Diagnosing gallbladder cancer

An accurate gallbladder cancer diagnosis is the first step in developing a gallbladder cancer treatment plan. Your team of cancer care experts will use a variety of tests and tools designed for diagnosing gallbladder cancer, evaluating the disease and developing your individualized treatment. Throughout your treatment, the care team will use imaging and laboratory tests to monitor your response to treatment and modify your plan when needed.

Common tools used for diagnosing gallbladder cancer and staging the disease include:

Physical exam

If you’re experiencing suspicious symptoms, or there’s some other reason to think you could have cancer in your gallbladder, a physical exam is often the first method your doctor will use to check.

• During the exam, your doctor may feel around your belly to determine whether there are any suspicious lumps or swelling.
• You may be asked if you feel any pain or tenderness as your doctor presses down on different areas of the abdomen.
• Various lymph nodes, such as those near the shoulders, may also be checked for lumps, as gallbladder cancer may spread to these areas.
• Your doctor looks for signs of jaundice, which is a yellowing of the skin and whites of the eyes.

Before a physical exam, your doctor may ask you a series of questions about symptoms and any past health problems.

Some of the most common symptoms of gallbladder cancer include:

• Pain or lumps in the abdominal area
• Nausea
• Vomiting
• Jaundice

Your doctor may want to know whether you’ve experienced any of these or other symptoms, how long they’ve lasted, and their severity.

While it’s an important part of the diagnostic process, gallbladder cancer may not be detectable through a physical exam in the early stages. Since the gallbladder is buried deep within the abdomen, it may be difficult to notice lumps or signs of cancer from outside the body. Even if a physical exam does lead your doctor to suspect there may be cancer in the gallbladder, other tests are needed to make the diagnosis.

Lab tests

Your doctor may test your blood to determine the level of bilirubin, a chemical that makes bile yellow. High levels of bilirubin may indicate a problem with either the gallbladder or the liver. Other markers of abnormal liver and/or gallbladder function that may be detected by a blood test are albumin, alkaline phosphatase, AST, ALT and GGT.

Levels of certain proteins known as tumor markers may also be checked. These proteins are often elevated in patients with certain types of cancers, although they are not specific to a certain kind of cancer, and levels may be higher than normal because of certain non-cancerous conditions. CEA and CA 19-9 are two tumor markers that may be associated with gallbladder cancer.

CT scan

A CT scan for gallbladder cancer uses X-ray images intended to give a detailed view of the abdomen and the gallbladder.

Ultrasound

This procedure is often performed with an ultrasound transducer, or wand, on the skin over the abdomen. In some cases, your doctor may perform an endoscopic or laparoscopic ultrasound. For these techniques, the ultrasound device is attached to a tube, and inserted through the mouth, or through a small surgical incision.

MRI

A magnetic resonance imaging (MRI) scan is designed to examine the soft tissues within the body and is often used to diagnose gallbladder cancer.

MRI scans reveal what the gallbladder and surrounding area look like in great detail. These details may even help distinguish between a noncancerous (benign) growth and a cancerous (malignant) tumor.

An MRI scan may also help determine the size of the tumor and any spread beyond the gallbladder. To increase the clarity of the MRI images, you may receive an injection of a dye, which spreads through your bloodstream and provides contrast in the final images.

Two types of specialized MRI scans may be used to help diagnose gallbladder cancer:

• Magnetic resonance cholangiopancreatography (MRCP) uses a regular MRI machine, but it focuses specifically on the bile ducts, creating detailed images of these structures (further described below).
• Magnetic resonance angiography (MRA) uses a regular MRI machine to look at the blood vessels surrounding your gallbladder and determine whether a tumor has caused a blockage in blood flow or any other abnormalities are present. Before this scan, you may receive a contrast dye inject to increase the clarity of the images.

X-ray

A standard X-ray of the chest may be performed to see if the cancer cells have spread to the lungs.

Cholangiography

This test allows your doctor to look at the bile ducts. It may also help in planning surgery. This test may be performed either by using an MRI machine or endoscope, or by inserting a needle through the skin of the abdomen.

There are three main types of cholangiography:

• Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure that involves a flexible and hollow instrument called an endoscope being inserted into your throat until it reaches the upper part of the small intestine. Before an ERCP, you’re given a sedative drug, so you’re not awake or able to feel the procedure. Once the endoscope has reached the small intestine, a catheter is passed through the hollow part of the instrument. The catheter releases a contrast dye into the area, and then an X-ray machine takes pictures. The contrast dye increases the clarity of the images produced by the X-ray and reveals whether the bile ducts and pancreatic duct are narrow or blocked. Because the endoscope allows access to the gallbladder area, important procedures such as a biopsy (removing cells for testing) or stent placement (placing a tube to unblock a duct) may be performed at the same time as an ERCP.
• Percutaneous transhepatic cholangiography (PTC) involves a needle being inserted into the skin covering your abdominal area, until it reaches the bile duct. You’re given a sedative drug prior to a PTC, to induce sleepiness, and an anesthetic to numb the abdominal area. Once the needle has reached the bile duct, it releases a contrast dye and an X-ray machine takes pictures. A biopsy or stent placement can also be performed at the same time as a PTC. ERCP is more commonly used than a PTC, as it is less invasive and provides the same advantages.
• Magnetic resonance cholangiopancreatography (MRCP), also described in the MRI section, uses an MRI machine to create detailed images of the bile ducts. MRCP is a noninvasive scan that looks at the bile ducts without needing to enter your body with an endoscope or needle (as in an ERCP and PTC). A biopsy or stent placement cannot be performed during an MRCP.

Biopsy

In some cases when gallbladder cancer is detected on other tests, a surgeon may remove the gallbladder first and send a sample to the pathologist afterwards. A biopsy may be performed during laparoscopy or cholangiography. When diagnosing gallbladder cancer, your doctor may also use a procedure called fine needle aspiration, in which a thin needle is inserted into the gallbladder to remove cells, usually under the guidance of an ultrasound or CT scan.

Understanding test results

Gallbladder cancer may be difficult to detect in its early stages, as it may not cause noticeable symptoms or lumps. Oftentimes, the cancer is discovered when the gallbladder is removed for other reasons, such as an infection or gallstones.

If you or your doctor suspect gallbladder cancer, and you undergo a series of diagnostic tests, your care team will contact you when the results are in and explain them to you.

The information included in the results varies depending on which tests were performed, but it may include bilirubin levels from a blood test and descriptions of images taken with various scans, such as an MRI or CT scan. If a biopsy was performed, your doctor is able to share whether the cells that were removed are cancerous.

Once gallbladder cancer is diagnosed, the next step is staging, which is a process that uses many of the same diagnostic tests above to assess whether the cancer has spread beyond the gallbladder and where it may have spread. By determining if and where the cancer has spread, your doctor is able to recommend a treatment plan.

Next topic: How is gallbladder cancer treated?