Diagnosis & Staging
Image of gallbladder
Gallbladder cancer is rare.
There are usually no symptoms in the early stages of gallbladder cancer.
Common symptoms in people with later stage gallbladder cancer include:
- Pain in the upper right abdomen.
- Nausea (feeling queasy) or vomiting.
- Jaundice (when your skin and whites of your eyes turn yellow).
- Gallbladder enlargement (when your gallbladder is larger than it should be). This would only be found if you had an imaging test done, such as an abdominal ultrasound.
Less common symptoms include:
- Loss of appetite.
- Unexplained weight loss.
- Swelling of your abdomen.
- Fever.
- Itchy skin.
- Black tarry stools (poop).
If you have any signs or symptoms that you are worried about, please talk to your family doctor or nurse practitioner.
Most gallbladder cancers are found during surgery to remove the gallbladder (cholecystectomy).
Tests that may help diagnose gallbladder cancer include:
- Ultrasound: to see the tumour.
- Endoscopic ultrasound: a doctor puts an endoscope with a small ultrasound device through your mouth and into your esophagus.
- CT (computed tomography) scan: to see the tumour and if the cancer has spread.
- MRI (magnetic resonance imaging): to see the tumour and if the cancer has spread.
- Biopsy: surgery to take a sample of the growth or area. The sample is examined by a specialist (pathologist) to see if it is cancer.
- A laparoscopy may be done for staging (see below). A laparoscope is thin tube with a light and camera on it. It is put through a cut made in your abdomen. This procedure is done under general anesthetic.
- A biopsy is usually only done for gallbladder cancers that cannot be removed by surgery.
Adenocarcinomas
- About 95% (95 out of 100) of gallbladder cancers.
- Begin in the cells that line the gallbladder and then grow into the wall of the gallbladder.
- Three types of adenocarcinomas:
- Non-papillary: more than 75% (75 out of 100) of gallbladder adenocarcinomas.
- Papillary: about 6% (6 out of 100) of gallbladder adenocarcinomas.
- Mucinous: least common gallbladder adenocarcinoma.
Rare types of gallbladder cancer include:
- Sarcoma.
- Squamous cell carcinoma.
- Adenosquamous carcinoma.
- Carcinosarcoma.
- Signet ring carcinoma.
- Small cell carcinoma.
- Carcinoid.
Staging describes the cancer. Staging is based on how much cancer is in the body, where it was first diagnosed, if the cancer has spread and where it has spread to.
The stage of the cancer can help your health care team plan your treatment. It can also tell them how your cancer might respond to treatment and the chance that your cancer may come back (recur).
Gallbladder cancer staging:
- Stage 0: Tumour (cancer growth) is only in the inner lining of the gallbladder. It has not grown into the gallbladder wall.
- Stage 1A: Tumour has grown into the connective tissue layer (lamina propria) of the gallbladder.
- Stage 1B: Tumour has grown into the muscle layer around the lamina propria.
- Stage 2A: Tumour has grown into the connective tissue on top of the muscle layer on the side of the gallbladder that is next to the liver.
- Stage 2B: Tumour has grown into the perimuscular connective tissue on the side of the gallbladder next to the peritoneum (a layer of tissue that lines your abdominal cavity).
- Stage 3A: One of the following:
- Tumour has grown through the outer layer of the gallbladder (serosa)
- Tumour has grown into the liver.
- Tumour has grown into 1 nearby organ.
- Stage 3B: Tumour has grown through the outer layer of the gallbladder or into the gallbladder wall AND has spread to 1-3 nearby lymph nodes.
- Stage 4: Cancer has spread to any of the following areas:
- Main blood vessels leading into the liver (portal vein or hepatic artery), with or without spreading to 1-3 lymph nodes.
- Two or more organs outside the gallbladder, with or without spreading to 1-3 lymph nodes.
- 4 or more nearby lymph nodes.
- Parts of the body farther away from the gallbladder, such as the lungs. This is called distant metastasis.
The grade of the cancer describes how different the cancer cells look from normal cells and how fast the cancer cells are growing. A pathologist will give the cancer a grade after looking at the cells under a microscope.
Gallbladder cancer can be grade 1, 2, or 3. The lower the number, the lower the grade.
Low grade: cells are abnormal but look a lot like normal cells. Low grade cancers usually grow slowly and are less likely to spread.
High grade: cells are abnormal and do not look like normal cells. High grade cancers usually grow more quickly and are more likely to spread.
