Gallbladder cancer

Gallbladder cancer is rare. About 1,100 people in the UK are diagnosed with it each year. It's most common in people over 75, and women get it more often than men.

The gallbladder is a small pouch that sits under the right side of the liver. It stores bile, a fluid the liver makes, and bile helps your body digest food and break down fats.

Bile travels through the bile ducts. These are tubes that connect the liver and the gallbladder to the small bowel.

Doctors don't know the exact causes of gallbladder cancer. There are, though, some risk factors that can raise your chance of developing it.

Having 1 or more risk factors doesn't mean you will get gallbladder cancer. And if you have none, that doesn't mean you won't get it.

Gallbladder cancer is most common in people over the age of 75.

Gallbladder cancer is more common in women than in men.

If you've had gallstones, or an inflamed gallbladder (cholecystitis), your risk of gallbladder cancer is higher than other people's. But most people with these conditions never develop gallbladder cancer.

Primary sclerosing cholangitis (PSC) is a rare condition. It causes inflammation and narrowing of the bile ducts, and people who have it face a higher risk of gallbladder cancer.

Calcium can sometimes build up in the wall of the gallbladder. Doctors call this a porcelain gallbladder. If you have it, your risk of gallbladder cancer is slightly higher than normal.

Polyps in the gallbladder are non-cancerous (benign) growths, but having them raises your risk of developing gallbladder cancer. The bigger the polyp, the higher that risk. Doctors tend to worry more when a polyp is bigger than 1cm.

Some types of long-lasting (chronic) infection are linked to a higher risk of gallbladder cancer.

Gallbladder cancer is slightly more common in people who are born with abnormal bile ducts.

People who smoke have a higher risk of gallbladder cancer.

If you're very overweight, your risk of developing gallbladder cancer goes up.

If a close relative has had gallbladder cancer, your own risk of the disease is slightly higher. By close relative, we mean a parent, brother or sister.

Sometimes gallbladder cancer is found during surgery to remove the gallbladder. This can happen when someone is having the operation because of gallstones or inflammation of the gallbladder.

Other people go to their doctor because they have symptoms. The doctor can refer them to a hospital specialist and arrange tests to find the cause of the symptoms.

The doctor will first ask about your general health and any medical problems you've had in the past. Then the doctor will examine your tummy area (abdomen). You may also have blood tests and some other tests.

An external ultrasound scan for gallbladder cancer uses sound waves to build up a picture of the gallbladder and the organs around it.

A CT scan takes a series of X-rays and puts them together to build a three-dimensional (3D) picture of the inside of your body.

An MRI scan uses magnetism to build up a detailed picture of areas inside your body.

An MRCP is a type of MRI scan that looks at the gallbladder and the organs near it. Your doctor can tell you more about the test.

An ERCP (endoscopic retrograde cholangio-pancreatography) lets the doctor look at your bile ducts, gallbladder and pancreas. During the test the doctor can take small samples of tissue (biopsies). The doctor can also treat a blockage in the bile ducts, which helps with jaundice.

An EUS (endoscopic ultrasound) is similar to an ERCP, but it uses ultrasound. Doctors may also use it to take biopsies.

A PTC, or percutaneous transhepatic cholangiography, is a test that uses X-rays to look at the bile ducts. Doctors can also use it to unblock a bile duct, which helps with jaundice.

Your test results help your doctors learn more about the size and position of the gallbladder cancer, and whether it has spread. This is called staging.

After a biopsy or an operation to remove the gallbladder, the doctor looks at the cells under a microscope to find the grade. The grade gives an idea of how quickly the cancer might grow or spread.

Knowing the stage and grade supports your doctors as they plan the best treatment for you.

A team of specialists will meet to discuss the best treatment for you. This is called a multidisciplinary team (MDT).

After the MDT meeting, you'll usually meet with your specialist doctor and nurse, who will talk you through your treatment plan.

Your specialist doctor should explain:

• the aim of the treatment, whether it's to cure the gallbladder cancer or control it
• the benefits of the treatment
• the disadvantages of the treatment, for example the risks and side effects
• any other treatments that may be available
• what may happen if you don't have the treatment

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They'll also talk to you about the things to consider when you make decisions about treatment. Make sure you have a contact number, so you know who to call if you have more questions.

Your treatment for gallbladder cancer may include surgery to remove the gallbladder. The surgeon may also take out some lymph nodes and part of the liver. And if the cancer has spread into a nearby organ, they may remove part or all of that organ too.

Chemotherapy for gallbladder cancer uses anti-cancer (cytotoxic) drugs to destroy cancer cells. You may have it after surgery, to reduce the risk of the cancer coming back. Doctors call this adjuvant treatment.

You may also be offered chemotherapy if surgery isn't possible, or if the cancer has come back or spread. In these cases it can help shrink the cancer or slow its growth.

The chemotherapy drugs most commonly used to treat gallbladder cancer are:

• capecitabine
• gemcitabine
• cisplatin

Some people have chemotherapy and radiotherapy together, which is called chemoradiation. Others have chemotherapy with an immunotherapy drug called durvalumab.

Radiotherapy uses high-energy rays, called radiation, to treat cancer. The rays destroy cancer cells in the area where the treatment is given.

If gallbladder cancer has spread but there's only a small area of cancer, you may have radiotherapy to help with your symptoms.

When gallbladder cancer blocks a bile duct, it can cause jaundice. Doctors can often treat this with a tube called a stent, which holds the duct open so it's no longer blocked.

You may have some treatments as part of a clinical trial.

You may have lots of different emotions after finishing gallbladder cancer treatment. You may feel anxious between appointments, and this is natural.

Everyone deals with illness, and the feelings that come with it, in their own way. You may find it helpful to talk to family and friends, or to your doctor or specialist nurse.

It's important to know where to get support or information if you need it. To find support:

• ask your doctor or someone from your cancer team for advice about support in your area
• find local cancer support services

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan gallbladder cancer forum, where you can talk to others affected by gallbladder cancer, ask questions and share your experience

Macmillan Cancer Support also runs a course called Help to Overcome Problems Effectively (HOPE). It helps people during and after cancer treatment. It's a free, interactive, group-based, self-management support course. It runs for 6 weeks, and each weekly session lasts 2.5 hours.

Recovery after gallbladder cancer treatment can take time, and some days you'll feel better than others.

Even if you already live a healthy lifestyle, you may choose to make a few positive changes after treatment.

Small changes, like eating well and keeping active, can improve your health and wellbeing and support your body as it recovers.

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