Cholangiocarcinoma & Gallbladder Cancer

Gallbladder cancer and cholangiocarcinoma, or bile duct cancer, are rare in the U.S. Because these are uncommon cancers, it’s important that you work with a cancer treatment team that has experience treating biliary cancer. The multidisciplinary team at MUSC Hollings Cancer Center, the state’s only NCI-designated cancer center, includes medical oncologists, surgical oncologists, radiation oncologists, psychologists, nurse navigators and more who are dedicated to providing you the best possible care.

We also offer a next-day access program for people with newly diagnosed, non-metastatic cholangiocarcinoma so that you can begin discussing a treatment plan with a surgeon right away.

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What is cholangiocarcinoma? | What is gallbladder cancer? | Symptoms | Treatment | Care Locations | Gallbladder Cancer Risk Factors | Cholangiocarcinoma Risk Factors

What is cholangiocarcinoma?

Cholangiocarcinoma, or bile duct cancer, is cancer within the bile ducts that carry bile between the liver, where it is produced, the gallbladder, where it is stored, and the small intestine, where it is used to break down food.

You may see the terms intrahepatic, which refers to the bile ducts inside the liver, and extrahepatic, which refers to the bile ducts outside the liver. There are two types of extrahepatic bile duct cancers – perihilar, when the cancer forms where the ducts meet, and distal, when the cancer forms closer to the small intestine. Most bile duct cancers are extrahepatic.

Overall, about 8,000 people in the U.S. will be diagnosed with bile duct cancer each year.

What is gallbladder cancer?

Your gallbladder is a small organ beneath your liver. It’s a storage tank for bile, the substance that breaks down fat into fatty acids.

When cells in the gallbladder start to grow out of control, cancer begins. Cancer in the gallbladder is rare — about 5,000 people in the U.S. will be diagnosed with gallbladder cancer each year.

Symptoms of bile duct or gallbladder cancer

Gallbladder cancer and bile duct cancer often don’t show symptoms at first. Because the gallbladder is small and tucked behind the liver, doctors can’t really feel it when they conduct regular physical exams.

Signs of chronic inflammation, like being diagnosed with cholecystitis, may be the first clue that cancer is developing. 

Symptoms of advanced disease can include: 

• Jaundice. Jaundice is a symptom of a number of liver problems as well as gallbladder cancer and bile duct cancer. In the case of gallbladder or bile duct cancer, the tumor blocks the flow of bile, which then backs up into the bloodstream and causes a yellowing of the whites of the eyes, the skin, the underside of the tongue and the gum line. Besides this yellowing, other symptoms of jaundice include:
  • Itchy skin
  • Dark urine
  • Bowel movements that are pale or clay-colored.
• Lump in the belly. If the flow of bile has been blocked, it can cause the gallbladder to swell, causing lumps in the abdomen.
• Pain. Pain under the right ribcage when taking a deep breath or right shoulder pain. 

Gallbladder cancer and cholangiocarcinoma treatment

The most common treatments for gallbladder cancer and cholangiocarcinoma are surgery and systemic therapy to include chemotherapy, immunotherapy and/or targeted therapy.

There have been significant advances in systemic therapies. At Hollings, we conduct a molecular profile of your tumor to understand which treatments are most likely to be effective. Your doctor will work with a multidisciplinary team to review your case and develop a plan that takes into account the best therapies for you as well as the optimal order for you to receive those therapies. 

When doctors look at images of the gallbladder and bile ducts, if it looks like all of the cancer could be removed, they’ll schedule a potentially curative surgery. Cancer surgeries for the gallbladder and bile ducts are complex procedures that require highly skilled surgical teams, like the team at Hollings.

If doctors recommend surgery to remove your gallbladder, know that you can live a perfectly normal life without your gallbladder. Whenever possible, our teams will use minimally invasive methods, like robotic surgery or laparoscopic surgery. Minimally invasive surgeries require smaller incisions (cuts), which usually means a faster recovery time and less pain.

Chemotherapy is also often used. It may be used to shrink a tumor before surgery (neoadjuvant), to kill any microscopic cancer cells after surgery, or as a treatment by itself if surgery isn't an option. 

Also, as a National Cancer Institute-designated cancer center, Hollings offers clinical trials, personalized systemic therapy regimens and advanced treatment options with the goals of shrinking advanced tumors so that you can have surgery and treating metastatic disease. 

Our specialists would be happy to evaluate you or your loved one to help you to explore the best options for your situation. 

Refer a bile duct or gallbladder cancer patient

To refer a bile duct or gallbladder cancer patient to Hollings, please call nurse coordinator Kelsey Cook at 843-985-7262.

Nurse navigator support

Our nurse navigators are an integral part of cancer care. They can help you to navigate through the health system, organize your appointments, and access additional resources. Our gastrointestinal cancer nurse navigator Anthony DeMeo, MSN, RN, will help you understand what to expect during treatment and answer questions you may have.

Gallbladder cancer risk factors

Risk factors increase your risk of getting cancer — they do not mean that you will automatically get cancer and they do not mean that people without these risk factors won’t get cancer. Some risk factors are unchangeable, like getting older. But some lifestyle risk factors can be changed.

The combination of obstruction, chronic inflammation and infection are most likely to lead to cancer. 

• Gallstones. Most people with gallbladder cancer have gallstones. Keep in mind, though, that most people with gallstones will not go on to develop cancer.
• Obesity.
• Primary sclerosing cholangitis (PSC). This rare condition is an inflammation of the bile ducts. Most people with PSC also have inflammatory bowel disease (IBD). 
• Ancestry and family history. Gallbladder cancer is more common in certain groups, including Native Americans of the Southwest, Mexicans, and Chilean Mapuche Indians, and people from India, Pakistan and Central Europe. There also appears to be a familial connection in some cases. 

Bile duct cancer (cholangiocarcinoma) risk factors

• Primary sclerosing cholangitis (PSC). This rare condition is an inflammation of the bile ducts. Most people with PSC also have inflammatory bowel disease. 
• Cirrhosis. Scarring of the liver, which can be caused by heavy alcohol use or by a condition called metabolic dysfunction-associated steatohepatitis.
• Hepatitis B or hepatitis C. Chronic hepatitis B or hepatitis C infections are associated with an increased risk of bile duct cancer.
• Bile duct stones and gallstones.
• Alcohol use. This includes beer and wine as well as liquor. 
• Liver fluke infection. Liver flukes are tiny parasitic worms that can be eaten along with uncooked or undercooked fish, particularly in Asia where these liver flukes are native.