Gallbladder and Bile Duct Cancers

Cancer is when cells in any part of the body become abnormal and keep growing to form a mass or lump called a tumour. 

Gallbladder and bile duct cancers are 2 different types of cancers but affect the same area of the body. Bile duct cancer is sometimes called cholangiocarcinoma or biliary tract cancer. 

About 85% of gallbladder cancers are adenocarcinomas, which are tumours that start in the cells that line the inside of the gallbladder. The other, less common, types of gallbladder cancer include squamous cell carcinoma, sarcoma and lymphoma.

Bile duct cancer can happen in different places within the bile duct system. Cancers in the bile ducts that are within the liver are called intrahepatic, cancers at the point where the left and right hepatic ducts meet are called Klatskin tumours and cancers in the common bile duct outside the liver are extrahepatic tumours. 

Malignant (cancerous) tumours have the potential to spread to other parts of the body through the bloodstream or lymph vessels and form another tumour at a new site. This new tumour is known as secondary cancer or metastasis.

About 1430 Australians are diagnosed each year with gallbladder and bile duct cancers.

People 65 or over are more likely to be diagnosed with these cancers than younger people.

The exact cause of most gallbladder cancers is not known, but factors that increase your risk include: 

• having had gallstones or inflammation of the gallbladder in the past 
• family history of gallbladder cancer (close relative such as mother, father, sibling or child) 
• other gallbladder and bile duct conditions and abnormalities, such as gallbladder polyps, choledochal cysts (bile-filled cysts) and calcified gallbladder (also known as porcelain gallbladder). 

The main risk factor for bile duct cancer is long term inflammation of the bile ducts. This may be caused by liver problems such as hepatitis and fatty liver disease. Other risk factors include exposure to certain chemicals in the printing industry, or having inflammatory bowel disease or liver conditions (which can cause scar tissue in the bile ducts). 

However, most people with these risk factors do not develop cancer.

Gallbladder cancer and bile duct cancer can be difficult to diagnose in their early stages as they don’t usually cause symptoms. Sometimes, cancer is found when the gallbladder is removed or examined for another reason, such as gallstones. But most people who have surgery for gallstones do not have gallbladder cancer. 

If there are symptoms, they may include: 

• abdominal pain, often on the upper right side 
• nausea (feeling sick) or vomiting 
• jaundice (yellowing of the skin and eyes), causing dark urine (wee), pale bowel movements (poo) 
• general weakness or fatigue 
• a lump in the abdomen 
• unexplained weight loss 
• a constant itch 
• fever.

These may include a full blood count (to measure your white blood cells, red blood cells and platelets), liver function tests (to measure chemicals that are found or made in your liver) and tumour markers (to measure chemicals produced by cancer cells).

For this scan, you will lie down. A health professional called a sonographer will spread gel over the affected part of your body, and move a small device over the area. 

Soundwaves are used to create pictures of the inside of your body. The ultrasound images are then projected onto a computer screen. An ultrasound is painless and takes about 15 –20 minutes.

Special machines are used to scan and create pictures of the inside of your body. During the scan you may have an injection of dye (called contrast) into one of your veins, which makes the pictures clearer. You will need to lie still on an examination table which slides into a large metal tube. A special type of MRI called magnetic resonance cholangiopancreatography (MRCP) shows the bile ducts in more detail. The scans are painless, though the MRI machine can be noisy.

You will be given a general anaesthetic. The doctor will make small cuts in your abdomen. A thin tube with a camera on the end (laparoscope) will be inserted into your body so the doctor can see your gall bladder, bile ducts and other parts of your abdomen.

This is an x-ray of the bile ducts to see if there is any narrowing or blockage.

The doctor inserts a flexible tube with a camera on the end (endoscope) down your throat into your small intestine and into your bile duct while you are sedated. The camera takes images of your gut.

This is the removal of some tissue from the affected area for examination under a microscope. This can be done during a laparoscopy, a cholangiography or by a thin needle guided by ultrasound or CT scan.

Staging describes how far the cancer has spread. Knowing the stage helps doctors plan the best treatment for you. 

Gallbladder and bile duct cancers are staged using the TNM (tumour–nodes–metastasis) system, which indicates the size of the tumour, whether it has spread to nearby lymph nodes or if has spread to other parts of the body.

Staging gallbladder and bile duct cancers 

The TMO system is used along with a number value from 0-IV. 

Stage 0 -  Indicates the cancer is only in the place of origin and has not spread to nearby organs. 

Stage I - Cancer cells have begun to spread to nearby tissue but are not deeply embedded. Lymph nodes are not affected. This stage is also known as early-stage cancer.

Stage II - The cancer is deeply embedded into nearby tissue. Lymph nodes may or may not be affected. This is called localised cancer.  

Stage III - The cancer is larger and deeply embedded into surrounding tissue and lymph nodes are usually affected. This is also called localised cancer.

Stage IV - The cancer has spread to other parts of the body. This is known as advanced or metastatic cancer.

Surgery is the most common treatment for gallbladder cancer and bile duct cancer. For people with early-stage disease, the gallbladder can be completely removed and the bile duct openings in the liver can be attached directly to the bowel. Sometimes a stent (small tube made of plastic or metal) will be inserted into the bile duct to help the bile flow past a blockage into the small bowel. The extent of the surgery depends on the location and stage of the tumour. Your surgeon will discuss the type of operation you may need and the side effects and risks of surgery. 

