves and detects the echoes as they bounce off the organs. The pattern of echoes is processed by a computer to produce images.

The echoes produced by most tumors differ from those of normal tissue. These patterns of echoes can help distinguish some types of benign and malignant tumors from one another. Relatively new techniques known as endoscopic or laparoscopic ultrasound combine ultrasound with the use of a thin, lighted tube that has an attached viewing device (an endoscope or laparoscope). The endoscope is inserted through the mouth and passed through the stomach and near the gallbladder area. The laparoscope is inserted through a surgical incision (cut) in the side of the patient's body. Both procedures allow the doctor to place the ultrasound transducer near the gallbladder to produce more detailed images than a standard ultrasound. If there is a tumor, the doctor may be able to tell if and how far it has invaded the gallbladder wall, which helps in planning for surgery. Ultrasound can often tell whether the cancer has invaded the liver.

Computed tomography (CT): The CT scan is an x-ray procedure that produces detailed cross-sectional images of your body. Instead of taking one picture, like a conventional x-ray, a CT scanner takes many pictures as it rotates around you while you are lying on a narrow platform. A computer then combines these pictures into an image of a slice of your body. The machine will take pictures of multiple slices of the part of your body that is being studied.

CT scans are often used to make the initial diagnosis of gallbladder cancer, and are helpful in staging the cancer (determining the extent of its spread).

CT scans can also show the organs near the gallbladder, as well as lymph nodes and distant organs where metastatic cancer (cancer that has spread) might be present. The CT scan can help to determine if surgery is a good treatment option.

This test can help tell if your cancer has spread into your liver or other organs. Often after the first set of pictures is taken you will receive an intravenous injection of a dye, a contrast agent to help outline structures in your body. A second set of pictures is then taken.

CT scans can also be used to guide a biopsy needle precisely into a suspected metastasis. For this procedure, called a CT-guided needle biopsy, the patient remains on the CT scanning table, while a radiologist advances a biopsy needle toward the location of the mass. A fine needle biopsy sample (tiny fragment of tissue) or a core needle biopsy sample (a thin cylinder of tissue about ½ inch long and less than 1/8 inch in diameter) is removed and examined under a microscope.

CT scans are more tedious than regular x-rays because they take longer and you need to lie still on a table while they are being done. But just like other computerized devices, they are getting faster and your stay might be pleasantly short. Also, you might feel a bit confined by the ring you lie within when the pictures are being taken.

You will need to put up with the intravenous (IV) line through which the contrast dye is injected. The injection can also cause some flushing. Some people are allergic and get hives or, rarely, more serious reactions like trouble breathing and low blood pressure. Please be sure to tell the doctor if you have ever had a reaction to any contrast material used for x-rays. You may be asked to drink 1 to 2 pints of a solution of contrast material. This helps outline the intestine and allows the doctor to tell the difference between the intestine and any abnormal tissue that the CT scan may show.

Magnetic resonance imaging (MRI): MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of tissue and by certain diseases. A computer translates the pattern of radio waves given off by the tissues into a very detailed image of parts of the body. Not only does this produce cross-sectional slices of the body like a CT scanner, it can also produce slices that are parallel with the length of your body. A contrast material might be injected just as with CT scans, but is used less often. Although most doctors prefer CT scans as the first study to look at the gallbladder, an MRI scan may sometimes provide more detailed information, particularly if the doctors want to know whether the cancer is growing into nearby blood vessels.

MRI scans are particularly helpful in examining the brain and spinal cord. MRI scans are a little more uncomfortable than CT scans. First, they take longer, often up to an hour. Also, you have to be placed inside a tube, which is confining and can upset people with claustrophobia. The machine also makes a thumping noise that you may find disturbing. Many places provide headphones with music to block this out.

