Gallbladder Cancer

Diagnosis

Some of the tests used for the diagnosis of gallbladder cancer are:

• Physical examination and medical history: Comprehensive physical examination is done to determine the signs of gallbladder cancer, such as jaundice. The doctor may also discuss the symptoms experienced by the patients. Further, certain factors increase the risk of gallbladder cancer. Therefore, the doctor will assess those risk factors in the patients.
• Laboratory analysis: The patients may also undergo various laboratory analyses to determine the presence of certain chemicals and tumor markers. The doctor may order testing for liver functions, such as levels of various liver enzymes (AST, alkaline phosphatase, GGT, and ALT) and albumin. Further, any issue in the gallbladder raises the level of bilirubin in the blood, which can be detected through laboratory analysis. Certain substances are also produced by the cancer cells that are released in the blood. These are known as tumor markers. There may be a higher level of CA 19-9 and CEA in patients with gallbladder cancer.
• CT scan: If the physical examination and laboratory analysis make the doctor suspicious about any condition, he may recommend the patients undergo imaging testing. CT scan provides detailed images of the gallbladder and assists in diagnosing gallbladder cancer and detecting gallbladder cancer staging. In some cases, CT angiography may also be performed to evaluate the blood vessels surrounding the gallbladder. The doctor may also use a CT scan to guide the needle during a biopsy, a procedure known as a CT-guided biopsy.
• Magnetic resonance cholangiopancreatography: In this technique, the doctor uses magnetic resonance imaging to obtain images of the gallbladder. The procedure is similar to that of the standard MRI. The doctor does not use any dye in the endoscope during the procedure.
• Endoscopic retrograde cholangiopancreatography: During this procedure, the doctor sedates the patient before inserting an endoscope (a thin, long tube with a camera at the end) into the mouth and passes through the stomach and intestine. A small catheter is inserted into the endoscope and guided into the common bile duct. The catheter then injects the dye into the bile duct. The dye outlines the pancreatic and bile ducts during X-ray. The image may detect the blockage or narrowing of the ducts. Endoscopic retrograde cholangiopancreatography is more invasive as compared to MRCP. However, it has the advantage of collecting the samples from the bile duct or performing further procedures to open the blocked or narrowed duct.
• Percutaneous transhepatic cholangiography: During this procedure, the doctor places a hollow and thin needle into a bile duct in the liver through the abdominal skin. The procedure is performed under sedation. The doctor may also use local anesthesia to numb the skin before inserting the needle. The doctor then injects the contrast dye through the needle. The patient is subject to X-rays as the dye passes through the bile ducts. This test allows the doctor to obtain the tissue sample or open up the blocked or narrowed bile duct. As the procedure is more invasive compared to ERCP, it is not recommended unless the ERCP result is unclear or ERCP cannot be performed on the patient for some reason.
• Ultrasound: Ultrasound uses sound waves to obtain images of the gallbladder. It is usually the first imaging test recommended to the patient for diagnosing gallbladder cancer. Abdominal ultrasound is done in patients with abdominal pain or with symptoms of jaundice. Abdominal ultrasound may also be used in patients during a biopsy in a procedure called an ultrasound-guided biopsy. Laparoscopic ultrasound or endoscopic ultrasound may also be recommended to the patients. In these techniques, the doctor inserts the tube (with the ultrasound transducer at one end) near the gallbladder. The doctor may either insert the tube through the mouth (endoscopic ultrasound) or make an incision on the skin of the abdomen (laparoscopic ultrasound).
• Biopsy: In this procedure, the cancer specialist obtains the sample of abnormal tissue from the gallbladder and sends it to the laboratory for further analysis. Some of the techniques used for biopsy are laparoscopy biopsy, cholangiography biopsy, and needle biopsy.