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Treatment of advanced, unresectable gallbladder cancer

Bhoomi Mehrotra, MD
Tanios Bekaii-Saab, MD
Section Editor
Richard M Goldberg, MD
Deputy Editor
Diane MF Savarese, MD


Gallbladder cancer (GBC) is an uncommon but highly fatal malignancy; fewer than 5000 new cases are diagnosed each year in the United States. The majority is found incidentally in patients undergoing exploration for cholelithiasis; a tumor will be found in 1 to 2 percent of such cases [1-4]. The poor prognosis is thought to be related to advanced stage at diagnosis, which is due both to the anatomic position of the gallbladder, and the vagueness and nonspecificity of symptoms.

Surgery is the only potentially curative modality for patients with GBC. However, only a minority of patients is eligible for curative intent surgery because of disease extent (either locoregionally advanced and unresectable because of local invasion into critical structures or metastasized beyond locoregional confines). For the remainder, treatment is palliative in nature. (See "Adjuvant treatment for localized, resected gallbladder cancer".)

The goal of palliation for advanced GBC (as for other pancreaticobiliary cancers) is relief of pain and jaundice along with prolongation of life. Patients who have pain from local growth may benefit from radiation therapy (RT) with or without concomitant chemotherapy. Although biliary or intestinal bypass can be considered, percutaneous or endoscopic approaches are generally preferred, given the limited median survival in patients with advanced disease (generally, less than six months).

Here we will discuss the treatment of advanced unresectable GBC. The epidemiology, risk factors, clinical features, and diagnostic evaluation of GBC, and treatment for localized, potentially resectable disease are covered separately, as is treatment for advanced bile duct cancer (cholangiocarcinoma). (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis" and "Treatment options for locally advanced cholangiocarcinoma" and "Systemic therapy for advanced cholangiocarcinoma".)


Jaundice caused by biliary obstruction is the presenting feature in 30 to 60 percent of patients with GBC; the usual cause is direct infiltration of the common hepatic duct by tumor [5]. Most patients who present with jaundice are typically not amenable to a curative resection.

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Literature review current through: Nov 2017. | This topic last updated: Oct 03, 2016.
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