Treatment options for gallbladder cancer
The treatment for gallbladder cancer depends on:
- how big the cancer is and whether it has spread (the stage)
- is it near important blood vessels?
- can the cancer be removed completely with surgery?
- your general health and level of fitness
Your doctor will discuss your treatment, its benefits and the possible side effects with you.
Deciding which treatment you need
A team of doctors and other professionals discuss the best treatment and care for you. They are called a multidisciplinary team (MDT).
The MDT usually includes:
- a surgeon
- a gastroenterologist - specialist in diseases of the digestive system
- an oncologist - cancer specialist
- a radiologist – a doctor specialising in reporting x-rays and scans
- a clinical nurse specialist (CNS) - a nurse who offers support and advice during and after treatment
- a pathologist - doctor who specialises in looking at cells under the microscope
To decide which treatment you need, your team looks at your tests and scan results to see if they can remove (resect) the cancer or not. Your cancer can be:
Resectable - which means they can remove it with surgery.
Unresectable - which means that surgery to remove all the cancer is not possible. The cancer may have grown into nearby organs (locally advanced) or spread elsewhere in the body (advanced). If surgery is not possible, other treatments might be used such as chemotherapy, targeted cancer drugs or radiotherapy.
Surgery
After your diagnosis with gallbladder cancer, your specialist will carry out tests. This is to see if it is possible to remove your cancer. If it is, you can have surgery as long as you are fit enough for the operation.
The surgery is to remove the gallbladder (a cholecystectomy). During surgery the surgeon may also remove a small amount of the liver surrounding the gallbladder. Or if the cancer has spread, they may remove more of the liver and some of the surrounding organs such as the bile duct.
They will usually also remove some lymph nodes near the gallbladder. This is a lymphadenectomy. The lymph nodes are checked in the laboratory to see if they contain cancer cells. You might need a second operation if cancer cells are found.
Your specialist uses the results from the laboratory to work out the stage of your cancer. And if you need further treatment.
Targeted cancer drugs and immunotherapy
Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack cancer. These are called immunotherapy. As these drugs work differently to chemotherapy they have different side effects.
You might have targeted cancer drugs or immunotherapy as part of your treatment for gallbladder cancer. You might have these drugs on their own or with chemotherapy.
Radiotherapy
You might have radiotherapy after surgery because your:
• surgeon thinks there are still some cancer cells left behind
• cancer has spread to the lymph nodes
This is adjuvant treatment. You may have chemotherapy with radiotherapy (chemoradiotherapy).
You might have radiotherapy to relieve symptoms caused by the cancer such as a blockage in the bile duct or if the cancer has spread to another part of the body. This is palliative radiotherapy.
Chemotherapy
Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in your bloodstream.
For gallbladder cancer, chemotherapy may be used after surgery, to reduce the risk of the cancer coming back (adjuvant treatment).
It may also be used if surgery is not possible or if the cancer has come back after surgery (recurrence). This can help shrink or slow down the growth of the cancer.
The chemotherapy drugs most often used for gallbladder cancer include:
- gemcitabine
- cisplatin
- 5-fluorouracil
- capecitabine
- oxaliplatin
Chemotherapy is also sometimes given as part of a clinical trial.
Treatment by stage
The treatment is chosen depending how far a cancer has grown and spread. There are 4 main stages.
It is important to remember that it is very rare to find gallbladder cancer at this early stage. Most stage 1 gallbladder cancers are found almost by accident. Rarely gallbladder cancers are found during a simple cholecystectomy for gallstones or inflammation of the gallbladder.
If the cancer is found very early (stage T1a), no further treatment is usually needed. In this situation, you would usually have a simple operation to remove just your gallbladder (cholecystectomy).
But even early stage gallbladder cancer can come back. So if the cancer has grown through the muscle layer of the gallbladder wall (stage T1b), or is in the part of the gallbladder close to the liver, your surgeon is likely to do a bigger operation. This is called an extended cholecystectomy. This means the surgeon will also take out the part of the liver nearest the cancer, and the surrounding lymph nodes. This helps to lower the risk of the cancer coming back.
Sometimes the surgeon won’t know you had cancer until after your operation, when the reports on your gallbladder come back from the laboratory. In this case, your doctor may suggest that you have a second operation. This will also be an extended cholecystectomy.
Most stage 2 gallbladder cancers are found during surgery to remove the gallbladder because of inflammation or gallstones. You might have another operation, either an extended cholecystectomy or a more extensive operation. Your doctor might suggest radiotherapy in case it helps stop the cancer returning.
Your specialist might suggest the chemotherapy drug capecitabine after surgery to remove your gallbladder cancer. This treatment aims to help stop the cancer from coming back.
They may talk to you about a clinical trial you might be able to join.
In the past surgery wasn't usually possible for people with stage 3 gallbladder cancer. With new surgical techniques, such as extended cholecystectomy, surgery can be possible in some people. This can help people live longer.
Other treatment options might include:
- surgery followed by chemotherapy
- a clinical trial
- a targeted cancer drug or immunotherapy
Unfortunately it is not possible to cure stage 4 gallbladder cancer with surgery. This is because surgery targets one area of the body. It won't remove any secondaries in the body.
Your specialist might suggest chemotherapy or a targeted cancer drug. These treatments go into your bloodstream and work throughout your body.
Chemotherapy can include the drugs cisplatin and gemcitabine.
You might have surgery to relieve symptoms. For example if the cancer is blocking your biliary system (the part of the body that makes, stores and releases bile).
Radiotherapy is also sometimes used to relieve symptoms.
You might be able to take part in a clinical trial.
Gallbladder cancer that has come back
Doctors generally treat cancer of the gallbladder that has come back (recurred) in the same way as stage 4 gallbladder cancer. Your treatment might depend on whether you have had radiotherapy or surgery in the past, and on where the cancer has come back.
There is a maximum amount of radiotherapy that you can have to any one part of your body. If you have too much it can damage healthy body tissues. So if you have had radiotherapy before, you might not be able to have it again.
Treatment to help with symptoms
Treatment to control your symptoms is sometimes called palliative treatment. It will not cure your cancer. It aims to improve your symptoms and quality of life.
You might have this type of treatment if:
- you decide you do not want chemotherapy, targeted cancer drugs or radiotherapy
- you are not well enough for anti-cancer drug treatment
- your cancer has come back after having all the cancer treatments that are available
This is called best supportive care. This is where your local palliative care team and GP help manage your symptoms with medications. This does not slow down the growth of the cancer but should help improve your quality of life whilst living with cancer.
Your choices
Your doctor might offer you a choice of treatments. Discuss each treatment with them and ask how they can control any side effects. This helps you make the right decision for you. You also need to think about the other factors involved in each treatment, such as:
- whether you need extra appointments
- if you need more tests
- the distance you need to travel to and from hospital
- time spent at the hospital for each treatment
You might have to make further choices as your situation changes. It helps to find out as much as possible each time. You can stop a treatment whenever you want to if you find it too much to cope with.
