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. The aim of surgery is to cure your cancer. After surgery you might have some further treatment, such as chemotherapy. This is called adjuvant treatment.
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:
- specialist in diseases of the digestive system (gastroenterologist)
- cancer specialist (oncologist)
After your diagnosis with gallbladder cancer, your specialist will carry out tests. This is 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 surgery is to remove the gallbladder (a cholecystectomy). During surgery the surgeon may also remove a small amount of the liver surrounding the gallbladder. Or if the cancer has spread, they may remove more of the liver and some of the surrounding organs such as the bile duct.
They will usually also remove some lymph nodes near the gallbladder. This is a lymphadenectomy. The lymph nodes are checked in the laboratory to see if they contain cancer cells. You might need a second operation if cancer cells are found.
Your specialist uses the results from the laborartory to work out the stage of your cancer. And if you need further treatment.
You might have radiotherapy after surgery because your:
• surgeon thinks there are still some cancer cells left behind
• cancer has spread to the lymph nodes
This is adjuvant treatment. You may have chemotherapy with radiotherapy (chemoradiotherapy).
You might have radiotherapy to relieve symptoms caused by the cancer such as a blockage in the bile duct or if the cancer has spread to another part of the body. This is palliative radiotherapy.
Some clinical trials have looked into chemotherapy after surgery for gallbladder cancer. One trial showed that a chemotherapy drug called capecitabine helped people live longer after surgery to remove their gallbladder cancer.
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. Rarely gallbladder cancers 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.
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 the chemotherapy drug capecitabine after surgery to remove your gallbladder cancer. This treatment aims to help stop the cancer from coming back.
They may talk to you about a clinical trial you might be able to join.
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 chemotherapy
- a clinical trial
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 the chemotherapy drugs cisplatin and gemcitabine. Radiotherapy might also be used to help relieve your symptoms.
They might suggest clinical trials you may be able to join.
Gallbladder cancer that has come back
Doctors generally treat cancer of the gallbladder that has come back (recurred) in the same way as stage 4 gallbladder cancer. Your treatment might depend 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 or chemotherapy.
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.