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Treatment decisions

Find out about the treatments used for gallbladder cancer.

The main treatments

As with many types of cancer, the earlier your cancer is diagnosed, the easier it is to get it under control and possibly cure it.

Surgery is the main treatment for gallbladder cancer. But you might have radiotherapy or chemotherapy alone, together or with surgery.

The treatment that is best for you depends on:

  • the type of gallbladder cancer you have
  • the stage of your cancer
  • Your general health

You are looked after by a team of doctors who specialise in different aspects of treatment but work together. This might include a:

  • surgeon
  • specialist in diseases of the digestive system (gastroenterologist)
  • cancer specialist (oncologist)

Surgery

After your diagnosis with gallbladder cancer, your specialist will carry out tests to see if it is possible to remove your cancer. If it is, you can have surgery as long as you are fit enough for the operation.

The main surgery is when the gallbladder is removed (a cholecystectomy). Whichever gallbladder operation you have depends on where the cancer is and whether it has spread to surrounding tissue, into the liver or to other body organs.

If you have surgery, your surgeon will examine your gallbladder and the surrounding area during your operation. The surgeon will want to remove at least some of the lymph nodes from around your gallbladder. This is called lymphadenectomy.

This is to check to see if they contain cancer cells that have broken away from the main cancer. The surgeon sends the lymph nodes to the laboratory where they are checked.

This helps your specialist work out the stage of your cancer and then decide which treatment is best for you.

Removing lymph nodes

You might need a second operation to remove any lymph nodes that contain cancer cells. This surgery aims to reduce the risk of the cancer coming back in the future.

In this operation, your surgeon might also remove some tissue from sites on your tummy (abdomen) if you had your gallbladder removed by keyhole surgery. These sites are where the surgeon put the instruments through - you may hear them called port sites. This is to reduce the risk of leaving cancer cells in these areas.

Radiotherapy

You’re most likely to have radiotherapy alongside other treatments for gallbladder cancer.

Your doctor may suggest radiotherapy after surgery as part of a trial to try and kill off any cancer cells that may have been left behind. This is called adjuvant radiotherapy.

Because gallbladder cancer is so rare, it has been difficult to carry out large enough clinical trials to show if this helps to stop the cancer returning. Some small studies seem to suggest that it might help. But we need evidence from randomised controlled trials to know this for sure.

You might have radiotherapy along with chemotherapy (called chemoradiotherapy). Your specialist might suggest this if the cancer has spread too far outside your gallbladder to be completely removed with surgery. Again, doctors are still not certain how well this works. Ongoing clinical trials will hopefully give us some definite answers.

Sometimes doctors use radiotherapy to treat symptoms of advanced gallbladder cancer. You might hear this called palliative radiotherapy. The cancer can block your bile duct, which can cause jaundice. Or it can press on nerves, which can cause pain. Radiotherapy treatment can shrink the cancer for a time and relieve such symptoms.

Chemotherapy

Some clinical trials have looked into chemotherapy after surgery for gallbladder cancer. But at the moment there is not enough strong evidence to know if this helps people live longer.

It can be difficult to find enough people for clinical trials with such a rare cancer. In order to show any benefit from giving chemotherapy after surgery for gallbladder cancer, we would need large randomised trials.

Treatment by stage

The treatment is chosen depending how far a cancer has grown and spread. There are 4 main stages.

It is important to remember that it is very rare to find gallbladder cancer at this early stage. Most stage 1 gallbladder cancers are found almost by accident. Fewer than 2 out of 10 gallbladder cancers (20%) are found during a simple cholecystectomy for gallstones or inflammation of the gallbladder.

If the cancer is found very early (stage T1a), no further treatment is usually needed. In this situation, you would usually have a simple operation to remove just your gallbladder (cholecystectomy). 

But even early stage gallbladder cancer can come back. So if the cancer has grown through the muscle layer of the gallbladder wall (stage T1b), or is in the part of the gallbladder close to the liver, your surgeon is likely to do a bigger operation. This is called an extended cholecystectomy. This means the surgeon will also take out the part of the liver nearest the cancer, and the surrounding lymph nodes. This helps to lower the risk of the cancer coming back.

