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<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE" /><meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]" /><meta name="citation_title" content="Gallbladder Cancer Treatment (PDQ®)" /><meta name="citation_publisher" content="National Cancer Institute (US)" /><meta name="citation_date" content="2022/03/25" /><meta name="citation_author" content="PDQ Adult Treatment Editorial Board" /><meta name="citation_pmid" content="26389371" /><meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65933/" /><meta name="citation_keywords" content="gallbladder cancer" /><meta name="citation_keywords" content="gallbladder cancer" /><link rel="schema.DC" href="http://purl.org/DC/elements/1.0/" /><meta name="DC.Title" content="Gallbladder Cancer Treatment (PDQ®)" /><meta name="DC.Type" content="Text" /><meta name="DC.Publisher" content="National Cancer Institute (US)" /><meta name="DC.Contributor" content="PDQ Adult Treatment Editorial Board" /><meta name="DC.Date" content="2022/03/25" /><meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65933/" /><meta name="description" content="Gallbladder cancer treatment for cancer found during routine gallbladder surgery is often surgery alone. Unresectable, recurrent or metastatic gallbladder cancer treatment options include relief of biliary obstruction, radiation, and chemotherapy. Get more information in this clinician summary." /><meta name="og:title" content="Gallbladder Cancer Treatment (PDQ®)" /><meta name="og:type" content="book" /><meta name="og:description" content="Gallbladder cancer treatment for cancer found during routine gallbladder surgery is often surgery alone. Unresectable, recurrent or metastatic gallbladder cancer treatment options include relief of biliary obstruction, radiation, and chemotherapy. Get more information in this clinician summary." /><meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65933/" /><meta name="og:site_name" content="NCBI Bookshelf" /><meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" /><meta name="twitter:card" content="summary" /><meta name="twitter:site" content="@ncbibooks" /><meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062904/" /><link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65933/" /><link rel="stylesheet" href="/corehtml/pmc/css/figpopup.css" type="text/css" media="screen" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css" /><link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_print.min.css" type="text/css" media="print" /><style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style><script type="text/javascript" src="/corehtml/pmc/js/jquery.hoverIntent.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/common.min.js?_=3.18"> </script><script type="text/javascript" src="/corehtml/pmc/js/large-obj-scrollbars.min.js"> </script><script type="text/javascript">window.name="mainwindow";</script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/book-toc.min.js"> </script><script type="text/javascript" src="/corehtml/pmc/js/bookshelf/2.26/books.min.js"> </script><meta name="book-collection" content="NONE" />
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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65933_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65933_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65933_"><span class="title" itemprop="name">Gallbladder Cancer Treatment (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Adult Treatment Editorial Board</span>.</p><p class="small">Published online: March 25, 2022.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062904__167">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of gallbladder cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062904__168">This summary is reviewed regularly and updated as necessary by the PDQ Adult Treatment Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062904__1"><h2 id="_CDR0000062904__1_">General Information About Gallbladder Cancer</h2><div id="CDR0000062904__116"><h3>Incidence and Mortality</h3><p id="CDR0000062904__92">Estimated new cases and deaths from gallbladder (and other biliary) cancer in the United States in 2022:[<a class="bk_pop" href="#CDR0000062904_rl_1_1">1</a>]</p><ul id="CDR0000062904__93"><li class="half_rhythm"><div>New cases: 12,130.</div></li><li class="half_rhythm"><div>Deaths: 4,400.</div></li></ul><p id="CDR0000062904__2">Cancer that arises in the gallbladder is uncommon.
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</p></div><div id="CDR0000062904__156"><h3>Clinical Features</h3><p id="CDR0000062904__157">The most common symptoms caused by gallbladder cancer are
|
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jaundice, pain, and fever.</p></div><div id="CDR0000062904__158"><h3>Histopathology and Diagnostics</h3><p id="CDR0000062904__81">In patients whose
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|
superficial cancer (T1 or confined to the mucosa) is discovered on pathological examination of tissue after
|
|
gallbladder removal for other reasons, the disease is often cured without
|
|
further therapy. In patients who present with symptoms, the tumor is
|
|
rarely diagnosed preoperatively.[<a class="bk_pop" href="#CDR0000062904_rl_1_2">2</a>] In such cases, the tumor often cannot be
|
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removed completely by surgery and the patient cannot be cured, although palliative measures
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|
may be beneficial. For patients with T2 or greater disease, extended resection with partial hepatectomy and portal lymph node dissection may be an option.[<a class="bk_pop" href="#CDR0000062904_rl_1_3">3</a>,<a class="bk_pop" href="#CDR0000062904_rl_1_4">4</a>]
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</p></div><div id="CDR0000062904__159"><h3>Other Prognostic Factors</h3><p id="CDR0000062904__82">Cholelithiasis is an associated finding in most cases, but less than 1% of patients with cholelithiasis develop
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this cancer. </p></div><div id="CDR0000062904_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062904_rl_1_1">American Cancer Society: Cancer Facts and Figures 2022. American Cancer Society, 2022. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2022/2022-cancer-facts-and-figures.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed May 25, 2022.</div></li><li><div class="bk_ref" id="CDR0000062904_rl_1_2">Chao TC, Greager JA: Primary carcinoma of the gallbladder. J Surg Oncol 46 (4): 215-21, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2008087" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2008087</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_1_3">Shoup M, Fong Y: Surgical indications and extent of resection in gallbladder cancer. Surg Oncol Clin N Am 11 (4): 985-94, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12607584" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12607584</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_1_4">Sasson AR, Hoffman JP, Ross E, et al.: Trimodality therapy for advanced gallbladder cancer. Am Surg 67 (3): 277-83; discussion 284, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11270889" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11270889</span></a>]</div></li></ol></div></div><div id="CDR0000062904__3"><h2 id="_CDR0000062904__3_">Cellular Classification of Gallbladder Cancer</h2><p id="CDR0000062904__4">Some
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histologic types of gallbladder cancer have a better prognosis than others; papillary carcinomas have
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the best prognosis.
