Surgery

Surgery is the primary treatment for resectable gallbladder cancer that the doctor believes can be completely removed. Surgery may also be used palliatively to relieve symptoms, pain, and complications like biliary obstruction. When surgery is used "curatively," the doctor usually performs an extended (radical) cholecystectomy. In this procedure, the doctor removes the gallbladder, nearby lymph nodes, and part of the liver. Sometimes when gallbladder cancer is diagnosed incidentally, that is during surgery for gallstones, a re-operation may be needed to remove any residual cancer. The doctor may also remove other nearby tissue. The doctor may also perform palliative surgery to remove tumors blocking the bile duct or intestine.

Radiation Therapy

Radiation therapy uses high-energy rays produced by a machine to destroy cancer cells. Doctors may give radiation therapy to eliminate any traces of cancer left after surgery. The most common form of radiation for this disease is external beam radiation, in which a large machine delivers radiation to the tumor from outside the body directed from multiple different angles. Radiation therapy may be used to kill any cancer cells remaining after surgery, as a primary treatment for unresectable gallbladder cancer, or palliatively to shrink tumors and relieve blockages.

Chemotherapy

Chemotherapy is the use of drugs to treat rapidly growing cancer cells in an effort to destroy them. Chemotherapy medications may be given through the vein (intravenously) or by mouth (orally). Chemotherapy is used for gallbladder cancer that cannot be cured with surgery. Chemotherapy may shrink or slow the growth of gallbladder cancer, but will not cure the disease. Chemotherapy may also be given after surgery (along with radiation therapy) as an adjuvant therapy, to kill any remaining cancer cells. In some cases, gallbladder cancers can also be treated with targeted therapies in clinical trials. The doctor may also inject chemotherapy drugs directly into the hepatic artery. The hepatic artery supplies gallbladder cancers with blood and nutrients, so this type of therapy delivers chemotherapy drugs directly to the cancer.

Targeted Therapy

In some cases, gallbladder cancers are associated with genetic mutations that can be targeted by specific agents with clinical benefit. Targeted therapies or precision medicines are designed to block a specific target, usually a protein or genetic change, that can influence the growth and development of cancer cells. Since targeted therapies directly attack the cancer cells, they tend to have less side effects than traditional medications such as chemotherapy, which target all rapidly-dividing cells. The two main types of targeted therapy are small-molecule drugs and monoclonal antibodies:

• Small-molecule drugs can enter cancer cells and target certain proteins and enzymes that are involved in key cell functions such as growth and division. Small-molecule drugs can block these substances, and prevent them from stimulating tumor growth.
• Monoclonal antibodies function very much like the antibodies that the body produces naturally in response to infection and disease. Monoclonal antibodies bind to harmful substances in the body, such as cancer cells, viruses, and bacteria, and signal the body's immune system to find and destroy the harmful substances. These antibodies target specific proteins on cancer cells that are involved in cancer growth and spread.

Palliative Treatments

Doctors also use palliative or supportive treatments to relieve symptoms caused by the cancer, particularly in its advanced stages. Supportive procedures for gallbladder cancer include inserting a stent if a tumor is blocking the bile ducts, performing surgery to create a pathway around a blockage, or inserting a catheter to drain excess bile if there is a blockage. Palliative treatments may also include prescription pain medications to relieve pain.

Clinical Trials

Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation.

Immunotherapy is the use of medicines to help a person’s immune system better recognize and destroy cancer cells. Many of these drugs are being tested in clinical trials to see if they might help treat gallbladder cancer.