Gallbladder Cancer Diagnosis

Therefore, determining early on that you have gallbladder cancer and the stage of your disease will greatly impact your individualized treatment plan and outcome.

As with other cancers, a primary gallbladder cancer in the early stages is small and limited to just the gallbladder. In later stages, the cancer has grown and possibly spread to other locations in the body such as the liver, lung, bones or lymph nodes.

Gallbladder cancer symptoms are usually felt only when the cancer has reached an advanced stage. Some of the more common signs and symptoms of gallbladder cancer can include:

• Abdominal pain and swelling
• Nausea and/or vomiting
• Lumps in the belly
• Jaundice — when bile ducts are blocked and cannot drain into the intestines, this build-up of a yellowish substance called bilirubin passes into the blood and results in the yellowing of the eyes and skin.

You should speak with your doctor if you are experiencing any of the above symptoms. But keep in mind that gallbladder cancer is rare, and these symptoms are more likely to be caused by something else.

There are several ways to confirm a gallbladder cancer diagnosis. At Winship, your care team may use one or more of the following tests and procedures to diagnose and determine the stage of your cancer. Gallbladder cancer diagnostic tests can include:

Medical history and physical exam. Your doctor will discuss your medical history with you, including any risk factors. They will also perform a physical exam, paying close attention to the abdominal area where they will check for any lumps, tenderness or swelling, as these may indicate a gallbladder issue.

Blood tests. Blood tests can be used to find out if you have an elevated level of bilirubin, a byproduct of the digestive breakdown of red blood cells that naturally passes through the gallbladder. If your gallbladder is not processing bilirubin the way it should, it can cause a buildup of the chemical, which can cause an increase in bilirubin in the bloodstream and lead to jaundice or gallstones.

Imaging tests. Using X-rays, sound waves and magnetic fields, advanced imaging tests take detailed pictures of the inside of the body to detect any abnormalities or tumors. These are the most common imaging modalities used for gallbladder tumor detection:

• Ultrasound. A transducer uses sound waves to detect any abnormal growths inside the body. Ultrasound, along with CT, is often used to diagnose primary gallbladder tumors. But ultrasounds can be limited in their ability to detect metastatic disease, in which case further imaging may be required.
• Computed tomography (CT) scan. CT scans take cross-sectional images of the inside of your body to detect any unusual growths or tumors in the gallbladder as well as thickening of the gallbladder wall. CT scans are useful in diagnosing and staging primary gallbladder cancers and can be enhanced with contrast.
• Magnetic resonance imaging (MRI). MRIs show detailed images of the soft tissue of the inside of the body using radio waves and strong magnets. MRIs are useful in determining whether a tumor is benign or cancerous and whether that cancer has spread to other areas of the body.
• Cholangiography. This imaging procedure uses contrast-enhanced x-ray to see if there are any blockages or gallstones in the bile ducts. Cholangiograms are typically done during surgery to remove the gallbladder to minimize or prevent damage to the common bile duct, which drains into the small intestine.
• FDG PET-CT scan. This type of scan uses contrast-enhancement to give doctors a highly accurate image of the gallbladder and its surrounding area. FDG PET-CT scans are helpful both with identifying and staging cancers. Because these scans are able to detect spread that may not be evident through other exams, FDG PET-CT can be very effective for determining whether surgery is an option or not.

Laparoscopy. A minimally invasive surgical procedure involving the use of a laparoscope, or tiny fiber optic camera, to examine the gallbladder and surrounding organs. It is a common method for removing the gallbladder, if necessary.

Gallbladder biopsy. Because of how difficult it can be to diagnose malignant gallbladder disease under imaging, biopsy is often used to target suspected cancerous lesions, especially in cases where endoscopy has been unsuccessful or is not feasible. During a biopsy, small samples of tissue are removed from the gallbladder, sent to a lab for analysis and tested for cancer. Gallbladder biopsy results can indicate whether there are any cancerous cells present and can be helpful in planning for surgery or treatment.

There are several different types of biopsies that may be used for the gallbladder:

• During cholangiography — During this procedure, a sample is taken from the bile duct and analyzed for cancer.
• During laparoscopy — A sample of the gallbladder and surrounding areas that look suspicious may be taken for further analysis.

Needle biopsy — After numbing the skin, a thin needle is inserted into the tumor and cells are removed to confirm diagnosis.