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The histologic types of gallbladder cancer include the following:[<a class="bk_pop" href="#CDR0000062904_rl_3_1">1</a>]</p><ul id="CDR0000062904__5"><li class="half_rhythm"><div>Carcinoma <i>in situ</i>.
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</div></li><li class="half_rhythm"><div>Biliary intraepithelial neoplasia, high grade.</div></li><li class="half_rhythm"><div>Intracystic papillary neoplasm with high-grade intraepithelial neoplasia.</div></li><li class="half_rhythm"><div>Mucinous cystic neoplasm with high-grade intraepithelial neoplasia.</div></li><li class="half_rhythm"><div>Adenocarcinoma.
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</div></li><li class="half_rhythm"><div>Adenocarcinoma, biliary type.</div></li><li class="half_rhythm"><div>Adenocarcinoma, intestinal type.
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</div></li><li class="half_rhythm"><div>Adenocarcinoma, gastric foveolar type. </div></li><li class="half_rhythm"><div>Mucinous adenocarcinoma.</div></li><li class="half_rhythm"><div>Clear cell adenocarcinoma.
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</div></li><li class="half_rhythm"><div>Signet-ring cell carcinoma.
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</div></li><li class="half_rhythm"><div>Squamous cell carcinoma.
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</div></li><li class="half_rhythm"><div>Adenosquamous carcinoma.</div></li><li class="half_rhythm"><div>Undifferentiated carcinoma.</div></li><li class="half_rhythm"><div>High-grade neuroendocrine carcinoma.</div></li><li class="half_rhythm"><div>Small cell neuroendocrine carcinoma.</div></li><li class="half_rhythm"><div>Mixed adenoneuroendocrine carcinoma.</div></li><li class="half_rhythm"><div>Intraductal papillary neoplasm with an associated invasive carcinoma.</div></li><li class="half_rhythm"><div>Mucinous cystic neoplasm with an associated invasive carcinoma.</div></li></ul><div id="CDR0000062904_rl_3"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062904_rl_3_1">Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 303–9.</div></li></ol></div></div><div id="CDR0000062904__6"><h2 id="_CDR0000062904__6_">Stage Information for Gallbladder Cancer</h2><div id="CDR0000062904__114"><h3>AJCC Stage Groupings and TNM Definitions</h3><p id="CDR0000062904__126">The American Joint Committee on Cancer (AJCC) has designated staging by the TNM
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classification to define gallbladder cancer.[<a class="bk_pop" href="#CDR0000062904_rl_6_1">1</a>]</p><div id="CDR0000062904__182" class="table"><h3><span class="title">Table 1. Definitions of TNM Stage 0<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__182/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__182_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">0</td><td colspan="1" rowspan="3" style="vertical-align:top;">Tis, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__183" class="table"><h3><span class="title">Table 2. Definitions of TNM Stage I<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__183/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__183_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">I</td><td colspan="1" rowspan="3" style="vertical-align:top;">T1, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria or muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__184" class="table"><h3><span class="title">Table 3. Definitions of TNM Stage IIA<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__184/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__184_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIA</td><td colspan="1" rowspan="3" style="vertical-align:top;">T2a, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__185" class="table"><h3><span class="title">Table 4. Definitions of TNM Stage IIB<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__185/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__185_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIB</td><td colspan="1" rowspan="3" style="vertical-align:top;">T2b, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__186" class="table"><h3><span class="title">Table 5. Definitions of TNM Stage IIIA<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__186/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__186_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="3" style="vertical-align:top;">IIIA</td><td colspan="1" rowspan="3" style="vertical-align:top;">T3, N0, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__187" class="table"><h3><span class="title">Table 6. Definitions of TNM Stage IIIB<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__187/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__187_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="9" style="vertical-align:top;">IIIB</td><td colspan="1" rowspan="9" style="vertical-align:top;">T1–3, N1, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria or muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastases to one to three regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__188" class="table"><h3><span class="title">Table 7. Definitions of TNM Stage IVA<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__188/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__188_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="4" style="vertical-align:top;">IVA</td><td colspan="1" rowspan="4" style="vertical-align:top;">T4, N0–1, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastases to one to three regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><div id="CDR0000062904__189" class="table"><h3><span class="title">Table 8. Definitions of TNM Stage IVB<sup>a</sup></span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK65933.13/table/CDR0000062904__189/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000062904__189_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Stage</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">TNM</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Description</th></tr></thead><tbody><tr><td colspan="1" rowspan="29" style="vertical-align:top;">IVB</td><td colspan="1" rowspan="13" style="vertical-align:top;">Any T, N2, M0</td><td colspan="1" rowspan="1" style="vertical-align:top;">TX = Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0 = No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria or muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastases to four or more regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M0 = No distant metastasis.