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:
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.
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 physical examination allows the doctor to look for any signs of gallbladder cancer. During a physical examination, the doctor may:
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.
Ultrasound uses high-frequency sound waves to make images of structures in the body. It is used to:
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:
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:
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:
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.
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:
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.
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:
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.
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:
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.