Gallbladder cancer !

Gallbladder cancer is a malignant tumour of the gallbladder lining; early on it rarely causes symptoms, so it is often found late or after gallbladder removal.

Updated 2026-10-29

Structures involved

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Why it happens

What it is

Malignant tumour arising from the lining of the gallbladder, usually an adenocarcinoma. Early disease rarely causes symptoms, so it is often found late or by chance after a cholecystectomy.

Who gets it

Uncommon worldwide but with striking geographic variation: rates are among the highest in Chile and the Andean region of South America, and in northern India. It is more frequent in women and older adults, following the pattern of gallstones, so it matters in Latin American practice.

Causes

Chronic gallbladder inflammation, most often from long-standing gallstones
Porcelain gallbladder (wall calcified by chronic inflammation)
Gallbladder polyps, especially larger or growing ones
Anomalous pancreaticobiliary duct junction, which lets pancreatic juice reflux into the bile ducts
Chronic typhoid (Salmonella Typhi) carriage

Risk factors

Gallstones, especially large or long-standing ones
Female sex and older age
Andean or Indigenous American ancestry and living in high-incidence areas
Obesity
Porcelain gallbladder and gallbladder polyps
Choledochal cysts and primary sclerosing cholangitis

Pathophysiology

Chronic irritation of the mucosa by stones and bile drives a sequence from metaplasia through dysplasia to carcinoma. The gallbladder wall is thin, has no submucosa and lies directly on the liver, so the tumour spreads early into the liver bed (segments IV and V), the lymph nodes and the peritoneum. Invasion of the bile ducts causes obstructive jaundice.

Classification

TNM staging: the depth of wall invasion (T stage) is the key prognostic factor
Incidental (found in the cholecystectomy specimen) or clinically suspected
Histology: adenocarcinoma in the large majority; squamous and adenosquamous types are rare

Symptoms and signs

Often none in early stages
Right upper quadrant pain that may mimic biliary colic or cholecystitis
Painless obstructive jaundice with itching, dark urine and pale stools in advanced disease
Weight loss, loss of appetite and fatigue
Palpable mass in the right upper quadrant
Nausea and vomiting from duodenal obstruction in late disease

Diagnosis

Clinical: Suspected in older patients with gallstones who develop jaundice, weight loss or a right upper quadrant mass. Many cases are found by the pathologist after a routine cholecystectomy.
Tests: Liver function tests with a cholestatic pattern (raised bilirubin and alkaline phosphatase). Tumour markers such as CA 19-9 and CEA may be raised but are not diagnostic. Histology confirms it; percutaneous biopsy is often avoided when the tumour looks resectable, to limit seeding.
Imaging: Ultrasound comes first: wall thickening, a polypoid mass or a mass replacing the gallbladder. Contrast CT and MRI with MRCP stage the tumour (liver invasion, bile ducts, vessels and nodes); PET-CT is sometimes added.

Differential diagnosis

Acute or chronic cholecystitis
Xanthogranulomatous cholecystitis
Adenomyomatosis or a benign gallbladder polyp
Cholangiocarcinoma
Liver tumour or metastasis invading the gallbladder
Pancreatic head cancer (obstructive jaundice)

Goal of treatment

Complete removal with clear margins when the disease is localised; otherwise relief of jaundice and symptoms, systemic therapy to prolong life, and good palliative care.

Treatment

Surgical: Simple cholecystectomy can be enough for very early tumours confined to the mucosa (T1a).
Surgical: Extended (radical) cholecystectomy for more invasive tumours: the gallbladder is removed with a margin of the liver bed (segments IVb and V) and the regional lymph nodes, sometimes with the bile duct. Incidental cancers beyond T1a usually go back to surgery.
Medical: Systemic chemotherapy (antimetabolite and platinum combinations), sometimes with immune checkpoint inhibitors, after surgery or for advanced disease; regimens vary between guidelines.
Procedure: Palliative biliary drainage with an endoscopic or percutaneous stent to relieve jaundice and itching; a duodenal stent for gastric outlet obstruction.
Conservative: Palliative care for pain, nutrition and symptom control.

Complications

Obstructive jaundice and cholangitis
Gastric outlet or duodenal obstruction
Liver invasion and liver failure
Peritoneal carcinomatosis and malignant ascites
Port-site or peritoneal seeding after surgery for an unsuspected cancer

Prognosis

Prognosis depends mainly on the stage. Early tumours found incidentally can be cured, but most patients present with advanced disease and survival is poor.

Prevention

Cholecystectomy for symptomatic gallstones
Cholecystectomy is often advised for porcelain gallbladder and for larger or growing polyps; size thresholds vary between guidelines
Pathological examination of every cholecystectomy specimen

Test yourself

Think of the answer, then tap the question to see it.

What is the strongest risk factor for gallbladder cancer?

Gallstones with chronic inflammation, especially large, long-standing stones.

Which liver segments are removed in an extended cholecystectomy?

Segments IVb and V (the gallbladder bed), together with the regional lymph nodes.

Why does gallbladder cancer invade the liver early?

The gallbladder wall is thin, has no submucosa, and its bed lies directly on the liver (segments IV and V).

What is a porcelain gallbladder and why does it matter?

A gallbladder wall calcified by chronic inflammation; it is linked to cancer (less strongly than once thought), and cholecystectomy is often advised.

In which parts of the world is gallbladder cancer especially common?

Chile and the Andean region of South America, and northern India, mostly in women.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Gallbladder Carcinoma (StatPearls (NCBI Bookshelf), 2024).

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Representative model, for educational purposes only.

Gallbladder highlighted on the Durgical 3D model