</td></tr><tr><td colspan="1" rowspan="16" style="vertical-align:top;">Any T, Any N, M1</td><td colspan="1" rowspan="1" style="vertical-align:top;">TX = Primary tumor cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T0 = No evidence of primary tumor.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tis = Carcinoma <i>in situ</i>.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T1 = Tumor invades the lamina propria or muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1a = Tumor invades the lamina propria.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T1b = Tumor invades the muscular layer.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T2 = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum). Or, tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2a = Tumor invades the perimuscular connective tissue on the peritoneal side, without involvement of the serosa (visceral peritoneum).</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">–T2b = Tumor invades the perimuscular connective tissue on the hepatic side, with no extension into the liver.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T3 = Tumor perforates the serosa (visceral peritoneum) and/or directly invades the liver and/or one other adjacent organ or structure, such as the stomach, duodenum, colon, pancreas, omentum, or extrahepatic bile ducts.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">T4 = Tumor invades the main portal vein or hepatic artery or invades two or more extrahepatic organs or structures.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">NX = Regional lymph nodes cannot be assessed.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N0 = No regional lymph node metastasis.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N1 = Metastases to one to three regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">N2 = Metastases to four or more regional lymph nodes.</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">M1 = Distant metastases.</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">T = primary tumor; N = regional lymph node; M = distant metastasis.</p></div></dd><dt></dt><dd><div><p class="no_margin"><sup>a</sup>Reprinted with permission from AJCC: Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: <i>AJCC Cancer Staging Manual</i>. 8th ed. New York, NY: Springer, 2017, pp 303–9.</p></div></dd></dl></div></div></div><p id="CDR0000062904__70">
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<b><div class="milestone-start" id="CDR0000062904__34"></div>Localized and Locally Advanced</b>
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</p><p id="CDR0000062904__35">Patients with stage I disease have cancer confined to the gallbladder wall that can be
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completely resected. Stage I tumors that are discovered incidentally and resected during routine cholecystectomy have 5-year survival rates of
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nearly 100%.[<a class="bk_pop" href="#CDR0000062904_rl_6_2">2</a>]
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</p><p id="CDR0000062904__195">Patients with stage II or III disease have tumors with direct extension into the muscular layer, serosa, or adjacent organs, with or without involvement of locoregional lymph nodes.<div class="milestone-end"></div></p><p id="CDR0000062904__71">
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<b><div class="milestone-start" id="CDR0000062904__36"></div>Unresectable</b>
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</p><p id="CDR0000062904__196">Patients with disease that has spread beyond the locoregional lymph nodes or to distant organs have unresectable tumors, and standard therapy is directed at palliation. Patients with earlier-stage disease with poor performance status and/or significant comorbidities may also be deemed to be poor surgical candidates.<div class="milestone-end"></div></p></div><div id="CDR0000062904_rl_6"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062904_rl_6_1">Gallbladder. In: Amin MB, Edge SB, Greene FL, et al., eds.: AJCC Cancer Staging Manual. 8th ed. Springer; 2017, pp 303–9.</div></li><li><div class="bk_ref" id="CDR0000062904_rl_6_2">Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992. [<a href="/pmc/articles/PMC1242447/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1242447</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1558412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1558412</span></a>]</div></li></ol></div></div><div id="CDR0000062904__40"><h2 id="_CDR0000062904__40_">Treatment of Localized and Locally Advanced Gallbladder Cancer</h2><div id="CDR0000062904__64"><h3>Standard Treatment Options for Localized and Locally Advanced Gallbladder Cancer</h3><p id="CDR0000062904__43">When gallbladder cancer is previously unsuspected and is incidentally discovered in the
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mucosa of the gallbladder at pathologic examination, it is curable in more than
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80% of cases. Gallbladder cancer suspected before surgery because of
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symptoms, however, usually penetrates the muscularis and serosa and is curable in fewer
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than 5% of patients.