Angiography: Angiography is an x-ray procedure used to examine blood vessels. A small amount of contrast dye is injected into an artery to outline blood vessels before x-ray images are taken. The images allow the doctors to see if blood flow in a particular area is blocked or hindered by a tumor, and they can show any abnormal blood vessels in the area. Angiography can also show whether a gallbladder cancer has grown through the walls of certain blood vessels, or through the wall of the gallbladder. This information is mainly used to help surgeons decide whether a cancer can be removed and to help plan the operation. Digital subtraction angiography uses computers to produce more detailed images of blood vessels. Dynamic sequential CT scanning combines CT scanning and angiography.

Cholangiography: Cholangiography is similar to angiography. A small amount of contrast dye introduced into the gallbladder area allows a high-contrast image to be produced when that area is x-rayed. The x-ray images allow doctors to see if a tumor is in the gallbladder.

Endoscopic retrograde cholangiopancreatography (ERCP): In this procedure, a doctor passes a long, flexible tube down the patient's throat, through the esophagus and stomach, and into the common bile duct. A small amount of contrast dye helps outline the bile duct and pancreatic duct in x-ray images. The images can show narrowing or blockage of the bile duct or pancreatic duct and the doctor can also use the instrument to take cell samples. This procedure is used in gallbladder cancer mainly to help plan surgery.

Laparoscopy

In a laparoscopic procedure, a doctor uses a thin, lighted tube which is inserted through the abdominal wall to view the gallbladder, the liver, other internal organs, and tissue in the area around the gallbladder. The tube is inserted through a small incision (cut) in the front of the abdomen. Laparoscopy provides a view of organs that can help in planning surgery or other treatments, and can help doctors confirm the stage (how far the tumor has spread) of the cancer. Also, doctors can manipulate instruments through the incision to remove small tissue samples to examine under the microscope.

Laparoscopy is often used to remove the gallbladder as a treatment for gallstones or chronic inflammation of the gallbladder. This operation is called a laparoscopic cholecystectomy. If gallbladder cancer is found or suspected during that operation, it is frequently recommended that the surgeon convert the operation to an open cholecystectomy (removal of the gallbladder through a larger cut in the abdomen) to avoid releasing cancer cells into the abdominal cavity while removing the gallbladder. This depends on the size of the cancer and whether all the cancer was removed by the surgery.

Biopsy

Doctors can usually tell from imaging studies if it is likely a tumor has developed in the gallbladder. If so, they may remove the gallbladder without first taking a biopsy specimen (sample of tissue to check under the microscope). A biopsy may not be needed before an operation because the presence of gallstones or chronic inflammation of the gallbladder calls for removal of the gallbladder in most cases, anyway. A biopsy may be done during the operation to confirm the results of ultrasound, CT, MRI, and/or other tests. The surgeon may take a sample of tissue from or near the gallbladder. If it is suspected that a gallbladder cancer has spread to other organs, samples of abnormal areas are also removed and examined under a microscope.

There are several ways to take biopsy samples of gallbladder tissue. As noted earlier, biopsy specimens can be taken during laparoscopy. This allows the doctor to view the surface of the gallbladder and take samples of abnormal-appearing areas. A biopsy procedure called fine needle aspiration (FNA) is another option if the cancer appears advanced.

For FNA, a very thin needle is inserted through the skin and other tissues over the gallbladder without making a surgical incision. Placement of the needle is usually guided by ultrasound or CT scanning. With this approach, the needle is slowly moved forward while doctors check its position by viewing images provided by one of these imaging tests. When the images show that the needle is in the tumor, a sample is drawn into the needle and sent to the lab to be viewed under a microscope. Needle biopsies are often used if the doctor suspects that gallbladder cancer has spread to other organs, such as the liver. But if the cancer can be entirely removed by surgery, most surgeons would avoid a needle biopsy because it may promote spread of the cancer.

The images provided by MRI, CT scans, angiography, and particularly by cholangiography or ERCP, are often enough to allow a doctor to be reasonably certain that a gallbladder cancer is present when a patient has symptoms. In these cases, some gallbladder tissue is examined under the microscope after the gallbladder is removed. Last Revised: 08/06/2006