Gallbladder Cancer and Bile Duct Cancer: Symptoms, Treatment of the Gallbladder, and Therapy for Tumors or Cancer of the Bile Ducts

The gallbladder’s function is to store bile. This fluid is produced in the neighboring organ, the liver. Various factors can lead to the development of a tumor. In gallbladder cancer, abnormal cells divide uncontrollably and displace healthy tissue. In this case, the tumor is referred to as malignant. This tumor can grow from the gallbladder into the liver. It can also spread throughout the body via the bloodstream or the lymphatic system.

Gallbladder cancer is relatively rare. Each year, about three out of every 100,000 people are diagnosed with gallbladder cancer, with most patients being over 70 years old. Women are affected by gallbladder cancer more frequently than men. In Germany, approximately 2,300 men and just under 3,000 women are diagnosed with this form of cancer each year.

Women are more likely to have gallstones, which are risk factors for gallbladder cancer. It is believed that this is one reason why women are more likely to develop gallbladder cancer than men.

However, gallstones themselves are not the cause of gallbladder cancer. Gallstones can, however, lead to persistent inflammation of the gallbladder. Over the years, this persistent irritation can lead to the development of gallbladder cancer. For this reason, gallstones are found in about 80 percent of people with gallbladder cancer.

If the gallbladder is chronically inflamed, a “porcelain gallbladder” may form, which in turn increases the risk of gallbladder cancer. In the case of bile duct cancer, however, the following factors may play a role in the development of the tumor:

• Parasites
• Cigarette smoke
• The chronic inflammatory bowel disease ulcerative colitis

People with gallbladder cancer rarely notice early symptoms. Patients typically do not report symptoms until the tumor has already grown significantly. At that point, they often experience pain in the upper abdomen or weight loss. Severe fatigue or itching may also occur.

Only a highly advanced tumor obstructs the flow of bile into the small intestine. For this reason, gallbladder cancer often does not cause symptoms—such as those associated with jaundice—until it has reached an advanced stage. These symptoms include pale stools, dark urine, and yellowing of the whites of the eyes and the skin.

If gallbladder cancer is suspected, the doctor will first ask the patient about their medical history. This includes whether the patient has had gallstones in the past. A physical examination then follows. During this examination, the doctor will primarily palpate the abdomen to check for an enlarged gallbladder.

Next, a blood sample is taken from the patient to detect changes in bile and liver function values. Imaging techniques are also used, such as an ultrasound examination of the abdomen. This makes it possible to visualize the bile ducts and the gallbladder. Based on these tests, the doctor can distinguish gallbladder cancer from other conditions, such as gallstones, and make a definitive diagnosis. If the situation is unclear, a CT or MRI scan is often performed. This allows the doctor to determine the size and exact location of the tumor.

An MRI can be used to determine the size and location of the tumor.

In general, the choice of treatment for gallbladder cancer depends on how far the tumor has spread. If tumor growth is still limited, the gallbladder is surgically removed. This is most likely in the early stages of gallbladder cancer. However, it is often necessary to remove adjacent parts of the liver as well, because the tumor frequently infiltrates the liver.

If the tumor has already metastasized throughout the body or is invading vital blood vessels, gallbladder cancer can no longer be cured. In such cases, treatment is primarily aimed at improving the patient’s quality of life. The goal is to alleviate symptoms and prolong life. This is usually achieved through chemotherapy.

Patients who are not candidates for surgery but still suffer from a bile flow obstruction can be treated with interventional procedures. A drainage tube can usually be inserted using endoscopic techniques. These small tubes help ensure that bile can still drain, which relieves pressure on the gallbladder.

Patients in good general health have additional treatment options, such as radiation therapy or systemic chemotherapy.

The prognosis for gallbladder cancer depends heavily on the aggressiveness and spread of the tumor. For this reason, it is not easy to make a general statement regarding life expectancy for gallbladder cancer. However, since gallbladder cancer is often detected at a late stage, the prognosis for many patients is generally poor.

In most cases, the diagnosis of gallbladder cancer is made by gastroenterologists or surgeons. Procedures—such as endoscopic drainage stents placed in the bile duct—are performed by gastroenterologists. Surgical procedures are performed by visceral surgeons. There are several specialized centers in Germany for diseases of the bile ducts or gallbladder.