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</p><p id="CDR0000062904__44">One study reported on patterns of lymph node spread from gallbladder
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cancer and outcomes of patients with metastases to lymph nodes in 111
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consecutive surgical patients in a single institution from 1981 to 1995.[<a class="bk_pop" href="#CDR0000062904_rl_40_1">1</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335150/" class="def">Level
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of evidence: 3iiiA</a>] The standard surgical procedure was removal of the
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gallbladder, a wedge resection of the liver, resection of the extrahepatic bile
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duct, and resection of the regional (N1 and N2) lymph nodes. Kaplan-Meier
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estimates of the 5-year survival rates for node-negative tumors pathologically staged
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as T2 to T4 were 42.5% ± 6.5% and for similar node-positive tumors,
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31% ± 6.2%.
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</p><p id="CDR0000062904__177">Standard treatment options for localized and locally advanced gallbladder cancer include the following: </p><ol id="CDR0000062904__220"><li class="half_rhythm"><div><a href="#CDR0000062904__221">Surgery</a>.</div></li><li class="half_rhythm"><div><a href="#CDR0000062904__227">External-beam radiation therapy (EBRT)</a>.</div></li></ol><div id="CDR0000062904__221"><h4>Surgery</h4><p id="CDR0000062904__222">In previously unsuspected gallbladder cancer that is discovered in the
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surgical specimen after a routine gallbladder operation and confined to
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mucosa (T1), most patients are cured.[<a class="bk_pop" href="#CDR0000062904_rl_40_2">2</a>,<a class="bk_pop" href="#CDR0000062904_rl_40_3">3</a>] During laparoscopic removal of an unsuspected cancer, there is potential for implantation of carcinoma at all port sites (including the camera site).[<a class="bk_pop" href="#CDR0000062904_rl_40_4">4</a>] All port sites are typically excised completely, even for stage I cancers.</p><p id="CDR0000062904__223">The need for re-exploration for more extended resection in incidentally discovered T1b disease is controversial. A multicenter retrospective review identified lymph node metastases in 12% of patients who underwent re-resection after cholecystectomy, but there are no prospective data regarding relative outcome with a second surgery in these patients.[<a class="bk_pop" href="#CDR0000062904_rl_40_5">5</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000593395/" class="def">Level of evidence: 3iiiD</a>]</p><p id="CDR0000062904__224">Patients with T2 or T3 disease have higher rates of unsuspected invasive disease at the time of diagnosis. A multicenter retrospective review was performed on patients who underwent re-resection after carcinoma was discovered incidentally. Residual disease was present in 57% of patients with T2 disease (including 31% with lymph node involvement and 10% with liver involvement) and in 77% of patients with T3 disease (including 46% with lymph node metastases and 36% with liver involvement).[<a class="bk_pop" href="#CDR0000062904_rl_40_5">5</a>] On the basis of these observations, eligible patients may undergo re-exploration to resect liver tissue near the gallbladder bed, portal lymph nodes, and lymphatic tissue in the hepatoduodenal ligament. Retrospective analyses suggest delayed recurrences and potentially improved survival with extended re-resection.[<a class="bk_pop" href="#CDR0000062904_rl_40_6">6</a>-<a class="bk_pop" href="#CDR0000062904_rl_40_8">8</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000593395/" class="def">Level of evidence: 3iiiD</a>]</p><p id="CDR0000062904__225">For patients with locoregional lymph node involvement (at the cystic duct, common bile duct, hepatic artery, and portal vein), long-term disease-free survival can occasionally be achieved with radical resection. In jaundiced patients (stage III or stage IV), there should be consideration of preoperative percutaneous transhepatic biliary drainage for relief of biliary obstruction.</p><p id="CDR0000062904__226">Surgery with curative intent is not considered possible in patients with metastatic spread beyond the locoregional lymph nodes or to distant organs. </p></div><div id="CDR0000062904__227"><h4>EBRT</h4><p id="CDR0000062904__228">The use of EBRT with or
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without chemotherapy as a primary treatment has been reported in small groups
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of patients to produce short-term control. Similar benefits have been reported
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for radiation therapy with or without chemotherapy administered following
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resection.[<a class="bk_pop" href="#CDR0000062904_rl_40_9">9</a>,<a class="bk_pop" href="#CDR0000062904_rl_40_10">10</a>]</p><p id="CDR0000062904__229">There are no phase III studies to support the use of adjuvant radiation therapy, even for patients with high-risk localized disease.</p></div></div><div id="CDR0000062904__246"><h3>Treatment Options Under Clinical Evaluation for Localized and Locally Advanced Gallbladder Cancer</h3><p id="CDR0000062904__247">Treatment options under clinical evaluation for localized and locally advanced gallbladder cancer include the following:</p><ul id="CDR0000062904__248"><li class="half_rhythm"><div>Clinical trials are exploring ways of improving local control with radiation
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therapy combined with radiosensitizer drugs. When possible, patients are
