Gallbladder cancer is a rare condition that often causes few or no symptoms in its early stages. As a result, many cases are diagnosed only after the disease has advanced, which can make treatment more challenging and contribute to a poorer prognosis. It is the 22nd most common cancer worldwide and occurs more frequently in women, partly due to the higher prevalence of gallstones (cholelithiasis) among females.
Besides sex, factors that may increase the risk of gallbladder cancer include older age, a family history of the disease, smoking, and certain gallbladder or biliary conditions, such as porcelain gallbladder and primary sclerosing cholangitis.
While there is currently no standard screening programme for gallbladder cancer, individuals with known risk factors or symptoms suggestive of gallbladder disease should seek medical evaluation promptly.
What Is Gallbladder Cancer?
Gallbladder cancer is a rare but aggressive type of cancer that develops in the gallbladder, a small organ located beneath the liver. The gallbladder stores and releases bile, a digestive fluid that helps the body break down fats.
One of the challenges of gallbladder cancer is that it often causes few or no symptoms in its early stages. As a result, many cases are only diagnosed after the disease has advanced or spread to nearby tissues and organs, making treatment more difficult.
Over 80% of gallbladder cancers are adenocarcinomas, which develop from the glandular cells lining the inner surface of the gallbladder. As the cancer grows, it can spread through the gallbladder wall and into surrounding structures, particularly the liver and bile ducts.
The Stages of Gallbladder Cancer
Cancer staging describes how far a cancer has grown and spread. Understanding the stage of gallbladder cancer helps doctors determine the most appropriate treatment options and estimate the likely outlook.
Gallbladder cancer is generally classified from Stage 0 to Stage 4, with lower stages indicating that the cancer is confined to the gallbladder and higher stages indicating more extensive spread.
Doctors use the TNM staging system, developed by the American Joint Committee on Cancer (AJCC), to describe the extent of gallbladder cancer.
- T (Tumour): Describes how deeply the tumour has grown into or beyond the gallbladder wall.
- N (Nodes): Indicates whether the cancer has spread to nearby lymph nodes.
- M (Metastasis): Indicates whether the cancer has spread to distant parts of the body, such as the liver, peritoneum, or lungs.
The TNM findings are combined to determine the overall stage of the cancer.
Stage 0
Cancer is only found in the inner lining of the gallbladder and has not spread into deeper tissues.
Stage 1
Cancer has grown into the wall of the gallbladder but remains confined to the organ.
Stage 2
Cancer has grown deeper into the gallbladder wall but has not spread to nearby lymph nodes or distant organs.
Stage 3A
Cancer has grown beyond the gallbladder and into nearby tissues or organs, but it has not spread to nearby lymph nodes or distant organs.
Stage 3B
Cancer has spread to nearby lymph nodes but has not spread to distant organs.
Stage 4A
Cancer has spread extensively into nearby structures around the gallbladder. It may also involve nearby lymph nodes, but it has not spread to distant organs.
Stage 4B
Cancer has spread to distant parts of the body, such as the lungs, distant lymph nodes, or the lining of the abdomen. It may also involve multiple lymph nodes.
What Are The Treatment Options For Gallbladder Cancer?
Treatment options for gallbladder cancer depend on several factors, including the stage of the disease, the size and location of the tumour, whether the cancer can be surgically removed, and the patient's overall health. The main forms of treatment include surgery, radiotherapy, and chemotherapy, which may be used alone or in combination to improve outcomes and manage symptoms.
Gallbladder Surgery
Surgery is the primary treatment for patients with early-stage and other resectable gallbladder cancers. The aim is to remove the tumour completely whenever possible. The most common surgical procedure is a cholecystectomy, the removal of the gallbladder. Common procedures for gallbladder cancer include:
Simple Cholecystectomy
This involves the removal of only the gallbladder. This is typically done when cancer is detected incidentally during surgery for gallstones.
Extended Cholecystectomy
This is a more complete procedure, removing the gallbladder alongside parts of the liver, nearby lymph nodes, and potentially, parts of the bile duct or intestine.
Radical Resection
This is a more extensive procedure that comprises an extended cholecystectomy and more, removing nearby organs such as the duodenum or pancreas, according to how far the cancer has spread.
Radiotherapy
Radiotherapy uses high-energy radiation to destroy cancer cells, most commonly through external beam radiation therapy (EBRT). It may be used after surgery to reduce the risk of recurrence, alongside chemotherapy, or to help control symptoms and slow disease progression when surgery is not feasible.
Chemotherapy
Chemotherapy uses drugs to kill cancer cells or stop them from growing and spreading. It may be used:
- After surgery in selected patients to reduce the risk of recurrence
- Together with radiotherapy in certain treatment plans
- For advanced, recurrent, or metastatic gallbladder cancer when surgery is not possible
- To help relieve symptoms and improve quality of life
Overcoming Gallbladder Cancer with Dr Wong Jen San
As a rare and aggressive disease, gallbladder cancer can be difficult to detect and treat. Understanding its stages and available treatment options can help individuals recognise potential warning signs, seek medical attention promptly, and make informed decisions about their care. Because symptoms often develop only after the disease has progressed, it is important to consult a doctor if you experience persistent symptoms or have known risk factors for gallbladder disease.
At Hepatobiliary & Pancreatic Surgery Centre, our consultant hepatobiliary & pancreatic surgeon, Dr Wong Jen San, is committed to providing personalised care and comprehensive gallbladder check-ups tailored to each patient's needs. Book an appointment to take the next step towards better gallbladder health.
FAQs About the Stages of Gallbladder Cancer
Can gallbladder cancer be cured?
Yes. Like many cancers, gallbladder cancer is most treatable when detected early. The likelihood of successful treatment generally decreases as the cancer advances. Complete surgical removal of the cancer offers the best chance of long-term disease control or cure in suitable patients.
What is the survival rate for gallbladder cancer?
The prognosis for gallbladder cancer tends to be low owing to how difficult it is to detect before it is advanced. The five-year survival rate for localised gallbladder cancer, that is, the cancer has not spread beyond the gallbladder, is 67%. When the cancer has spread to nearby tissues or lymph nodes (regional disease), the five-year relative survival rate is 29%. For distant-stage disease, where the cancer has spread to other parts of the body, the five-year relative survival rate is 4%.
If my gallbladder cancer is only in its early stages (0–2), do I need to remove my entire gallbladder?
In most cases, yes. Surgical removal of the gallbladder (cholecystectomy) is the standard treatment for early-stage, resectable gallbladder cancer. Depending on the extent of the disease, the surrounding tissue, nearby lymph nodes, or part of the liver may also need to be removed. Most people can live a normal life without a gallbladder, as the liver continues to produce bile, which flows directly into the small intestine.
Meet Our Gallbladder Doctor in Singapore
Dr Wong Jen SanConsultant Hepatobiliary & Pancreatic SurgeonMBChB (UK), MMed (S'pore), MSc (S'pore), FRCS (Edin), FAMS
Dr Wong Jen San is a consultant hepatobiliary and pancreatic surgeon with expertise in the diagnosis and surgical management of conditions affecting the liver, pancreas, gallbladder, bile ducts, and digestive system. His clinical interests include hepatobiliary and pancreatic surgery, minimally invasive and robotic surgery, liver transplantation, gastrointestinal surgery, endoscopy, and general surgical procedures. Dr Wong is committed to providing evidence-based, patient-centred care tailored to each individual's condition and treatment needs.
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