Sometimes the surgeon won’t know you had cancer until after your operation, when the reports on your gallbladder come back from the laboratory. In this case, your doctor may suggest that you have a second operation. This will also be an extended cholecystectomy.

Your doctor may suggest radiotherapy after surgery for stage 1 gallbladder cancer. This is likely to be as part of a trial. The aim is to kill off any remaining cancer cells that may be left behind after the operation. But this has only been tried in clinical trials with small numbers of people, and we don’t yet know if it helps stop the cancer coming back.

Most stage 2 gallbladder cancers are found during surgery to remove the gallbladder because of inflammation or gallstones. You might have another operation, either an extended cholecystectomy or a more extensive operation. Again, your doctor might suggest radiotherapy in case it helps stop the cancer returning. 

Your specialist might suggest chemotherapy after your surgery, although this is still an experimental treatment for cancer of the gallbladder. This treatment aims to help stop the cancer from coming back.

In the past, doctors wouldn’t have thought surgery an option for people with stage 3 gallbladder cancer. But more advanced surgical techniques, such as extended cholecystectomy or more radical surgery, now offer hope for a possible cure. This treatment should at least give a longer survival time for some people with stage 3 gallbladder cancer.

Other treatment options might include:

  • surgery followed by radiotherapy
  • radiotherapy with chemotherapy to control symptoms

Your specialist might suggest chemotherapy after your surgery, although this is still an experimental treatment for cancer of the gallbladder. This aims to help stop the cancer from coming back.

Unfortunately, surgery to cure stage 4 cancer is not really an option. But your doctor may suggest surgery to relieve symptoms caused by the cancer blocking your biliary system (the part of the body that makes, stores and releases bile).

Your specialist might also suggest chemotherapy and radiotherapy to help relieve your symptoms. Chemotherapy is still an experimental treatment for cancer of the gallbladder.

Gallbladder cancer that has come back

Doctors generally treat cancer of the gallbladder that has come back (recurred) in the same way as stage 3 or 4 gallbladder cancer. But your treatment depends on whether you have had radiotherapy or surgery in the past, and on where the cancer has come back.

There is a maximum amount of radiotherapy that you can have to any one part of your body. If you have too much it can damage healthy body tissues. So if you have had radiotherapy before, you might not be able to have it again.

Treatment to help with symptoms

Treatment to control your symptoms is sometimes called palliative treatment. It doesn't aim to cure your cancer, but it might slow the cancer down a bit.

You might have this type of treatment if your cancer has spread too far to be cured, or if it has come back after it was first treated. Your doctor might suggest radiotherapy, chemotherapy or both together (chemoradiotherapy).

Your options

In some situations, you may not feel you have much of a choice. Your specialist may tell you that surgery is your best option for cure. Most doctors agree that surgery gives people with gallbladder cancer the best chance of cure or long term survival.

But, depending on the stage of your cancer, there may be different options for the operation you have. So sometimes there is a choice. You can discuss these options with your doctor or you may want to get a second opinion before you have your treatment. It can be a good idea to ask for the advice of more than one doctor experienced in treating this type of cancer.

A second opinion can give you more information and help you feel more confident about the treatment plan that is being suggested to you. Most doctors are happy to refer you to another specialist for a second opinion if you would find this helpful.

A second opinion means just that. It does not mean that the second doctor will take over your care. Your original specialist will usually still manage your treatment.

If your cancer is in the advanced stages, it is very unlikely that surgery will cure it. You may feel that having a big operation, with a long recovery period, may not be the best option for you. Your quality of life may be more important to you at this stage. This is a very personal decision, but it is important that you know all the facts and so you should discuss this with your doctor.

Last reviewed: 
14 Jul 2014
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    The Oncologist, 15: 168-181

  • Biliary cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow up. 
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