How is Gallbladder Cancer Diagnosed?

How do doctors diagnose gallbladder cancer?

Diagnosing gallbladder cancer usually involves a combination of medical history, physical examination, imaging tests, and laboratory testing. In some cases, the diagnosis is confirmed after the gallbladder has been surgically removed.

Medical history and physical examination

Your healthcare professional will ask about symptoms, including:

• Abdominal pain

• Nausea or vomiting

• Jaundice

• Unexplained weight loss

• Fever

• Changes in bowel movements

They may also ask about gallstones, gallbladder polyps, and other medical conditions. During a physical examination, your doctor may look for jaundice, abdominal tenderness, or swelling.

Blood tests

Blood tests cannot diagnose gallbladder cancer on their own, but they can provide important information.

Liver function tests

Liver function tests measure substances such as bilirubin and liver enzymes. Abnormal results may indicate bile duct blockage or liver dysfunction.

Complete blood count

A complete blood count evaluates red blood cells, white blood cells, and platelets. It may help identify anemia or signs of infection.

Tumor markers

CA 19-9 and CEA are tumor markers that may be measured in some patients. Elevated levels can occur with gallbladder cancer but are also found in other cancers and noncancerous conditions. They cannot confirm or exclude the diagnosis.

Ultrasound

Abdominal ultrasound is often the first imaging test performed when a person has symptoms suggesting a gallbladder problem. Ultrasound can identify gallstones, wall thickening, polyps, masses, and bile duct abnormalities.

CT scan

Computed tomography (CT) uses X-rays to create detailed images of internal structures. A CT scan can help determine:

• Tumor size

• Involvement of the liver

• Spread to lymph nodes

• Involvement of nearby organs

• Possible distant metastases

CT imaging is commonly used for staging and surgical planning.

MRI and MRCP

Magnetic resonance imaging (MRI) provides detailed images of soft tissues. Magnetic resonance cholangiopancreatography (MRCP) is a specialized MRI technique used to examine the bile ducts and pancreatic duct. These tests can help doctors evaluate bile duct obstruction and the relationship between a tumor and nearby structures.

Endoscopic ultrasound

Endoscopic ultrasound (EUS) combines endoscopy with ultrasound imaging. A thin, flexible tube containing an ultrasound device is passed through the mouth into the digestive tract. EUS may help evaluate certain tumors, lymph nodes, or nearby structures.

ERCP

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure used to examine and treat problems involving the bile ducts. During ERCP, a doctor passes an endoscope through the mouth and into the small intestine. A small catheter is used to access the bile ducts. ERCP may be used to:

• Relieve bile duct obstruction

• Place a stent

• Collect tissue or cell samples in selected circumstances

ERCP is generally used when there is a specific clinical need rather than as a routine diagnostic test for every patient.

Biopsy

A biopsy involves removing tissue or cells to examine for cancer. Biopsy approaches depend on tumor location and the treatment plan. An important distinction: When imaging suggests potentially resectable gallbladder cancer, doctors may avoid a needle biopsy of the primary tumor because of concerns about tumor seeding and because surgery may provide the diagnosis. For advanced or unresectable disease, a biopsy is often needed before starting systemic therapy.

Gallbladder cancer discovered after surgery

Some gallbladder cancers are discovered after a cholecystectomy, which is surgery to remove the gallbladder. The gallbladder may have been removed because of gallstones or inflammation. A pathologist then examines the tissue and unexpectedly identifies cancer. This is called incidental gallbladder cancer. Additional imaging, surgery, or other treatment may be recommended depending on how deeply the cancer has invaded the gallbladder wall.

What happens after diagnosis?

After confirming gallbladder cancer, your healthcare team will determine the stage and whether the cancer can be surgically removed. Treatment planning is ideally performed by a multidisciplinary team that may include:

• Hepatobiliary surgeon

• Medical oncologist

• Radiation oncologist

• Gastroenterologist

• Radiologist

• Pathologist