Surgery to remove the gallbladder is called a cholecystectomy. Often surrounding tissue including lymph nodes, bile ducts and part of the liver will also be removed. Surgery may be performed as either open surgery or keyhole (laparoscopic) surgery.

Download our booklet ‘Understanding Surgery’

Radiation therapy also called radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells. External beam radiation therapy (EBRT) uses radiation from a large machine called a linear accelerator. The radiation is usually from x-ray beams. 

You lie on a table and the machine delivers radiation to the targeted area. Each radiation session takes 10–20 minutes and is painless. A typical treatment plan might involve a session of radiation therapy every weekday for 4–6 weeks. In some instances, radiation therapy is given over a much shorter time period. The dose and duration of radiation therapy is decided by your radiation oncologist. 

Selective internal radiation therapy (SIRT) is sometimes used for bile duct cancer. In SIRT, tiny radioactive beads (microspheres) made of resin or glass are inserted into your body, and target the tumour through the bloodstream.

Download our booklet ‘Understanding Radiation Therapy’

Chemotherapy uses drugs to kill or slow the growth of cancer cells. You may have one chemotherapy drug, or be given a combination of drugs. This is because different drugs can destroy or shrink cancer cells in different ways. Your treatment will depend on your situation and the stage of the tumour. Your medical oncologist will discuss your options with you. 

Chemotherapy is usually given through a drip into a vein (intravenously) or as a tablet that is swallowed. Chemotherapy is commonly given in cycles which may be daily, weekly or monthly. For example, a cycle may last 3 weeks – you have the drug over a few hours, followed by a rest period, before starting another cycle. The length of the cycle and number of cycles depends on the drugs being given.

Download our booklet ‘Understanding Chemotherapy’

Immunotherapy is a drug treatment that uses the body’s own immune system to fight cancer. There are several different types of immunotherapy.

Download our fact sheet 'Understanding Immunotherapy'

Targeted therapy is a type of drug treatment. It attacks specific cancer cell features, known as molecular targets, to stop the cancer growing and spreading. Targeted therapy is not suitable for everyone. Your doctors may test the cancer to see if the cells contain a particular molecular target.

Download our fact sheet 'Understanding Targeted Therapy'

Your doctor may suggest you take part in a clinical trial. Clinical trials test new or modified treatments and ways of diagnosing disease to see if they are better than current methods. For example, if you join a randomised trial for a new treatment, you’ll be chosen at random to receive either the best existing treatment or the modified new treatment. Over the years trials have improved treatments and led to better outcomes for people diagnosed with cancer. If you decide to take part in a clinical trial, you can withdraw at any time. 

Visit Australian Cancer Trials for more information or contact the Australasian Gastro-Intestinal Trials Group (AGITG).

Download our booklet ‘Understanding Clinical Trials and Research’

Common side effects of treatment are below.

Surgery -bleeding, damage to nearby tissue and organs (including liver failure and bile leakage), pain, infection, blood clots, weak muscles (atrophy), lymphoedema.

Radiation therapy - fatigue, nausea and vomiting, liver inflammation, bowel issues (such as diarrhoea) skin problems, loss of fertility.

Chemotherapy - fatigue, loss of appetite, nausea and vomiting, bowel issues (such as diarrhoea) hair loss, mouth sores, skin and nail problems, increased chance of infections, loss of fertility, early menopause.

Immunotherapy - fatigue, nausea, skin rash and itching, joint pain, diarrhoea, dry eyes.

Targeted therapy - fatigue, nausea, diarrhoea, constipation, sore mouth, blood pressure changes, appetite loss, bleeding and bruising, skin problems, joint aches, headache.

Chemotherapy and radiation therapy may cause infertility. If you may want to have children in the future, it is important to discuss this with your treatment team before starting treatment. 

See our booklet 'Fertility and Cancer' or call 13 11 20 for more information.

Seek support - Feeling a range of emotions after a cancer diagnosis is normal. You may feel overwhelmed, anxious, fearful, angry, sad or lonely. Many people need emotional support before, during and after treatment. Adjusting to living with scars, changes to your physical appearance, changes to your lifestyle and how your body works can be hard. It may help to talk with a counsellor, psychologist, friend or family member. Talk to your medical team about what support services are available to you.

Download our booklet ‘Emotions and Cancer’ for more information.

Eat and drink well - If you have had your gallbladder removed, bile made by the liver will no longer be stored between meals. Bile instead will flow directly from your liver into your small intestine and there will still be enough bile produced for normal digestion. You should still be able to eat a normal diet after your gallbladder is removed, but it’s a good idea to avoid high-fat foods for a few weeks after surgery while your body adjusts. 

Eating well can help you cope with some of the common side effects of cancer treatment and help you recover faster. You can discuss individual nutrition with health professionals such as dietitians.

Download our booklet ‘Nutrition for People Living with Cancer’ for more information.

Get active - Research shows exercise can benefit people during and after cancer treatment. Being active can help you cope with some of the common side effects of cancer treatment and speed up recovery. It can also improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.

Download our booklet ‘Exercise for People Living with Cancer’ for more information.