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appropriately considered candidates for these studies.</div></li></ul></div><div id="CDR0000062904__TrialSearch_40_sid_4"><h3>Current Clinical Trials</h3><p id="CDR0000062904__TrialSearch_40_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062904_rl_40"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062904_rl_40_1">Tsukada K, Kurosaki I, Uchida K, et al.: Lymph node spread from carcinoma of the gallbladder. Cancer 80 (4): 661-7, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9264348" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9264348</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_2">Fong Y, Brennan MF, Turnbull A, et al.: Gallbladder cancer discovered during laparoscopic surgery. Potential for iatrogenic tumor dissemination. Arch Surg 128 (9): 1054-6, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8368924" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8368924</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_3">Chijiiwa K, Tanaka M: Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115 (6): 751-6, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/7910985" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7910985</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_4">Wibbenmeyer LA, Wade TP, Chen RC, et al.: Laparoscopic cholecystectomy can disseminate in situ carcinoma of the gallbladder. J Am Coll Surg 181 (6): 504-10, 1995. [<a href="https://pubmed.ncbi.nlm.nih.gov/7582223" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7582223</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_5">Pawlik TM, Gleisner AL, Vigano L, et al.: Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg 11 (11): 1478-86; discussion 1486-7, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17846848" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17846848</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_6">Shirai Y, Yoshida K, Tsukada K, et al.: Inapparent carcinoma of the gallbladder. An appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215 (4): 326-31, 1992. [<a href="/pmc/articles/PMC1242447/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1242447</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/1558412" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1558412</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_7">Yamaguchi K, Chijiiwa K, Saiki S, et al.: Retrospective analysis of 70 operations for gallbladder carcinoma. Br J Surg 84 (2): 200-4, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9052434" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9052434</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_8">Downing SR, Cadogan KA, Ortega G, et al.: Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection. Arch Surg 146 (6): 734-8, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21690451" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21690451</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_9">Smoron GL: Radiation therapy of carcinoma of gallbladder and biliary tract. Cancer 40 (4): 1422-4, 1977. [<a href="https://pubmed.ncbi.nlm.nih.gov/71193" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 71193</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_40_10">Hejna M, Pruckmayer M, Raderer M: The role of chemotherapy and radiation in the management of biliary cancer: a review of the literature. Eur J Cancer 34 (7): 977-86, 1998. [<a href="https://pubmed.ncbi.nlm.nih.gov/9849443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9849443</span></a>]</div></li></ol></div></div><div id="CDR0000062904__51"><h2 id="_CDR0000062904__51_">Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer</h2><div id="CDR0000062904__67"><h3>Treatment Options for Unresectable, Metastatic, or Recurrent Gallbladder Cancer</h3><p id="CDR0000062904__53">Unresectable, metastatic, and recurrent gallbladder cancer are not curable. Significant symptomatic benefit can often
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be achieved with relief of biliary obstruction. A few patients have very
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slow-growing tumors and may live several years.
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Patients with unresectable, metastatic, or recurrent gallbladder cancer should be considered for inclusion in clinical trials whenever possible. Information about ongoing clinical trials is available from the <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCI website</a>.</p><p id="CDR0000062904__179">Treatment options for unresectable, metastatic, or recurrent gallbladder cancer include the following: </p><ol id="CDR0000062904__233"><li class="half_rhythm"><div><a href="#CDR0000062904__234">Percutaneous transhepatic drainage or endoscopically placed stents, or surgical bypass</a>.</div></li><li class="half_rhythm"><div><a href="#CDR0000062904__237">Systemic chemotherapy</a>. </div></li></ol><div id="CDR0000062904__234"><h4>Percutaneous transhepatic drainage or endoscopically placed stents, or surgical bypass</h4><p id="CDR0000062904__235">Relief of biliary obstruction is warranted when symptoms such as pruritus and hepatic dysfunction outweigh other symptoms of the cancer. The preferred approach is percutaneous transhepatic drainage or endoscopically placed stents;[<a class="bk_pop" href="#CDR0000062904_rl_51_1">1</a>] surgical bypass may be appropriate when these approaches are infeasible. </p><p id="CDR0000062904__236">Palliative radiation therapy after biliary drainage may be beneficial, and patients may be candidates for inclusion in clinical trials that explore ways to improve the effects of radiation therapy with various radiation sensitizers such as hyperthermia, radiosensitizer drugs, or cytotoxic chemotherapeutic agents.