The stage (extent) of a gallbladder cancer is an important factor in determining treatment options. But other factors, such as whether the doctor feels the cancer is resectable by surgery and the person's general health and preferences may also play a role. How the cancer is discovered may also be important. For example, some cancers may be found on imaging tests before surgery, while others may be discovered only after surgery to treat another condition such as gallstones.

No matter what stage the cancer is, it's very important that you understand the goal of treatment before it starts -- whether it is to try to cure the cancer or to help relieve symptoms -- as well as the likelihood of the benefits and risks. This can help you make an informed decision when looking at your treatment options.

Stage IA

Most of these cancers are found after a simple cholecystectomy (either laparoscopic or open) when the gallbladder is removed to treat gallstones or chronic inflammation. The gallbladder is then looked at under a microscope in the lab, at which time the cancer is discovered. If the cancer is confirmed to be stage IA at this time, no further treatment may be needed.

If a stage IA tumor is discovered during a laparoscopic cholecystectomy (instead of later on in the lab), the doctor will most likely change the operation to an open cholecystectomy to reduce the risk of leaving some cancer behind.

If a possible early stage cancer is seen on imaging tests before surgery, the surgeon may do a laparoscopy to stage the cancer before any surgery to remove the gallbladder. If the cancer hasn't spread, and it looks like it is a stage IA, the doctor can remove the gallbladder with an open simple cholecystectomy, but most would recommend an extended cholecystectomy (which includes taking out nearby lymph nodes and a part of the liver). Most cancer centers recommend extended cholecystectomy for all gallbladder cancers, even stage IA to reduce the chances of the cancer coming back..

If, after a simple cholecystectomy, the cancer is found to be more advanced than stage IA, a second, more extensive operation is often done. This is to remove any cancer that may have spread outside the gallbladder before it was removed and to make sure the nearby lymph nodes weren't involved. Even the skin where the original incision was made may need to be removed (especially if the original surgery was done laparoscopically), as cancer cells may have lodged there.

If gallbladder cancer is suspected or diagnosed, it is a good idea to be seen by a surgeon with experience treating this type of cancer. Since gallbladder cancer is rare, not all surgeons are skilled at the more extensive operations needed to treat this cancer.

Stage IB

These cancers are usually treated by an extended cholecystectomy with removal of the gallbladder, nearby lymph nodes, and part of the liver. This should cure a high percentage of patients if their cancer is truly stage IB.

Some doctors may recommend adjuvant chemotherapy with or without radiation therapy after surgery, but it is not clear if this improves survival.

As mentioned above, if the gallbladder is removed during a simple cholecystectomy for another reason (gallstones, etc.) and a stage IB cancer is found, in most cases the surgeon will recommend another, more extensive operation to try to ensure all of the cancer was removed. Again, this operation should be performed by a surgeon with experience in extended cholecystectomy.

Stage II

These cancers have already reached an area beyond the gallbladder when they are found. People with stage II gallbladder cancer may want to seek out a surgeon experienced in treating these cancers for an opinion on whether or not the cancer is resectable and what the likely results of surgery would be. Again, this can be a complex operation.

Resectable: If the doctor believes that the cancer is resectable, an extended cholecystectomy is the preferred treatment option. This will probably include removing a larger part of the liver and nearby lymph nodes, and may include removing parts of other nearby organs.

If the gallbladder was removed during a simple cholecystectomy for another reason (gallstones, etc.) and a resectable stage II cancer was found, in most cases the surgeon will recommend another, more extensive operation to try to ensure all of the cancer was removed.

In many cases, doctors may recommend adjuvant chemotherapy and/or radiation therapy after surgery to try to lower the risk that the cancer will come back. This seems to help some patients live longer.

Unresectable: If the doctor feels that surgery is not a good option (for example, because of the size or location of the cancer or because of a person's general health), the focus of treatment is usually on trying to control the cancer and the symptoms it may cause. Treatment with radiation therapy and/or chemotherapy may be helpful for a time for some people. For those who are jaundiced because of bile duct blockage, a stent or catheter may be placed in the duct to allow the bile to flow. If needed, surgery to bypass the bile duct may be an option. For people having pain, radiation therapy, alcohol injections to the nerves around the gallbladder, and pain medicines may all be helpful.

Because these cancers can be very hard to treat with current options, some people may want to consider taking part in a clinical trial of new treatments.

Stage III

These cancers have reached more extensively beyond the gallbladder when they are found, although they have not yet spread to distant parts of the body. They are less likely to be resectable, although in some cases surgery may be an option. You may want to seek out a surgeon experienced in treating these cancers for an opinion on whether or not the cancer is resectable and what the likely results of surgery would be.

Resectable: These cancers are treated much like stage II gallbladder cancer, but the surgery needs to be even more extensive because blood vessels and other organs may need to be removed. Only some patients will be able to withstand the radical surgery needed. This kind of surgery can usually only be done by surgeons who specialize in cancers of the liver and gallbladder and at cancer centers where there is the expertise to support patients after the surgery.

In many cases, doctors may recommend adjuvant chemotherapy and/or radiation therapy after surgery to try to lower the risk that the cancer will come back. But it is not clear how helpful adjuvant therapy is in these situations.

Unresectable: For patients with stage III cancer that cannot be removed by surgery, the focus of treatment is usually on trying to control the cancer and the symptoms it may cause. Treatment with radiation therapy and/or chemotherapy may be helpful for a time for some people. For those who are jaundiced because of bile duct blockage, a stent or catheter may be placed in the duct to allow the bile to flow. If needed, surgery to bypass the bile duct may be an option. For people having pain, radiation therapy, alcohol injections to the nerves around the gallbladder, and pain medicines may be helpful.

Because these cancers can be very hard to treat with current options, some people may want to consider taking part in a clinical trial of new treatments.

Stage IV

These cancers have spread to distant parts of the body, so curative surgery is not an option. (Most often the cancer has spread to the lining of the abdomen, called the peritoneum.)

As with other unresectable cancers, treatment usually focuses on trying to control the cancer and the symptoms it may cause. Treatment with radiation therapy and/or chemotherapy may be helpful for a time for some people. For those who are jaundiced because of bile duct blockage, a stent or catheter may be placed in the duct to allow the bile to flow. If needed, surgery to bypass the bile duct may be an option. For people having pain, radiation therapy, alcohol injections to the nerves around the gallbladder, and pain medicines may be helpful.

Because these cancers can be very hard to treat with current options, some people may want to consider taking part in a clinical trial of new treatments.

Recurrent gallbladder cancer

Cancer is called recurrent when it comes back after treatment. Recurrence can be local (in or near the same place it started) or distant (spread to organs such as the lungs or bone). If the cancer comes back after initial treatment, further treatment may depend on where the cancer recurs, what kind of treatment was previously used, and on the patient's general health. In most cases the recurrent cancer is unresectable and is treated the same way as advanced (stage IV) gallbladder cancer (see above).

Recurrent gallbladder cancer is usually very hard to treat, so patients might want to consider taking part in a clinical trial of new treatments.

Last Medical Review: 11/02/2009
Last Revised: 11/02/2009