Tests for Gallbladder Cancer

Some gallbladder cancers are found after the gallbladder has been removed because of gallstones or to treat chronic (long-term) inflammation. Gallbladders removed for those reasons are always looked at under a microscope to see if there's cancer cells in them.

Most gallbladder cancers, though, aren't found until a person goes to a doctor because they have symptoms.

Medical history and physical exam

If there's reason to suspect you might have gallbladder cancer, your doctor will want to take a complete medical history to check for risk factors and to learn more about your symptoms.

Your doctor will examine you to look for signs of gallbladder cancer and other health problems. The exam will focus mostly on the abdomen (belly) to check for any lumps, tenderness, or fluid build-up. The skin and the white part of the eyes will be checked for jaundice (a yellowish color). The stool and urine will be checked for change in color. Sometimes, cancer of the gallbladder spreads to lymph nodes, causing a lump that can be felt beneath the skin. Lymph nodes above the collarbone and in several other locations may be checked.

If symptoms and/or the physical exam suggest you might have gallbladder cancer, tests will be done. These might include lab tests, imaging tests, and other procedures.

Blood tests

Tests of liver and gallbladder function

Lab tests might be done to find out how much bilirubin is in your blood. Bilirubin is the chemical that causes jaundice. Problems in the gallbladder, bile ducts, or liver can raise the blood level of bilirubin.

The doctor may also do tests for albumin, liver enzymes (alkaline phosphatase, AST, ALT, and GGT), coagulation studies (PT, PTT, INR) and certain other substances in your blood. Some of these tests are called liver function tests. They can help diagnose liver, bile duct, or gallbladder disease.

Tumor markers

Tumor markers are substances made by cancer cells that can sometimes be found in the blood. People with gallbladder cancer may have high blood levels of the markers called CEA and CA 19-9. Usually the blood levels of these markers are high only when the cancer is in an advanced stage. These markers are not specific for gallbladder cancer – that is, other cancers or even some other health conditions also can make them go up.

These tests can sometimes be useful after a person is diagnosed with gallbladder cancer. If the levels of these markers are found to be high, they can be followed over time to help tell how well treatment is working.

Imaging tests

Imaging tests use x-rays, magnetic fields, or sound waves to create pictures of the inside of your body. Imaging tests can be done for a number of reasons, including:

• To look for suspicious areas that might be cancer
• To help a doctor guide a biopsy needle into a suspicious area to take a sample for testing
• To learn how far cancer has spread
• To help make treatment decisions
• To help find out if treatment is working
• To look for signs of the cancer coming back after treatment

People who have (or might have) gallbladder cancer may have one or more of these tests:

Ultrasound

Ultrasound uses sound waves and their echoes to create images of the inside of the body. A small instrument called a transducer gives off sound waves and picks up their echoes as they bounce off organs inside the body. The echoes are converted by a computer into an image on a screen.

Abdominal ultrasound: This is often the first imaging test done in people who have symptoms like jaundice or pain in the right upper part of their abdomen (belly). This is an easy test to have, and it doesn't use radiation. You simply lie on a table while a technician moves the transducer on the skin over your abdomen.

This type of ultrasound can also be used to guide a needle into a suspicious area or lymph node so that cells can be removed (biopsied) and looked at under a microscope. This is called an ultrasound-guided needle biopsy.

Endoscopic ultrasound (EUS) or laparoscopic ultrasound: In these techniques, the doctor puts the ultrasound transducer inside the body and closer to the gallbladder. This gives more detailed images than a standard ultrasound. The transducer is on the end of a thin, lighted tube that has a camera on it. The tube is either passed through the mouth, down through the stomach, and near the gallbladder (endoscopic ultrasound) or through a small surgical cut on your belly (laparoscopic ultrasound).

Computed tomography (CT) scan

A CT scan uses x-rays to make detailed cross-sectional images of your body. It can be used to:

• Help diagnose gallbladder cancer by showing findings such as a mass filling the gallbladder, or a thickening of the gallbladder wall.
• Help stage the cancer (find out how far it has spread). CT scans can show the organs (such as the liver) and blood vessels (such as the hepatic arteries) near the gallbladder, as well as lymph nodes and distant organs where the cancer might have spread.

