Treatment for gall bladder cancer

Surgery is the main treatment for gall bladder cancer, especially for people with early-stage disease where the gall bladder can be completely removed.

Surgery to remove the gall bladder is called a cholecystectomy. Often surrounding tissue including lymph nodes, adjacent bile ducts and part of the liver will also be removed if gall bladder cancer is suspected. Surgery may be performed as either open surgery or keyhole (laparoscopic) surgery. If the tumour has been found after the gall bladder has been removed for another reason, further surgery may be required.

If the cancer has spread and the tumour is pressing on, or blocking, the bile duct, you may need a stent (small tube made of either plastic or metal). This holds the bile duct open and allows bile to flow into the small bowel again. Stents are placed under x-ray guidance or during an endoscopic retrograde cholangiopancreatography (ERCP).

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.

Download our booklet ‘Understanding Surgery’

Radiation therapy (also known as radiotherapy) uses high energy rays to destroy cancer cells, where the radiation comes from a machine outside the body. It is often given with chemotherapy in a treatment known as chemoradiation. It may be used for gall bladder cancer:

• after surgery, to destroy any remaining cancer cells and stop the cancer coming back
• if the cancer can’t be removed with surgery
• if the cancer has spread to other parts of the body (e.g. palliative radiation for the management of symptoms such as pain).

A course of radiation therapy needs to be carefully planned. During your first consultation session you will meet with a radiation oncologist who will take a detailed medical history and arrange a planning session. At the planning session (known as CT planning or simulation) you will need to lie still on an examination table and have a CT scan. You will be placed in the same position you will be placed in for treatment. The information from the planning session will be used by your specialist to work out the treatment area and how to deliver the right dose of radiation. Radiation therapists will then deliver the course of radiation therapy as set out in the treatment plan.

Radiation therapy does not hurt and is usually given in small doses over a period of time to minimise side effects. Each treatment only takes a few minutes but the set-up time can take longer.

Download our booklet ‘Understanding Radiation Therapy’

Chemotherapy (sometimes just called “chemo”) is the use of 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 your 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. Your medical oncologist will discuss your options with you.

Chemotherapy is commonly given in treatment cycles which may be daily, weekly or monthly. For example, one cycle may last three weeks where 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 chemotherapy drugs being given.

Download our booklet ‘Understanding Chemotherapy’

Your doctor or nurse may suggest you take part in a clinical trial. Doctors run clinical trials to 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 will 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.

You may find it helpful to talk to your specialist, clinical trials nurse or GP, or to get a second opinion. 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’

Complementary therapies are designed to be used alongside conventional medical treatments (such as surgery, chemotherapy and radiation therapy) and can increase your sense of control, decrease stress and anxiety, and improve your mood.

Some Australian cancer centres have developed “integrative oncology” services where evidence-based complementary therapies are combined with conventional treatments to create patient-centred cancer care that aims to improve both wellbeing and clinical outcomes.

Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Some complementary therapies and their clinically proven benefits are listed below:

acupuncture – reduces chemotherapy-induced nausea and vomiting; improves quality of life

aromatherapy – improves sleep and quality of life

art therapy, music therapy – reduce anxiety and stress; manage fatigue; aid expression of feelings

counselling, support groups – help reduce distress, anxiety and depression; improve quality of life

hypnotherapy – reduces pain, anxiety, nausea and vomiting

massage – improves quality of life; reduces anxiety, depression, pain and nausea

meditation, relaxation, mindfulness – reduce stress and anxiety; improve coping and quality of life

qi gong – reduces anxiety and fatigue; improves quality of life

spiritual practices – help reduce stress; instil peace; improve ability to manage challenges

tai chi – reduces anxiety and stress; improves strength, flexibility and quality of life

yoga – reduces anxiety and stress; improves general wellbeing and quality of life.

Let your doctor know about any therapies you are using or thinking about trying, as some may not be safe or evidence-based.

Download our booklet ‘Understanding Complementary Therapies’

Alternative therapies are therapies used instead of conventional medical treatments. These are unlikely to be scientifically tested and may  prevent successful treatment of the cancer. Cancer Council does not recommend the use of alternative therapies as a cancer treatment.

If you have been diagnosed with gall bladder cancer, both the cancer and treatment will place extra demands on your body. Research suggests that eating well and exercising can benefit people during and after cancer treatment.

If you have had your gall bladder 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 gall bladder 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 and being physically active can help you cope with some of the common side effects of cancer treatment, speed up recovery and improve quality of life by giving you more energy, keeping your muscles strong, helping you maintain a healthy weight and boosting your mood.

You can discuss individual nutrition and exercise plans with health professionals such as dietitians, exercise physiologists and physiotherapists.

Download our booklet ‘Nutrition for People Living with Cancer’

Download our booklet ‘Exercise for People Living with Cancer’

All treatments can have side effects. The type of side effects that you may have will depend on the type of treatment and where in your body the cancer is. Some people have very few side effects and others have more. Your specialist team will discuss all possible side effects, both short and long-term (including those that have a late effect and may not start immediately), with you before your treatment begins.

One issue that is important to discuss before you undergo treatment is fertility, particularly if you have been diagnosed at a younger age and want to have children in the future.

Download our booklet ‘Fertility and Cancer’

Common side effects may include:

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

Radiation therapy – Fatigue, nausea and vomiting, liver damage, bowel issues such as diarrhoea, skin problems, loss of fertility, early menopause.

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.

After treatment for gall bladder cancer (especially surgery), you may need to adjust to changes in the digestion of food or bowel function, in particular diarrhoea. These changes may be temporary or ongoing and may require specialised help. If your gall bladder has been removed, you can still break down fats in your small intestine. The bile simply flows directly from your liver to your duodenum, rather than passing through your gall bladder first. If you experience problems, talk to your GP, specialist doctor, specialist nurse or dietitian.