</p></div><div id="CDR0000062904__237"><h4>Systemic chemotherapy </h4><p id="CDR0000062904__238">Systemic chemotherapy is appropriate for selected patients with adequate performance status and intact organ function. Fluoropyrimidines, gemcitabine, platinum agents, and docetaxel have been reported to produce transient partial remissions in a minority of patients. The incidence of gallbladder cancer is low, and clinical trials often enroll patients with all subsites of biliary tract cancers. Therefore, data must be interpreted with caution when applied specifically to patients with gallbladder cancer. (Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000062905/">Bile Duct Cancer [Cholangiocarcinoma] Treatment</a> for more information.)</p><p id="CDR0000062904__249">Evidence (systemic chemotherapy):</p><ol id="CDR0000062904__239"><li class="half_rhythm"><div>In a phase III study, 410 patients with unresectable, metastatic, or recurrent biliary tract cancer were randomly assigned to receive of up to 6 months of gemcitabine versus gemcitabine and cisplatin.[<a class="bk_pop" href="#CDR0000062904_rl_51_2">2</a>]<ul id="CDR0000062904__240"><li class="half_rhythm"><div>With a median follow-up of 8.2 months, the median overall survival (OS) was superior for patients treated with combination chemotherapy (11.7 months vs. 8.1 months; hazard ratio [HR], 0.64; [95% confidence interval (CI), 0.52–0.80]; <i>P</i> < .001).[<a class="bk_pop" href="#CDR0000062904_rl_51_2">2</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>] </div></li><li class="half_rhythm"><div>A similar median OS benefit was demonstrated in all subgroups, including 149 patients with gallbladder cancer. </div></li><li class="half_rhythm"><div>Grade 3 and 4 toxicities occurred with similar frequency in both study arms, with the exception of increased hematologic toxic effects in patients randomly assigned to gemcitabine plus cisplatin and increased hepatotoxicity in patients randomly assigned to single-agent gemcitabine. </div></li></ul></div></li><li class="half_rhythm"><div> An international, multicenter, phase III study (<a href="https://www.cancer.gov/clinicaltrials/NCT03875235" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">TOPAZ-1</a> [<a href="https://clinicaltrials.gov/show/NCT03875235" title="Study NCT03875235" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT03875235</a>]) randomly assigned 685 patients with previously untreated unresectable locally advanced, recurrent, or metastatic biliary tract cancer to receive either durvalumab or placebo with cisplatin plus gemcitabine for up to eight cycles, followed by durvalumab or placebo maintenance until disease progression or unacceptable toxicity. After a median follow-up of 13.7 months for patients in the durvalumab group, the following was observed:[<a class="bk_pop" href="#CDR0000062904_rl_51_3">3</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335106/" class="def">Level of evidence: 1iA</a>]<ul id="CDR0000062904__250"><li class="half_rhythm"><div> The primary end point of median OS was significantly improved in the durvalumab group (12.8 months) compared with the placebo group (11.5 months) (HR, 0.80; 95% CI, 0.66–0.97; <i>P</i> = .021). In the durvalumab group, the OS rate was 35.1% at 18 months and 24.9% at 24 months, compared with 25.5% at 18 months and 10.4% at 24 months in the placebo group.</div></li><li class="half_rhythm"><div> There was no significant difference between groups in the number of grade 3 or 4 treatment-related adverse events or the number of events leading to discontinuation of a study medication.</div></li></ul></div></li><li class="half_rhythm"><div>A three-arm randomized phase III study of patients with unresectable gallbladder cancer compared best supportive care (n = 27), fluorouracil plus folinic acid (FUFA) weekly for 30 weeks (n = 28), and modified gemcitabine plus oxaliplatin (mGEMOX) for up to six 21-day cycles.[<a class="bk_pop" href="#CDR0000062904_rl_51_4">4</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000335125/" class="def">Level of evidence: 1iiA</a>]<ul id="CDR0000062904__241"><li class="half_rhythm"><div> With a median follow-up of 9 months, OS was 4.5 months for best supportive care (95% CI, 0.2−8.8), 4.6 months for FUFA (95% CI, 3−6.2), and 9.5 months for mGEMOX (95% CI, 5−14; <i>P</i> = .039). </div></li><li class="half_rhythm"><div> The only significant difference in grade 3 or 4 toxicities between the chemotherapy arms was transaminitis, which was more prevalent in the mGEMOX arm (<i>P</i> = .04). </div></li></ul></div></li><li class="half_rhythm"><div>A phase III noninferiority study (<a href="https://www.cancer.gov/clinicaltrials/NCT01470443" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCT01470443</a>) enrolled 114 patients with metastatic biliary tract cancers, including 30 (26%) with primary gallbladder cancer. Patients were randomly assigned to receive either capecitabine plus oxaliplatin (XELOX) or gemcitabine plus oxaliplatin (GEMOX).[<a class="bk_pop" href="#CDR0000062904_rl_51_5">5</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000632558/" class="def">Level of evidence: 1iiD</a>]<ul id="CDR0000062904__242"><li class="half_rhythm"><div> OS was not significantly different, at 10.4 months (95% CI, 8.0−12.6) for patients in the GEMOX group compared with 10.6 months (95% CI, 7.3−15.5) for patients in the XELOX group (<i>P</i> = .131).</div></li><li class="half_rhythm"><div> The primary end point of 6-month progression-free survival (PFS) was 44.6% for the GEMOX group and 46.7% for the XELOX group (95% confidence interval of difference in 6-month PFS rate, -12%−16%, meeting criteria for noninferiority). </div></li><li class="half_rhythm"><div>A predefined subgroup analysis based on the primary site of disease did not reveal a difference in objective response rate between the two arms in patients with gallbladder cancer (<i>P</i> = .598). </div></li></ul></div></li></ol><p id="CDR0000062904__243">Pending further clinical trials, cisplatin plus gemcitabine is considered the reference standard for patients with unresectable, metastatic, or recurrent gallbladder cancer. Extrapolating from the results of the TOPAZ-1 trial in biliary tract cancer, the checkpoint inhibitor durvalumab will likely become a standard-of-care addition to first-line therapy in combination with cisplatin and gemcitabine. Potential alternative regimens include gemcitabine plus capecitabine, GEMOX, and XELOX. Clinical trials should be considered for all patients.