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Gallbladder cancer

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Diagnosing gallbladder cancer

Diagnosis is the process of finding the underlying cause of a health problem. The process of diagnosis may seem long and frustrating, but it is important for the doctor to rule out other possible reasons for a health problem before making a cancer diagnosis. Diagnostic tests for gallbladder cancer are usually done when:

  • the symptoms of gallbladder cancer are present
  • the doctor suspects gallbladder cancer after talking with a person about their health and completing a physical examination
  • routine tests suggest a problem with the gallbladder

Many of the same tests used to initially diagnose cancer are also used to determine the stage (how far the cancer has progressed). Your doctor may also order other tests to check your general health and to help plan your treatment. Tests may include the following.

Medical history and physical examination

The medical history is a record of present symptoms, risk factors and all the medical events and problems a person has had in the past. The medical history of a person's family may also help the doctor to diagnose gallbladder cancer.

In taking a medical history, the doctor will ask questions about:

  • a personal history of
    • gallstones
    • porcelain gallbladder
    • choledochal cyst
    • anomalous pancreaticobiliary duct junction
    • gallbladder polyps
  • a family history of gallbladder cancer
  • signs and symptoms

A physical examination allows the doctor to look for any signs of gallbladder cancer. During a physical examination, the doctor may:

  • feel the abdomen for any lumps, tenderness, swelling or fluid
  • look at the whites of the eyes and skin for yellowing (a sign of jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow.)
  • feel the lymph nodes in the groin

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Blood chemistry tests

Blood chemistry tests measure certain chemicals in the blood. They show how well certain organs are functioning and can also be used to detect abnormalities. They may be used to diagnose gallbladder problems or gallbladder cancer.

  • Increased bilirubin (a chemical in bile) may indicate a blockage of the bile ducts or a problem with the liver because of a gallbladder tumour.
  • Increased alkaline phosphatase, alanine aminotransferase (ALT) and aspartate transaminase (AST) may indicate that the cancer has spread to the liver.

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Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:

  • view the gallbladder and check for gallbladder problems or gallbladder cancer in people with abdominal pain or jaundice
    • An abdominal ultrasound is often the first imaging test done when doctors suspect gallbladder cancer based on the person’s symptoms.
    • It can confirm if the wall of the gallbladder is thickened and provide information about the size of a tumour.
  • see if the cancer has also spread to the liver

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Computed tomography (CT) scan

A CT scan uses special x-ray equipment to make 3-dimensional and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures. It is used to:

  • check for cancer in the gallbladder
  • assess the extent of cancer in the gallbladder
  • see if cancer has spread outside the gallbladder to nearby lymph nodes, the liver or the abdominal cavity

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Tumour marker tests

Tumour markers are substances – usually proteins – in the blood that may indicate the presence of gallbladder cancer. Tumour marker tests are used to check a person's response to cancer treatment, but they can sometimes be used to help diagnose gallbladder cancer.

The tumour markers that may be measured are:

  • carbohydrate antigen 19-9 (CA19-9)
    • CA19-9 level may be increased with gallbladder cancer or other conditions. It is more likely to be increased if the gallbladder cancer is at an advanced stage.
  • carcinoembryonic antigen (CEA)
    • CEA level may also be increased with gallbladder cancer and other conditions.

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During a biopsy, tissues or cells are removed from the body so they can be tested in a laboratory. The pathology report from the laboratory will confirm whether or not cancer cells are present in the sample. Imaging tests often provide enough information to confirm the presence of a gallbladder tumour.

There is concern that a gallbladder cancer can be spread in the abdomen when a sample of the tissue is removed, so a biopsy is usually only done to confirm gallbladder cancer and allow the doctor to plan treatment.

The biopsies that can be used for gallbladder cancer are:

  • fine needle aspiration (FNA)
    • During FNA, the doctor inserts a very fine needle through the skin of the abdomen and into the gallbladder. Ultrasound or computed tomography (CT) is used to guide the needle during the procedure. When the needle is in the tumour, the doctor draws a sample into the needle. The sample is sent to the laboratory to be examined under a microscope.
    • FNA may be used to confirm the diagnosis of gallbladder cancer if other tests have shown that the cancer has already spread to other organs or cannot be completely removed by surgery (is unresectable).
  • endoscopic retrograde cholangiopancreatography
    • A biopsy can be done during endoscopic retrograde cholangiopancreatography (ERCP).
  • laparoscopylaparoscopyA procedure that uses an endoscope (a thin, tube-like instrument with a light and lens) to examine or treat organs inside the abdomen and pelvis.
    • A biopsy can also be done during a laparoscopy.

If it is fairly certain a person has gallbladder cancer because of test results and the gallbladder is removed by surgery, the surgeon will send the gallbladder tissue for examination and a biopsy isn't necessary.

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Endoscopic retrograde cholangiopancreatography (ERCP)

Doctors will do endoscopic retrograde cholangiopancreatography (ERCP) when they suspect gallbladder cancer. This procedure helps determine if any of the ducts (cystic, pancreatic and bile) are blocked because of gallstones or a gallbladder tumour. It allows the doctor to look inside the bile, cystic and pancreatic ducts and the pancreas using a flexible tube with a light and lens on the end (an endoscope).

An ERCP may be used to:

  • determine if there is a gallbladder tumour and if it can be removed
  • see if cancer has spread to the bile ducts and take samples of bile or the bile duct to look for cancer cells
  • help plan surgery
  • place a small tube (stent) into the bile duct to relieve a blockage caused by a gallbladder tumour

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Magnetic resonance imaging (MRI)

MRI uses powerful magnetic forces and radio-frequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-dimensional pictures. It may be used to check the extent and stage of the gallbladder cancer and see if it has spread to nearby bile ducts and other organs.

A special type of MRI called magnetic resonance cholangiopancreatography (MRCP) may be done in people with gallbladder cancer. It can provide detailed information about the bile ducts, gallbladder, liver and pancreas.

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Percutaneous transhepatic cholangiography (PTC)

A percutaneous transhepatic cholangiography (PTC) is an x-ray of the bile ducts and liver that uses a contrast dye to enhance the pictures. A thin needle is inserted through the skin into the gallbladder area. A special dye is injected into the bile ducts. The dye outlines the structure of the bile ducts, liver and gallbladder on the x-ray.

PTC may be used to:

  • determine if a gallbladder tumour is blocking the bile ducts
  • take a sample of the bile to check for cancer cells
  • show if a gallbladder tumour has spread to the liver

PTC may be done for tumours that doctors cannot remove by surgery or when they cannot get sample of the tumour with a fine needle aspiration.

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A laparoscopy allows the doctor to confirm how far a gallbladder tumour has spread. It may also help doctors plan further surgery and other treatments. During a laparoscopy, an endoscope is inserted through a small incision in the abdomen. The doctor examines the gallbladder, bile ducts and liver during this procedure. Laparoscopy may be used to:

  • confirm the presence and extent of a tumour
  • take samples of the tumour to confirm a diagnosis of gallbladder cancer

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An angiography is an x-ray of blood vessels. A dye is injected into an artery. The x-ray images show the blood flow in the area. An angiography may be used to see if the gallbladder tumour has grown into nearby blood vessels. This can help the doctor decide whether the cancer can be safely removed and assists with planning surgery.

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See a list of questions to ask your doctor about diagnostic tests.


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