Gallbladder Cancer: Diagnosis
How is gallbladder cancer diagnosed?
Gallbladder cancer is often hard to find. That’s partly due to where the gallbladder
is in the body. And many people don’t have symptoms in the early stages of the disease.
If your healthcare provider thinks you might have gallbladder cancer, you will need
certain exams and tests to be sure. Diagnosing gallbladder cancer starts with your
healthcare provider asking you questions. He or she will ask you about your health
history, your symptoms, risk factors, and family history of disease. Your healthcare
provider will also give you a physical exam.
What tests might I need?
You may have one or more of the following tests:
Endoscopic ultrasound (EUS)
Computed tomography (CT) scan
Magnetic resonance imaging (MRI) scan
Liver function blood tests
Tumor marker blood tests
Ultrasound. This test uses sound waves and a computer to create images of the inside of the body.
The sound waves bounce off parts of the body and send signals to the computer. A computer
then receives the signals and creates images.
Endoscopic ultrasound (EUS). This test combines ultrasound with a tool called an endoscope. It’s a long bendable
tube with a light and camera. It’s placed into the mouth or the rectum to reach the
digestive tract. EUS creates images of the digestive tract and nearby tissue and organs.
A small ultrasound tool is put on the end of the endoscope. It lets the doctor see
high-quality images of your organs. An EUS may help your doctor tell the difference
between a tumor that’s cancer (malignant) or not cancer (benign). During EUS, a small
piece of tissue can also be taken to check for cancer under a microscope.
Computed tomography (CT) scan. A CT scanner takes many X-rays as it rotates around you. A computer combines these
images to create detailed images. A CT scan can help show a gallbladder tumor or tell
if the cancer has spread.
Magnetic resonance imaging (MRI) scan. An MRI scan uses radio waves and strong magnets to create detailed images of the
inside of your body. Your doctor may use an MRI scan to look at organs, blood vessels,
and lymph nodes.
Cholangiography. This test uses X-rays and a dye injected into the bile ducts to see if they are blocked
or narrowed. These tests can also be used to get samples of cells or fluid to look
for cancer, or to place a stent (small tube) inside a duct to keep it open. The kinds
of this test are:
Magnetic resonance cholangiopancreatography (MRCP). This is a non-invasive way to take images of the bile ducts. It uses the same type
of machine used for MRI scans. It doesn’t need a contrast agent. And it’s not invasive
like other types of cholangiograms. A doctor may use MRCP just to image the bile ducts.
But this test can’t be used to get biopsy samples or to place small tubes (stents)
in the ducts to keep them open.
Endoscopic retrograde cholangiopancreatography (ERCP). The ducts are reached by passing an endoscope down the throat and into the small intestine.
Percutaneous transhepatic cholangiography (PTC). The ducts are reached by passing a needle through the skin and into the liver.
Laparoscopic cholecystectomy. This is a surgery to take out the gallbladder. It uses a tool called a laparoscope.
This thin, lighted tube lets a doctor see your gallbladder and nearby organs. The
doctor makes a small cut just above your belly button to insert the tube. Tools are
then passed through other cuts in the skin to take out the gallbladder. In many cases,
gallbladder cancer is found by chance when surgery is done for a problem such as gallstones.
A pathologist checks the gallbladder when it’s taken out with surgery. This is a doctor
who specializes in looking at cells under a microscope to check for problems, including
cancer. This type of surgery is not done if a healthcare provider thinks you have
gallbladder cancer. In that case, a larger surgery will be needed.
A biopsy is when a small amount of tissue is removed to be checked for cancer. A biopsy
may be taken during a laparoscopy. Or a fine needle biopsy may be done. A fine needle
biopsy is usually done with the aid of a CT scan to help locate the tumor. This is
called a CT scan-guided biopsy. Or an ultrasound can be used to find the tumor instead
of a CT scan. Once the tumor is located, the doctor inserts a needle using the images
as a guide and extracts a tissue sample. A specialized doctor called a pathologist
looks at the tissue under a microscope to check for cancer cells.
Liver function. These are blood tests that help show how well the liver is working. They can help
diagnose liver and bile duct diseases. The gallbladder is just under the liver and
is part of the liver and bile duct system. Gallbladder cancer can affect liver function.
The most common liver function tests are:
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Alkaline phosphatase (AP)
Gamma glutamyl transpeptidase (GGT)
Prothrombin time (PT)
Tumor markers. This is another type of blood test. These tests look for increases in certain substances
called tumor markers. Some cancers make these substances. If you have bile duct cancer,
two markers may be increased. They are carcinoembryonic antigen (CEA) and carbohydrate
antigen 19-9 (CA 19-9). If your tumor markers are high, it may mean that you have
cancer or another disease. A normal level of tumor markers doesn’t always mean there
is no cancer. Your doctor may repeat this test during your treatment to see how your
treatment is working.
Getting your test results
When your healthcare provider has the results of your tests, your provider will contact
you of the results. Your healthcare provider will talk with you about other tests
that may be needed if gallbladder cancer is found. Make sure you understand the results
and what follow up is needed.