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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="2019/01/29" /><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="2019/01/29" /><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: January 29, 2019.</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 who care for cancer 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 2019:[<a class="bk_pop" href="#CDR0000062904_rl_1_1">1</a>]</p><ul id="CDR0000062904__93"><li class="half_rhythm"><div>New cases: 12,360.</div></li><li class="half_rhythm"><div>Deaths: 3,960.</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
|
|
jaundice, pain, and fever.</p></div><div id="CDR0000062904__158"><h3>Histopathology and Diagnostics</h3><p id="CDR0000062904__81">In patients whose
|
|
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
|
|
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 the
|
|
majority of 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 2019. Atlanta, Ga: American Cancer Society, 2019. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed January 23, 2019.</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>Adenocarcinoma, not otherwise specified (NOS).
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</div></li><li class="half_rhythm"><div>Papillary carcinoma.
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</div></li><li class="half_rhythm"><div>Adenocarcinoma, intestinal type.
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</div></li><li class="half_rhythm"><div>Clear cell adenocarcinoma.
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</div></li><li class="half_rhythm"><div>Mucinous carcinoma.
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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>Small cell (oat cell) carcinoma.*
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</div></li><li class="half_rhythm"><div>Undifferentiated carcinoma.*
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<dl id="CDR0000062904__140" class="temp-labeled-list"><dt>-</dt><dd><p class="no_top_margin">Spindle and giant cell types.</p></dd><dt>-</dt><dd><p class="no_top_margin">Small cell types.</p></dd></dl></div></li><li class="half_rhythm"><div>Carcinoma, NOS.
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</div></li><li class="half_rhythm"><div>Carcinosarcoma.
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</div></li><li class="half_rhythm"><div>Other (specify).</div></li></ul><p id="CDR0000062904__89">*Grade 4 by definition.</p><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. New York, NY: 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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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/NBK65933.6/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;">Definition</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"><b><div class="milestone-start" id="CDR0000062904__34"></div>Localized (Stage I)</b></p><p id="CDR0000062904__35">Patients with localized (stage I) gallbladder cancer have cancer confined to the gallbladder wall that can be
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completely resected. They represent a minority of cases of gallbladder cancer.
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Patients with cancers confined to the mucosa have 5-year survival rates of
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nearly 100%.[<a class="bk_pop" href="#CDR0000062904_rl_6_2">2</a>] Patients with muscular invasion or beyond have a survival of
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less than 15%. Treatment of localized disease includes removal of regional lymphatics and lymph nodes should be removed along
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with the gallbladder in such patients.
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<div class="milestone-end"></div></p><p id="CDR0000062904__71"><b><div class="milestone-start" id="CDR0000062904__36"></div>Unresectable (Stage II–IV)</b></p><p id="CDR0000062904__37">With the exception of some patients with focal stage IIA disease, patients with stage II, III, or IV disease have cancer that cannot be completely resected. They represent the
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majority of cases of gallbladder cancer. Often the cancer invades directly
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into adjacent liver or biliary lymph nodes or has disseminated throughout the
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peritoneal cavity. Spread to distant parts of the body is not uncommon. At these stages, standard therapy is directed at palliation. Because of its rarity, no
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specific clinical trials exist; however, such patients can be included in
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trials aimed at improving local control by combining radiation therapy with
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radiosensitizer drugs.
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<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. New York, NY: 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_">Localized Gallbladder Cancer Treatment</h2><p id="CDR0000062904__43"><div class="milestone-start" id="CDR0000062904__64"></div>When gallbladder cancer is previously unsuspected and is 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 for node-negative tumors pathologically staged
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as T2 to T4 were 42.5% ± 6.5% and for similar nodepositive tumors,
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31% ± 6.2%.
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</p><p id="CDR0000062904__45"><b>Standard treatment options for localized gallbladder cancer</b>
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</p><p id="CDR0000062904__177">Standard treatment options for localized gallbladder cancer include the following: </p><ol id="CDR0000062904__65"><li class="half_rhythm"><div class="half_rhythm">Surgery: In previously unsuspected gallbladder cancer, discovered in the
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surgical specimen following a routine gallbladder operation and confined to
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mucosa or muscle layer (T1), the majority of patients are cured and require no
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further surgical intervention.[<a class="bk_pop" href="#CDR0000062904_rl_40_2">2</a>,<a class="bk_pop" href="#CDR0000062904_rl_40_3">3</a>] Re-exploration to resect liver tissue near
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the gallbladder bed or extended or formal hepatectomy and lymphadenectomy including N1 and N2 lymph node basins
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may be associated with delayed recurrences or extended survival in patients with stage I or II
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gallbladder cancer.[<a class="bk_pop" href="#CDR0000062904_rl_40_4">4</a>,<a class="bk_pop" href="#CDR0000062904_rl_40_5">5</a>] Apparently localized cancers that are suspected
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before or during the operation can be surgically removed with a wedge of liver
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and lymph nodes and lymphatic tissue in the hepatoduodenal ligament.
