Shahid Ahmed, PhD, MD, FRCPC, FACP, Saskatoon Cancer Center, University of Saskatchewan, Saskatoon, Canada, provides an update on the results of a multicenter retrospective population-based cohort study evaluating the impact of real-world second-line chemotherapy on survival in patients with advanced biliary tract and gallbladder cancers. This interview was recorded via an online conference call with The Video Journal of Oncology (VJOncology).

Gallbladder cancer is relatively uncommon compared to other hepatobiliary malignancies.

Gallbladder cancer is relatively uncommon compared to other hepatobiliary malignancies.

Liver & Gall bladder cancer surgery is done by Dr. Vinay Samuel Gaikwad
Associate Director & Head, Surgical Oncology

Treatment Options Based on the Extent of Gallbladder Cancer
The extent of gallbladder cancer is an important factor in deciding on treatment options. Whenever possible, surgery is the main treatment. It's the best chance of curing the cancer. Because of this, doctors generally divide gallbladder cancers into 2 groups:

Resectable cancers are those that doctors believe can be removed completely by surgery, based on the results of imaging procedures and other tests.
Unresectable cancers have spread too far or are in too difficult a place to be removed entirely by surgery.
Resectable gallbladder cancers
In terms of stages , stage I and II cancers and some stage III cancers that have not spread far beyond the gallbladder may still be treatable with surgery. But it's not an option if the cancer has spread into major blood vessels. Other factors, such as whether a person is healthy enough for surgery, also affect whether surgery is a good option. For instance, if the cancer has only invaded the liver in one area and not too deeply, it may be possible to remove all of the cancer. On the other hand, if the cancer has spread to both sides of the liver, to the lining of the abdominal cavity, to organs far away from the gallbladder, or if it surrounds a major blood vessel, surgery is unlikely to remove it all.

How the cancer is first found can impact treatment options, too. For example, some cancers are found on imaging tests before surgery, while others are found only after the gallbladder has been taken out to treat another condition such as gallstones.

If gallbladder cancer is suspected or diagnosed, it’s a good idea to be seen by a surgeon with experience treating this type of cancer. Gallbladder cancer is rare, and not all surgeons are skilled at the more extensive operations needed to treat it.

No matter what stage the cancer is, it’s very important that you understand the goal of treatment before it starts – whether it’s to try to cure the cancer or to help relieve symptoms – as well as the likelihood of the benefits and risks. This can help you make good decisions when looking at your treatment options.

Gallbladder cancers that might be resectable
These are earlier stage cancers that doctors believe might be removed completely by surgery. Treatment of these cancers depends in part on how they're first found.

Cancer found after surgery for another gallbladder problem
Some gallbladder cancers are found when the gallbladder is removed to treat gallstones or chronic inflammation. The removed gallbladder is looked at and tested in a lab, at which time the cancer is found. These are often early-stage cancers. If the cancer is confirmed to be only in the inner layers of the gallbladder (T1a) , with no signs of spread outside the gallbladder, no further treatment may be needed because there's a very good chance that all of the cancer was removed.

If the cancer is found to be in deeper layers of the gallbladder wall (T1b or greater), other tests will be done to look for any remaining cancer in the body and to see if it can be removed. These tests may include CT or MRI scans and a staging laparoscopy.

If the cancer is thought to be resectable after these tests, another, more extensive, operation will be done to remove part of the liver, nearby lymph nodes, and possibly parts of the bile duct. (If the initial surgery was a laparoscopic cholecystectomy, the skin around the original incision sites may be removed as well. This is done just in case cancer cells may have gotten on the skin when the gallbladder was removed through these small holes. It's not clear how useful this is. This may be followed by chemotherapy (chemo), with or without radiation, to try to keep the cancer from coming back, but it’s not clear how helpful this is.

If the imaging tests or staging laparoscopy show that the cancer can’t be removed, treatment options will be like those used for unresectable cancers.

Cancer found during surgery for another gallbladder problem
Sometimes, gallbladder cancer is discovered during surgery to remove the gallbladder (simple cholecystectomy). In this case, during the operation, the surgeon sees changed areas that look like they may be cancer. Small pieces of these changes (samples) are sent to the lab to be checked quickly while the operation goes on. Cancer cells are seen in the samples.

If the surgeon is experienced in treating gallbladder cancer and believes the cancer can be removed (is resectable), the operation may be changed to a more extensive operation called an extended cholecystectomy. (See Surgery for Gallbladder Cancer for details.)

If the surgeon isn’t experienced in treating gallbladder cancer or isn’t sure if the cancer is resectable, the operation may be stopped at this point. Other tests such as CT or MRI scans will then be done to look for any remaining cancer in the body and find out whether it's resectable.

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