</p><p id="CDR0000062904__244">All patients with unresectable, metastatic, or recurrent disease should have molecular testing for deficient mismatch repair (dMMR) or microsatellite instability (MSI-H). Extrapolating from a subgroup of patients with gastrointestinal and hepatopancreatobiliary tumors in the <a href="https://www.cancer.gov/clinicaltrials/NCT02534675" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">I-PREDICT</a> (<a href="https://clinicaltrials.gov/show/NCT02534675" title="Study NCT02534675" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT02534675</a>) and <a href="https://www.cancer.gov/clinicaltrials/NCT02628067" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">KEYNOTE-158</a> (<a href="https://clinicaltrials.gov/show/NCT02628067" title="Study NCT02628067" ref="pagearea=body&targetsite=external&targetcat=link&targettype=clinical-trial">NCT02628067</a>) studies, patients with either dMMR or MSI-H tumors can be considered for treatment with pembrolizumab.[<a class="bk_pop" href="#CDR0000062904_rl_51_6">6</a>,<a class="bk_pop" href="#CDR0000062904_rl_51_7">7</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000587991/" class="def">Level of evidence: 3iiiDiv</a>]</p><p id="CDR0000062904__245">Additional testing for <i>IDH1</i> mutation and <i>FGFR2</i> fusion may provide potential targets in clinical trials.</p></div></div><div id="CDR0000062904__TrialSearch_51_sid_5"><h3>Current Clinical Trials</h3><p id="CDR0000062904__TrialSearch_51_22">Use our <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/advanced-search" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">advanced clinical trial search</a> to find NCI-supported cancer clinical trials that are now enrolling patients. The search can be narrowed by location of the trial, type of treatment, name of the drug, and other criteria. <a href="https://www.cancer.gov/about-cancer/treatment/clinical-trials/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">General information</a> about clinical trials is also available.</p></div><div id="CDR0000062904_rl_51"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062904_rl_51_1">Baron TH: Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med 344 (22): 1681-7, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11386268" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11386268</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_2">Valle J, Wasan H, Palmer DH, et al.: Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 362 (14): 1273-81, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20375404" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20375404</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_3">Oh D, He AR, Qin S: A phase 3 randomized, double-blind, placebo-controlled study of durvalumab in combination with gemcitabine plus cisplatin (GemCis) in patients (pts) with advanced biliary tract cancer (BTC): TOPAZ-1. [Abstract] J Clin Oncol 40 (4 suppl): A-378, 2022.</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_4">Sharma A, Dwary AD, Mohanti BK, et al.: Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study. J Clin Oncol 28 (30): 4581-6, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20855823" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20855823</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_5">Kim ST, Kang JH, Lee J, et al.: Capecitabine plus oxaliplatin versus gemcitabine plus oxaliplatin as first-line therapy for advanced biliary tract cancers: a multicenter, open-label, randomized, phase III, noninferiority trial. Ann Oncol 30 (5): 788-795, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30785198" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30785198</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_6">Sicklick JK, Kato S, Okamura R, et al.: Molecular profiling of cancer patients enables personalized combination therapy: the I-PREDICT study. Nat Med 25 (5): 744-750, 2019. [<a href="/pmc/articles/PMC6553618/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6553618</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31011206" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31011206</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062904_rl_51_7">Marabelle A, Le DT, Ascierto PA, et al.: Efficacy of Pembrolizumab in Patients With Noncolorectal High Microsatellite Instability/Mismatch Repair-Deficient Cancer: Results From the Phase II KEYNOTE-158 Study. J Clin Oncol 38 (1): 1-10, 2020. [<a href="/pmc/articles/PMC8184060/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8184060</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31682550" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31682550</span></a>]</div></li></ol></div></div><div id="CDR0000062904__77"><h2 id="_CDR0000062904__77_">Changes to This Summary (03/25/2022)</h2><p id="CDR0000062904__78">The PDQ cancer information summaries are reviewed regularly and updated as
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changes made to this summary as of the date above.</p><p id="CDR0000062904__251">
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<b>
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<a href="#CDR0000062904__51">Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer</a>
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</b>