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Long-term disease-free survival will occasionally be achieved. In jaundiced patients (stage III or stage
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IV), there should be consideration of preoperative percutaneous transhepatic
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biliary drainage for relief of biliary obstruction.
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</div><div class="half_rhythm">Implantation of the carcinoma at all port sites (including the camera site)
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after laparoscopic removal of an unsuspected cancer is a problem. Even for
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stage I cancers, the port sites must be excised completely.[<a class="bk_pop" href="#CDR0000062904_rl_40_6">6</a>]
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</div></li><li class="half_rhythm"><div class="half_rhythm">External-beam radiation therapy (EBRT): 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_7">7</a>,<a class="bk_pop" href="#CDR0000062904_rl_40_8">8</a>]</div></li></ol><p id="CDR0000062904__49"><b>Treatment options under clinical evaluation for localized gallbladder cancer </b>
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</p><p id="CDR0000062904__178">Treatment options under clinical evaluation for localized gallbladder cancer include the following: </p><ul id="CDR0000062904__66"><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, such patients are
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|
appropriately considered candidates for these studies. <div class="milestone-end"></div></div></li></ul><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">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_5">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_6">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_7">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_8">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_">Unresectable, Recurrent, or Metastatic Gallbladder Cancer Treatment</h2><p id="CDR0000062904__53"><div class="milestone-start" id="CDR0000062904__67"></div>Patients with unresectable, recurrent, or metastatic 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
|
|
slow-growing tumors and may live several years.
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|
Patients with unresectable, recurrent, or metastatic 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__54"><b>Treatment options for unresectable, recurrent, or metastatic gallbladder cancer</b>
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|
</p><p id="CDR0000062904__179">Treatment options for unresectable, recurrent, or metastatic gallbladder cancer include the following: </p><ol id="CDR0000062904__127"><li class="half_rhythm"><div class="half_rhythm">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. </div><div class="half_rhythm">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. </div></li><li class="half_rhythm"><div class="half_rhythm">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. </div><div class="half_rhythm">A randomized, phase III study of up to 6 months of gemcitabine versus gemcitabine and cisplatin in 410 patients with unresectable, recurrent, or metastatic gallbladder cancer demonstrated an improvement in median overall survival (OS) among patients treated with combination therapy (11.7 months vs. 8.1 months; hazard ratio, 0.64; [95% confidence interval, 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>] A similar median OS benefit was demonstrated in all subgroups, including 149 patients with gallbladder cancer. 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-cisplatin and increased hepatotoxicity in patients randomly assigned to single-agent gemcitabine. </div><div class="half_rhythm">A multi-institutional, randomized, phase III study (<a href="https://www.cancer.gov/clinicaltrials/NCT01149122" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NCT01149122</a>) of advanced biliary cancers that evaluated the benefit of chemotherapy (gemcitabine and oxaliplatin) with or without erlotinib failed to meet its endpoint of improvement in OS and progression-free survival.[<a class="bk_pop" href="#CDR0000062904_rl_51_3">3</a>][<a href="/books/n/pdqcis/glossary_loe/def-item/glossary_loe_CDR0000632558/" class="def">Level of evidence: 1iiD</a>] </div></li></ol><p id="CDR0000062904__139">Other drugs and drug combinations await evaluation in randomized trials.<div class="milestone-end"></div></p><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">Lee J, Park SH, Chang HM, et al.: Gemcitabine and oxaliplatin with or without erlotinib in advanced biliary-tract cancer: a multicentre, open-label, randomised, phase 3 study. Lancet Oncol 13 (2): 181-8, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22192731" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22192731</span></a>]</div></li></ol></div></div><div id="CDR0000062904__77"><h2 id="_CDR0000062904__77_">Changes to This Summary (01/29/2019)</h2><p id="CDR0000062904__78">The PDQ cancer information summaries are reviewed regularly and updated as
|
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new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.</p><p id="CDR0000062904__180"><b><a href="#CDR0000062904__1">General Information About Gallbladder Cancer</a></b></p><p id="CDR0000062904__190">Updated <a href="#CDR0000062904__92">statistics</a> with estimated new cases and deaths for 2019 (cited American Cancer Society as reference 1).</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
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
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 who care for cancer 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 reviewer for Gallbladder Cancer Treatment is:</p><ul><li class="half_rhythm"><div>Valerie Lee, MD (Johns Hopkins University)</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/NBK65933.6/?report=reader">PubReader</a></li><li><a href="/books/NBK65933.6/?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. 2019 Jan 29. In: PDQ Cancer Information Summaries [Internet]. 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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">Localized Gallbladder Cancer Treatment</a></li><li><a href="#CDR0000062904__51" ref="log$=inpage&link_id=inpage">Unresectable, Recurrent, or Metastatic Gallbladder Cancer Treatment</a></li><li><a href="#CDR0000062904__77" ref="log$=inpage&link_id=inpage">Changes to This Summary (01/29/2019)</a></li><li><a href="#CDR0000062904__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Lymphedema (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Supportive and Palliative Care Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389442" ref="ordinalpos=1&linkpos=2&log$=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 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