Gallbladder cancer

Definition: What is gallbladder cancer?

The primary function of the gallbladder is to store bile, which is produced by the liver. The organ is located just beneath the liver. The produced bile flows through the bile ducts, passing the gallbladder, and is released into the upper small intestine, where it plays an important role in the absorption of fats.

Various factors can predispose the development of cancer of the gallbladder. This cancer, medically referred to as a carcinoma, consists of abnormal cells. These abnormalities arise due to mutations in the genetic material, causing the cells to divide uncontrollably and displace healthy tissue. The presence of such cells defines a tumor as malignant.

This tumor can grow locally and invade the adjacent liver. It may also metastasize through the bloodstream or lymphatic vessels. In this case, malignant gallbladder cells proliferative destructively in distant organs.

Gallbladder cancer is relatively rare. On average, approximately 3 out of every 100,000 people in Germany are diagnosed with gallbladder cancer yearly. Women are affected more frequently than men and the typical age of onset is over 70 years.

Causes and risk factors of gallbladder cancer

There are various risk factors associated with the development of cancer. Regarding gallbladder cancer, the most significant risk factor is chronic inflammation (cholecystitis) which is often accompanied by gallstone disease (cholelithiasis). In approximately 80% of cases gallstones are found. However, only about 1% of all patients who have gallstones go on to develop gallbladder cancer. 

A previous salmonella infection with chronic bacterial shedding (chronic carrier state) is also a risk factor. In addition, benign mucosal growths (polyps) of the gallbladder, measuring more than one centimeter in diameter, carry an increased risk of malignant transformation.

Chronic irritation of the gallbladder cells leads to an increased cell death followed by rapid cell regeneration. This heightened cell turnover may result in genetic mutations that can contribute to the development of cancer. In most cases, the malignant cells arise from the glandular epithelium of the gallbladder wall.

Symptoms of gallbladder cancer

Gallbladder cancer typically causes symptoms only at very late stages. Hence why the disease is usually diagnosed at an advanced stage, worsening the prognosis. In a lot of cases, the cancer is discovered incidentally after removal of the gallbladder due to acute inflammation or acute gallstone disease.

In later stages, patients may experience diffuse upper abdominal discomfort and jaundice, a yellowing of the skin and the white of the eye. This occurs when the bile flow is obstructed by the tumor. As a result, stool may become greasy and pale, urine may appear brownish, and pruritus can occur.

In some cases, the gallbladder may be enlarged due to the inflammatory process and can be palpable below the ribcage. The gallbladder wall is often be calcified and hardened, a state referred to as porcelain gallbladder.

Since many patients suffer from gallbladder stones simultaneously, related symptoms may be present. These include colicky upper abdominal pain after meals, nausea or vomiting.

In advanced stages, general symptoms may also develop such as weight loss, night sweats and fatigue.

How are gallbladder tumors diagnosed and treated?

A clinical suspicion of a cancer may arise on the above-listed symptoms, a physical examination and blood tests. In most cases, the diagnosis is made incidentally after surgical removal of the gallbladder, due to acute inflammation or gallstones.

Consequently, the initial diagnostic step involves an ultrasound examination. If the findings raise suspicion for gallbladder cancer, further diagnostic imaging may be required to assess the extent of the cancer, most commonly computed tomography (CT) or magnetic resonance imaging (MRI).

A positron emission tomography-CT (PET-CT) scan can be used to visualize the metabolic activity of tissues. It is frequently used in cancer diagnostics, as malignant cells typically exhibit elevated metabolic rates.

A definitive diagnosis is usually established through histopathological examination of the surgically removed gallbladder (cholecystectomy), which also represents the primary surgical treatment. In some cases, systemic chemotherapy or radiotherapy may be appropriate in addition to the surgery.

However, by the time of diagnosis, the cancer has often already metastasized extensively, rendering curative treatment unfeasible. In such cases, palliative care is initiated. The primary focus of palliative care is no longer the cure, but rather the symptom relief and preserving the patient’s quality of life. One typical palliative intervention is the placement of a biliary stent to restore bile flow and relieve symptoms such as jaundice. 

Life expectancy and prognosis of gallbladder cancer

The life expectancy with gallbladder cancer is difficult to estimate, as the prognosis strongly depends on the extent of the disease and the aggressiveness of the tumor. Nevertheless, on average gallbladder cancer has a poor prognosis, primarily due to the late diagnosis.

The five-year survival rate is below 5%, meaning that only about 5% of patients survive five years after the initial diagnosis. However, if the malignancy is detected incidentally at an early stage, the prognosis is significantly more favorable.

Prevention and early detection of gallbladder cancer

Since the prognosis depends on the timing of diagnosis, early detection of gallbladder cancer is essential. Therefore, it is advisable to seek medical attention, even in the presence of nonspecific upper abdominal symptoms. A thorough diagnostic evaluation early detection or exclusion of malignancy.

The prevention of gallbladder cancer is challenging, as the malignant transformation of healthy cells can never be fully avoided. However, general measures aimed at reduced the incidence of gallbladder diseases are recommended. 

To minimize the risk of gallstone formation, patients should avoid diets high in cholesterol and low in fiber, as well as prolonged periods of fasting. Any form of inflammation of the gallbladder should be effectively treated to prevent chronic progression. Non-modifiable risk factors such as genetic predisposition, sex or age cannot be influenced.

Which physicians and clinics specialize in gallbladder cancer?

The initial diagnosis is typically made by specialists in gastroenterology and the treatment requires an interdisciplinary approach, carried out by visceral surgeons for surgical intervention and by oncologists and gastroenterologists for systemic therapy. In Germany, several specialized centers offer comprehensive care for patients with gallbladder cancer.

As the treatment of gallbladder cancer should always be carried out by qualified and experienced specialists, selecting a competent healthcare provider is essential. For this reason, we have made it out mission to connect prospective patients with medical specialists to ensure high-quality care based on the latest scientific evidence.

All physicians listed here are recognized experts in their respective fields and have been carefully selected by our team. All of them possess extensive experience in the diagnosis and treatment of gallbladder cancer and is available to take on your case.