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</p><p id="CDR0000062904__252">Added <a href="/books/NBK65933.13/#CDR0000062904__239">text</a> about a phase III clinical trial, TOPAZ-1, which randomly assigned 685 patients with previously untreated unresectable locally advanced, recurrent, or metastatic biliary tract cancer to receive either durvalumab or placebo with cisplatin plus gemcitabine for up to eight cycles, followed by durvalumab or placebo maintenance until disease progression or unacceptable toxicity (cited Oh et al. as reference 3 and level of evidence 1iA); after a median follow-up of 13.7 months in the durvalumab group, overall survival was improved in the durvalumab group and there was no significant difference between groups in the number of grade 3 or 4 treatment-related adverse events or the number of events leading to discontinuation of a study medication.</p><p id="CDR0000062904__253">Added <a href="#CDR0000062904__243">text</a> to state that, extrapolating from the results of the TOPAZ-1 trial in biliary tract cancer, the checkpoint inhibitor durvalumab will likely become a standard-of-care addition to first-line therapy in combination with cisplatin and gemcitabine.</p><p id="CDR0000062904__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062904__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000062904__AboutThis_1"><h2 id="_CDR0000062904__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062904__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062904__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of gallbladder cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062904__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062904__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/adult-treatment" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Adult Treatment Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062904__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062904__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062904__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p>The lead reviewers for Gallbladder Cancer Treatment are:</p><ul><li class="half_rhythm"><div>Valerie Lee, MD (Johns Hopkins University)</div></li><li class="half_rhythm"><div>Ari Seifter, MD (University of Illinois at Chicago)</div></li></ul><p id="CDR0000062904__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062904__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062904__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Adult Treatment Editorial Board uses a <a href="/books/n/pdqcis/CDR0000062796/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062904__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062904__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062904__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062904__AboutThis_15">PDQ® Adult Treatment Editorial Board. PDQ Gallbladder Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/gallbladder/hp/gallbladder-treatment-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/gallbladder/hp/gallbladder-treatment-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389371]</p><p id="CDR0000062904__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062904__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062904__AboutThis_18">Based on the strength of the available evidence, treatment options may be described as either “standard” or “under clinical evaluation.” These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062904__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062904__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65933.13/?report=reader">PubReader</a></li><li><a href="/books/NBK65933.13/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65933" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65933" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Adult Treatment Editorial Board. Gallbladder Cancer Treatment (PDQ®): Health Professional Version. 2022 Mar 25. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li><li><a href="#" class="toggle-glossary-link" title="Enable/disable links to the glossary">Disable Glossary Links</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65933.17/">NBK65933.17</a></span> January 26, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65933.16/">NBK65933.16</a></span> December 22, 2023</li><li><span class="bk_col_itm"><a 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class="bk_col_itm"><a href="/books/NBK65933.5/">NBK65933.5</a></span> January 25, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65933.4/">NBK65933.4</a></span> January 19, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65933.3/">NBK65933.3</a></span> February 2, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65933.2/">NBK65933.2</a></span> February 4, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65933.1/">NBK65933.1</a></span> July 8, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062904__1" ref="log$=inpage&link_id=inpage">General Information About Gallbladder Cancer</a></li><li><a href="#CDR0000062904__3" ref="log$=inpage&link_id=inpage">Cellular Classification of Gallbladder Cancer</a></li><li><a href="#CDR0000062904__6" ref="log$=inpage&link_id=inpage">Stage Information for Gallbladder Cancer</a></li><li><a href="#CDR0000062904__40" ref="log$=inpage&link_id=inpage">Treatment of Localized and Locally Advanced Gallbladder Cancer</a></li><li><a href="#CDR0000062904__51" ref="log$=inpage&link_id=inpage">Treatment of Unresectable, Metastatic, or Recurrent Gallbladder Cancer</a></li><li><a href="#CDR0000062904__77" ref="log$=inpage&link_id=inpage">Changes to This Summary (03/25/2022)</a></li><li><a href="#CDR0000062904__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389442" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Retinoblastoma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389190" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Neuroblastoma Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389493" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cervical Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Cervical Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389471" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> 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