Magnetic resonance imaging (MRI) scan

Like CT scans, MRI scans show detailed images of soft tissues in the body. But MRI scans use radio waves and strong magnets instead of x-rays. A contrast material called gadolinium may be injected into a vein before the scan to see details better.

MRI scans provide a great deal of detail and can be very helpful in looking at the gallbladder and nearby tissue, blood vessels (such as the portal vein), and lymph nodes. Sometimes they can help tell whether a tumor is cancer or benign (non-cancer). A special type of MRI scan called an MR cholangiopancreatography (MRCP) can also be used to look at the bile ducts.

Laparoscopy

Laparoscopy is a type of surgery. The doctor puts a thin tube with a light and a small video camera on the end (a laparoscope) into a small incision (cut) in the front of your abdomen (belly) to look at the gallbladder, liver, and other nearby organs and tissues. Sometimes more than one cut is made. This is usually done in the operating room with general anesthesia (drugs are used to put you into a deep sleep and not feel pain during the surgery).

Laparoscopy can help doctors plan surgery or other treatments, and can help them determine the stage (extent) of the cancer. If needed, doctors can also put special instruments in through the incisions to take out biopsy samples for testing.

Laparoscopy is often used to take out your gallbladder. This operation is called a laparoscopic cholecystectomy. If gallbladder cancer is found or suspected during that operation, surgeons usually change to an open cholecystectomy (removal of the gallbladder through a larger cut in the abdomen). The open method lets the surgeon see more and may lower the chance of releasing cancer cells into the abdomen when the gallbladder is removed. The use of the open procedure depends on the size of the cancer and w hether surgery can remove it all.

Biopsy

During a biopsy, the doctor removes a tissue sample to be looked at with a microscope to see if cancer (or some other disease) is present. If gallbladder cancer is suspected, a biopsy is usually not done before surgery to remove the gallbladder. This is because doctors are often concerned that sticking a needle into the tumor or otherwise disturbing it without completely removing it might allow cancer cells to spread.

If imaging tests show a tumor in the gallbladder and there are no clear signs that it has spread, the doctor might decide to proceed directly to surgery to remove the suspected gallbladder tumor. (See Surgery for Gallbladder Cancer.) In this case, the gallbladder is checked for cancer after it's been removed.

In other cases, a doctor may feel that a biopsy of a suspicious area is the best way to know for sure if it's cancer. For example, imaging tests may show that a tumor has spread or grown too large to be removed completely by surgery. Many gallbladder cancers are not removable by the time they're first found.

Needle biopsy: If the cancer is too big or has spread too much to be removed with surgery, a needle biopsy may be done to confirm the diagnosis and help guide treatment. For this test, the skin is numbed with a local anesthetic, and a thin, hollow needle is put in through the skin and into the tumor without making a cut in the skin. The needle is usually guided into place using ultrasound or CT scans. When the images show that the needle is in the tumor, cells and/or fluid are drawn into the needle and sent to the lab to be tested.

In most cases, this is done as a fine needle aspiration (FNA) biopsy, which uses a very thin needle attached to a syringe to suck out (aspirate) a sample of cells. Sometimes, the FNA doesn't get enough cells for a definite diagnosis, so a core needle biopsy, which uses a slightly larger needle to get a bigger sample, may be done.

Lab tests of biopsy samples

Along with looking at the biopsy samples with a microscope to see if they contain cancer cells, other lab tests might also be done on the samples.

For example, cancer cells in biopsy samples (or surgery samples) might be tested for certain gene or protein changes (sometimes called genotyping or molecular profiling). This could include changes in the FGFR2, NTRK, IDH1, BRAF, RET, KRAS, and HER2 genes. The results of these tests can help determine if certain targeted drugs might be helpful in treating the cancer.

For more information on biopsies and how samples are tested, see Biopsy and Cytology Tests.