Gallbladder And Bile Duct Cancer

Diagnosis

Your doctor will ask you about your medical history and do a physical examination. The examination will focus mainly on the abdomen. Your doctor will check for masses, areas of tenderness, fluid accumulation and enlarged organs. In addition, your doctor will check your skin and eyes for jaundice and your lymph nodes at various locations for swelling.

You may be given the following tests:

• Blood chemistry tests - Laboratory tests can measure the levels of liver and gallbladder enzymes, and of bilirubin, which is the chemical in bile that gives it its color. Too much of it in the blood indicates that the bile duct might be blocked, or there might be gallbladder or liver problems. An elevated level of alkaline phosphatase also can point to bile duct obstruction or gallbladder disease. Blood tests cannot determine, however, if elevated levels of these substances are caused by cancer or by some other condition.

• Ultrasound - Ultrasound detects about one-half of gallbladder cancers, and also can help to find a bile duct obstruction or tumor if the mass is large enough. Ultrasound uses sound waves to make images of internal organs. Ultrasound also can be used in combination with endoscopy and laparoscopy. These procedures are needed only in certain cases. In endoscopy, a flexible viewing tube called an endoscope is inserted into the mouth, through the stomach and into the first part of the small intestine where the bile duct empties. Laparoscopy is a limited type of surgery that involves placing a surgical instrument called a laparoscope through a small cut on the side of the body. Both procedures allow the ultrasound transducer to be placed closer to the gallbladder, producing more detailed images than a standard ultrasound.

• Computed tomography (CT) - This test uses a rotating X-ray beam to make detailed, cross-sectional images of the body. A CT scan can identify a tumor inside the gallbladder or one that has spread outside of it. It also ccan help to evaluate whether the tumor has spread to the bile duct, liver or nearby lymph nodes.

• Magnetic resonance imaging (MRI) and MRCP - These scans also create cross-sectional images of internal organs, but use radio waves and powerful magnetic fields instead of radiation. They can make more detailed images than ultrasounds and CT scans, and are effective in showing whether a tumor is only in the gallbladder or has invaded the nearby liver. A special type of magnetic resonance imaging - magnetic resonance cholangiopancreatography (MRCP) - produces pictures that make the bile ducts stand out, and is considered among the best noninvasive ways to test for bile duct cancer. A biopsy still will be needed to confirm the diagnosis, however.

• Endoscopic retrograde cholangiopancreatography (ERCP) - In this procedure, a flexible tube is passed down the throat, through the esophagus and stomach, and into the common bile duct. A small amount of contrast dye is used to help outline the bile duct in X-ray images, which can show if the bile duct is narrowed or blocked. The advantage of ERCP is that the same instrument also can be used to take biopsies of a blocked area. A blockage also can be relieved by placing a device called a stent during ERCP, which can sometimes avoid the need for surgery. A stent is a wire-mesh tube that helps to keep the bile duct open.

• Surgery - Sometimes surgery must be done to determine if there is cancer in the gallbladder or bile duct.

• Biopsy - Ultimately, to be certain of the diagnosis, a sample of tissue will be taken from the tumor or mass to be examined in a laboratory. A sample of tissue can be taken during an ERCP, with a needle guided by a CT scan, or during surgery.

Expected Duration

Gallbladder and bile duct cancers will continue to grow unless treated.