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 because many people don’t have symptoms in the early stages of
the disease (when the cancer is small and hasn't spread).
In many cases, gallbladder cancer is found by chance when surgery is done to remove
the gallbladder to treat a problem like gallstone. This surgery is called a laparoscopic
cholecystectomy. A laparoscope is a thin, lighted tube that lets a healthcare provider
see your gallbladder and nearby organs. The healthcare provider 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. A pathologist checks the gallbladder
when it’s taken out with surgery. A pathologist specializes in looking at cells under
a microscope to check for problems, including cancer.
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, thin, bendable tube with a light and camera. It’s put in through the
mouth or the rectum to reach the small intestine near the gallbladder. EUS creates
images of the digestive tract and nearby tissues and organs. A small ultrasound tool
is on the end of the endoscope. It lets the healthcare provider see high-quality images
of your organs. 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 healthcare provider may
use an MRI scan to look at organs, blood vessels, and lymph nodes.
Cholangiography. These tests are used to see if the bile ducts are blocked or narrowed
by a tumor. Some of these tests can also be used to get samples of cells or fluid
to look for cancer or to put a stent (small tube) inside a duct to keep it open.
Magnetic resonance cholangiopancreatography (MRCP). This 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. (This means nothing is put in your body to do this test.)
A healthcare provider may use MRCP just to get pictures of the bile ducts. But this
test can’t be used to get biopsy samples or to put stents in the ducts to keep them
Endoscopic retrograde cholangiopancreatography (ERCP). The ducts are reached by passing
an endoscope down the throat and into the small intestine. Dye is put into the ducts,
and then X-rays are done. Samples can be taken out through the endoscope to be checked
Percutaneous transhepatic cholangiography (PTC). The ducts are reached by passing
a needle through the skin over the belly and into the liver. Dye is injected and X-rays
are taken to look at the ducts. Samples can be removed, and stents can be placed during
A biopsy is when a small piece of tissue is removed to be checked for cancer. A biopsy
can be done during some of the imaging tests listed above. 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 healthcare
provider puts the needle in through your skin using the images as a guide. A tiny
tissue sample is then taken out through the needle and checked 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 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 gallbladder 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 you may have another disease. A normal level of
tumor markers doesn’t always mean there is no cancer. Your healthcare provider 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, he or she will contact
you with the results. Your healthcare provider will talk with you about other tests
you may need if gallbladder cancer is found. Make sure you understand the results
and what follow-up you need.