Gallbladder Cancer

Gallbladder cancer is one of the biliary tract cancers, and like cholangiocarcinoma, it’s rare and often caused by unknown reasons. There were approximately 122,500 new cases and 89,000 deaths globally in 2022 and more commonly found in women. If caught early, when it’s small, there’s a good chance for survival, but many of these cancers are aggressive and caught at later stages, making them very difficult to treat. Over half of all cases and deaths occur in individuals aged 50–74. The global burden is projected to increase by more than 65% by 2042.

Symptoms of gallbladder cancer often mirror other conditions, which is why it can be very challenging to identify and treat this cancer. The majority of cases are called "incidental findings” and occur when doctors happen to find the cancer during unrelated procedures or tests. It is aggressive when caught at an advanced stage.

What is gallbladder cancer?

The gallbladder is a pear-shaped organ found just under the liver, in the upper abdomen. The gallbladder stores bile, a fluid produced by the liver that helps digest fat. Gallbladder cancer forms in cells lining the gallbladder and grows outward as it spreads.

Types of gallbladder cancer

Almost all gallbladder cancers are adenocarcinomas. These are cancers that begin in glands that line internal organs and make mucus and other fluids. 

Adenocarcinoma

Around 90% of gallbladder cancer is classified as adenocarcinoma. There are three types of gallbladder adenocarcinomas:

• non papillary (most common)
• papillary (this is rare and less likely to spread)
• mucinous (most rare, in cells that produce mucus)

Rare types of gallbladder cancer

A few other rare types of gallbladder cancer include adenosquamous carcinoma, squamous cell carcinoma, and carcinosarcoma. These cancers form in different cells in the gallbladder and they can be more aggressive than adenocarcinomas. 

Staging gallbladder cancer

If you have gallbladder cancer, you need to know your stage. This helps you understand where the cancer is now, the best treatment plan for your unique situation, and your outlook.

Gallbladder cancer is staged on a scale from 0-4 (many researchers use roman numerals 0-IV)  using the TNM staging system. In general:

• Stage 0 (carcinoma in situ): Abnormal cells are in the innermost layer of the gallbladder but have not grown into deeper tissue.
  Stage 1: Cancer has grown into the inner connective tissue (1A) or the muscle layer (1B) of the gallbladder but has not spread beyond it.
  Stage 2: Cancer has grown through the muscle layer into surrounding connective tissue, but has not reached the outer surface or nearby organs.
  Stage 3: Cancer has either grown through the outer surface of the gallbladder into the liver or a nearby organ (3A), or has spread to regional lymph nodes (3B).
  Stage 4 (also called "metastatic"): Cancer has grown into major blood vessels near the liver or invaded two or more organs beyond the liver (4A), or has spread to distant lymph nodes or other organs such as the lungs (4B).

What causes gallbladder cancer?

Risk factors put you at a higher risk of getting cancer. Some risk factors can be controlled with lifestyle changes, and others cannot. Older age, smoking, and obesity increase your risk of many cancers.

Just because you have a risk factor, that doesn’t mean you will get gallbladder cancer—especially when it comes to gallstones, as these are very common yet gallbladder cancer is rare.

These are scenarios researchers have found that can increase your risk: 

• Gallstones (up to 90% of patients also have gallstones and a history of inflammation)
• Porcelain gallbladder (wall of gallbladder is covered in calcium deposits)
• Polyps (small growths from the gallbladder’s mucus membrane)
• Biliary cysts (bile-filled sacs that can have pre-cancerous changes)
• Infections (typhoid and H. pylori)

Preventing gallbladder cancer

You can’t prevent gallbladder cancer. However, because gallstones are a risk, they should be treated. 

As with every cancer, there are steps you can take to adopt a healthy lifestyle and reduce your overall cancer risk, such as maintaining a healthy weight, not smoking, and limiting or eliminating alcohol. 

Learn more about cancer prevention from the American Institute for Cancer Research.

What are some gallbladder cancer statistics? 

According to GLOBOCAN 2022:

• Approximately 122,500 new cases of gallbladder cancer and 89,000 deaths worldwide in 2022.
• Women account for nearly 65% of all cases and deaths globally (it's one of the few cancers where women are significantly more affected than men)
• 22nd most commonly diagnosed cancer worldwide (the 23rd most common in men and the 20th most common in women)
• Over half of all gallbladder cancer cases and deaths occur in individuals aged 50–74 years.
• Less than 20% of patients are eligible for complete surgical resection at the time of diagnosis.

According to the World Cancer Research Fund:

• China, India, and Japan had the highest number of gallbladder cancer cases and deaths in 2022.
• The highest age-standardized rates are found in northeastern India and southern Chile, where rates in women are more than twice those seen in men.

What are my odds of surviving it?

Gallbladder cancer is often caught at late stages, when it’s most difficult to treat. Doctors use what’s called “survival statistics” to understand the likelihood of a patient beating the disease.

Approximately 21% of patients are alive five years after a gallbladder cancer diagnosis.

Detailed survival statistics are based on where the cancer is located and if it has spread:

Localized

The cancer hasn’t spread

• 68% of patients are alive five years after diagnosis

Regional

The cancer spread to nearby lymph nodes

• 28% of patients are alive five years after diagnosis

Distant

The cancer has spread to lymph nodes and/or organs

• 3.6% of patients are alive five years after diagnosis

What types of tests should I expect to undergo?

Doctors will use these tests to diagnose gallbladder cancer:

• Physical exam
• Blood tests checking bilirubin, liver enzymes, and tumor markers

Biopsy, endoscopy, laparoscopy, surgery, cholangiography, and angiography may also be used to identify and diagnose gallbladder cancer.

Once you’ve been diagnosed, you can expect these tests:

• CT scan
• Ultrasound
• MRI
• PET scan

Ask your doctor about these additional tests—ideally before you begin treatment.

• Biomarker testing
• Genetic testing

I’m facing a diagnosis: What are my next steps?

If you’re facing a diagnosis, the GI Cancers Alliance is here for you. 

If you’re newly diagnosed, work with your doctor to create a treatment plan. It’s important to find an expert who specializes in gallbladder cancer and visit a major cancer center if possible. Gallbladder cancer treatment, especially surgery, is complex. 

Treatment plans may include a combination of:

• Immunotherapy
• Surgery (to cure cancer or to reduce symptoms)
• Chemotherapy 
• Radiation (if tumors cannot be removed by surgery)
• Targeted therapy

We strongly encourage you to get a second opinion from another trusted doctor so you feel confident moving forward.