Diagnosis of gallbladder cancer

Diagnosis is the process of finding out the cause of a health problem. Diagnosing gallbladder cancer may begin with a visit to your family doctor. Your doctor will ask you about any symptoms you have and may do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for gallbladder cancer or other health problems.

Gallbladder cancer is often found in the later stages because it usually does not cause any symptoms earlier.

It is sometimes found after the gallbladder is removed for other reasons such as gallstones or chronic cholecystitis (long-term inflammation of the gallbladder).

The process of diagnosis may seem long and frustrating. It’s normal to worry, but try to remember that other health conditions can cause similar symptoms as gallbladder cancer. It’s important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of gallbladder cancer.

The following tests are commonly used to rule out or diagnose gallbladder cancer. Many of the same tests used to diagnose cancer are used to find out 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.

Your health history is a record of your symptoms, risk factors and all the medical events and problems you have had in the past. Your doctor will ask questions about your history of:

• symptoms that suggest gallbladder cancer
• non-cancerous conditions of the gallbladder such as gallstones or chronic cholecystitis

Your doctor may also ask about a family history of gallbladder cancer.

A physical exam allows your doctor to look for any signs of gallbladder cancer. During a physical exam, your 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 jaundice)
• feel the lymph nodes in the groin

Find out more about physical exam.

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

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

Find out more about blood chemistry tests.

An ultrasound uses high-frequency sound waves to make images of parts of the body. It is used to view the gallbladder and check for problems or cancer in people with abdominal pain or jaundice.

An abdominal ultrasound is often the first imaging test done when doctors suspect gallbladder cancer. It can confirm if the wall of the gallbladder is thicker than normal and provide information about the size of a tumour.

An ultrasound is also used to see if the cancer has spread to the liver.

Find out more about an ultrasound.

A computed tomography (CT) scan uses special x-ray equipment to make 3-D and cross-sectional images of organs, tissues, bones and blood vessels inside the body. A computer turns the images into detailed pictures.

A CT scan is used to:

• check for cancer in the gallbladder
• find out where the cancer is in the gallbladder
• see if cancer has spread outside the gallbladder to nearby lymph nodes, the liver or other places in the abdomen

Find out more about a CT scan.

Tumour markers are substances found in the blood, tissues or fluids removed from the body. An abnormal amount of a tumour marker may mean that a person has gallbladder cancer.

Tumour marker tests are generally used to check your response to cancer treatment. They can also be used to help diagnose gallbladder cancer.

The following tumour markers may be measured for gallbladder cancer:

Carbohydrate antigen 19-9 (CA19-9) levels may be higher with gallbladder cancer or other conditions. It is more likely to be high if the gallbladder cancer is at an advanced stage.

Carcinoembryonic antigen (CEA) levels may be higher with gallbladder cancer and other conditions.

Find out more about tumour marker tests.

During a biopsy, the doctor removes tissues or cells from the body so they can be tested in a lab. A report from the pathologist will confirm whether or not cancer cells are found in the sample.

But often imaging tests, such as an ultrasound and a CT scan, provide enough information to confirm that there is a gallbladder tumour, and a biopsy doesn’t need to be done. There is concern that when tissue is removed in a biopsy the cancer can spread in the abdomen.

A biopsy for gallbladder cancer can be done during an ERCP (endoscopic retrograde cholangiopancreatography), a laparoscopy or a fine needle aspiration (FNA).

With an FNA, the doctor inserts a very fine needle through the skin of the abdomen and into the gallbladder. An ultrasound or CT scan is used to guide the needle during the procedure. An 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 with surgery.

Find out more about a biopsy.

An ERCP (endoscopic retrograde cholangiopancreatography) uses a flexible tube with a light and lens on the end (an endoscope) to help determine if the cystic, pancreatic or bile ducts are blocked.

An ERCP may be used to:

• determine if there is a gallbladder tumour and if it can be removed
• 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

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

A PTC may be used to:

• see 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

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

Magnetic resonance imaging (MRI) uses powerful magnetic forces and radiofrequency waves to make cross-sectional images of organs, tissues, bones and blood vessels. A computer turns the images into 3-D pictures.

An MRI may be used to see if the cancer has spread to nearby bile ducts and other organs.

A special type of MRI called an MRCP (magnetic resonance cholangiopancreatography) can provide detailed information about the bile ducts, gallbladder, liver and pancreas.

Find out more about an MRI.

A laparoscopy uses an endoscope inserted through a small cut in the abdomen. The doctor examines the gallbladder, bile ducts and liver during this procedure. A laparoscopy may be used to:

• take samples of the tumour to confirm a diagnosis of gallbladder cancer
• see how far the cancer has spread
• plan further surgery and other treatments

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 can help plan surgery.

To make the decisions that are right for you, ask your healthcare team questions about diagnosis.