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Gallbladder cancer is an uncommon disease that is associated with and chronic gallbladder inflammation. Gallbladder cancer is more common in women, older patients, and Native Americans. Although most people with gallbladder cancer Gallbladder Cancer Tumors progress from the gallbladder into the cystic and hepatic ducts, have gallstones, only 1 in 200 people with gallstones develop gall- causing to back up into the and eventually the bloodstream. bladder cancer. As the tumors grow, they obstruct the flow of bile from the gallbladder and liver to the intestine. This causes backup Dilated of bile into the liver and eventually into the bloodstream, causing common , a condition in which the skin turns yellow. LIVER Cystic duct hepatic duct

Symptoms and Diagnosis 3

Gallbladder cancer is dangerous because it is often diagnosed late in Gallbladder 2 its course, when the tumors are already large enough to cause block- ageandinvadenearbystructures.Mostofthetimeitisfoundonlywhen 1 a patient is having for gallstones. The cancer can also present Disease Progression

R with subtle, vague symptoms like loss of appetite, chronic abdominal E DUO 1 Tumor begins growing DENU D M discomfort, , itching (pruritus), yellowing of the whites of in the gallbladder. D A 2 L the eyes (scleral icterus), and jaundice. The last 3 signs are caused by Tumor invades the B L Normal flow through ducts and blocks L high levels of bile in the blood that deposit into tissues. Unlike certain the flow of bile. A the common G other , there are no tests or procedures that are used rou- 3 Bile backs up tinely for early detection or prevention of gallbladder cancer. into the liver. Thediagnosisismadebasedonacombinationofhistoryandphysi- calexamination,laboratorytests,radiologicimaging(ultrasound,com- Symptoms of Bile Obstruction putedtomography,magneticresonanceimaging,and/orpositronemis- sion tomography), and biopsy.Often, a procedure called endoscopic retrogradecholangiopancreatography(ERCP)isusedtotemporar- ily relieve the obstruction caused by the tumor. In some cases, endo- scopic ultrasound (EUS) is used to obtain a biopsy for diagnosis.

Treatment The first step after diagnosing gallbladder cancer is to determine if Yellowing of the eyes (scleral icterus) Itching (pruritus) it is limited to the gallbladder and ducts (localized) or if it spread to and skin (jaundice) other organs in the body (metastatic). If the disease is localized, sur- gery is the only treatment that offers a possibility of cure. If the tu- Some patients may need after surgery.If the dis- mor is too large, sometimes chemotherapy can be used to shrink it ease is metastatic at the time of diagnosis, usually surgery is not in- so that surgery can be easier and safer. The operation can be in- dicated and chemotherapy is the first choice of treatment. volved and requires a prolonged recovery time. Typically, a radical is performed; this involves removing the gallblad- der along with a small amount of adjacent liver and lymph nodes. Very FOR MORE INFORMATION rarely, a more extensive operation is needed to remove parts of the National Cancer Institute smallbowelandthepancreas(Whippleprocedure).Ifthecancerwas www.cancer.gov/types/gallbladder/patient/about-gallbladder- found while performing a cholecystectomy,a second operation to re- cancer-pdq move parts of the liver and lymph nodes may be necessary.

Authors: Ioana Baiu, MD, MPH; Brendan Visser, MD The JAMA Patient Page is a public service of JAMA. The information and Conflict of Interest Disclosures: All authors have completed and submitted the recommendations appearing on this page are appropriate in most instances, but they ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. are not a substitute for . For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page Sources: Downing SR, Cadogan K, Ortega G, et al. Early-stage gallbladder cancer in may be photocopied noncommercially by physicians and other health care the Surveillance, Epidemiology, and End Results database: effect of extended surgical professionals to share with patients. To purchase bulk reprints, call 312/464-0776. resection. Arch Surg. 2011;146(6):734-738. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;6:99-109.

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