Gallbladder and Bile Duct Cancers

The bile duct system and gallbladder (collectively known as the biliary tree) are involved in the drainage and delivery of bile from the liver into the intestine. Bile production is one of the most vital functions of the liver, and it is necessary for the appropriate absorption of nutrients from the intestine. Disorders of the biliary tree can alter this function.

Gallbladder cancer is a disease in which malignant cells form in the tissues of the gallbladder. Primary gallbladder cancer starts in the innermost layer and spreads through the outer layers as it grows.

Bile duct cancer can occur in the ducts within the liver (intrahepatic cholangiocarcinoma) or outside the liver (extrahepatic cholangiocarcinoma). Cancers of the bile duct are uncommon, about one to two cases for every 100,000 people are diagnosed in the United States each year.

Tumors that originate in the gallbladder or bile duct start in the innermost layer and spread through the outer layers. These cancers can be cured with surgery only if found before they have spread. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.

Our patients with gallbladder and bile duct cancers are treated at the Moores Gastrointestinal Cancer Unit. See the Gastrointestinal Cancer Unit for more information.

You can also review the tabs at top of this page for information on gallbladder and bile duct cancer symptoms and risks, diagnosis, and treatment.

Symptoms

Symptoms may include:

• Abdominal pain
  
• Nausea and/or vomiting
  
• Jaundice
  
• Gallbladder enlargement
  
• Weight loss
  
• Severe itching
  
• Black stools
  

It is important to know that some of these symptoms may be caused by non-cancerous diseases.

Risks

Factors that may increase your risk for gallbladder or bile duct tumors are:

• Gallstones
  
• Bile duct stones
  
• Age
  
• Sex (women are twice as vulnerable as men)
  
• Race (American Indians are five times as vulnerable)
  
• Bile duct abnormalities
  
• Gallbladder polyps
  
• Diet
  
• Obesity
  
• Exposure to hazardous chemicals and toxic substances
  
• Primary sclerosing cholangitis
  
• Ulcerative colitis
  
• Parasitic infections
  

Early diagnosos is the key. Your physician diagnoses gallbladder and bile duct cancers with:

• A history and physical exam
• Blood tests
• One or more imaging tests (such as endoscopic procedures, ultrasound, angiography, a CT scan, and MRI scan)
• Biopsy

Surgical removal by our team of liver surgeons can be curative. In selected cases, a multidisciplinary approach of radiotherapy/chemotherapy by our liver cancer specialists and subsequent liver transplantation may be necessary.

The most common disorder of the biliary tree (the gallbladder and bile duct system) is cholelithiasis, or gallstones.

Gallstone removal

• Usually located in the gallbladder, and if symptomatic, can be removed laparoscopically (without open surgery) along with the gallbladder
• Patients usually go home on the same day as surgery and full recuperation time is about two weeks.

Treatment for benign bile duct strictures

• Can occur from injury or inflammatory disease
• Treatment may be non-operative with endoscopic retrograde cholangiography at which time the narrowing is balloon dilated and stented or may require operative repair.

Removal of malignant tumors in biliary tree

• Removal of a portion of bile duct may be necessary.
• Depending on tumor location, complete removal of the tumor may also involve concomitant resection of the liver or pancreas.

Operations on the biliary tree

• Can be done safely and usually without blood transfusion
  If major resections of liver or pancreas are involved, the operative time is about three to six hours
• The hospital stay is about seven days and full recuperation time is about six weeks.
• Under most circumstances, excellent outcomes are achieved

Gallbladder removal

If caught early, before it has spread, gallbladder cancer can be cured by surgery that removes the entire gallbladder.

Bile duct system

• If a bile duct tumor can be removed surgically, bypass procedures may be performed to prevent obstruction of the gastrointestinal and biliary tracts and to relieve patient symptoms.
• Additional treatment may be provided to relieve the discomfort of jaundice, a build-up of bilirubin that is seen with characteristic yellowing of the skin and whites of the eyes.

Many operations require liver section, a complex operation requiring special expertise.  At UCSD, surgical oncologists (cancer surgeons), Drs. Andrew Lowy and Michael Bouvet, as well as liver transplant surgeons, Drs. Alan Hemming and Ajai Khanna, have unique skills in these procedures.