# Symptom control in advanced gallbladder cancer: pain, ascites and nutrition

Source: https://onco.cc/terms/gallbladder-cancer-symptom-control/  
OnCo record `gallbladder-cancer-symptom-control` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Advanced gallbladder cancer causes pain under the right ribs, fluid in the abdomen and weight loss. Pain is treated with opioids and, for pain that spreads to the back, a nerve block of the coeliac plexus; fluid is drained by needle or a permanent tunnelled tube; weight loss is managed by dietetic support rather than by any drug proven in this cancer.

## Summary

Right upper quadrant and back pain from hilar and coeliac node involvement responds to opioid titration under the usual analgesic ladder. Neurolytic coeliac plexus block, tested in a 100-patient double-blind randomised trial in unresectable pancreatic cancer, lowered pain scores more than opioids alone (p 0.005) without changing opioid consumption, quality of life or survival; it is used for the same upper abdominal visceral pain in biliary cancer by extension, and can be done under endoscopic ultrasound or CT guidance. Malignant ascites from peritoneal spread is drained by paracentesis, and a tunnelled peritoneal catheter allows home drainage when taps are needed more than every few weeks; in a 94-patient series insertion succeeded in all, with catheter infection in 2 percent, leakage in 4 percent and occlusion in 2 percent, and median survival after insertion of 1.7 months, which places the procedure late in the illness. Cachexia and biliary obstruction both impair nutrition: fat malabsorption from obstructed bile flow and duodenal obstruction should be treated (stenting, pancreatic enzymes where indicated) before appetite stimulants are considered, and early integrated palliative care is the standard framework. UK care is delivered through hepatobiliary multidisciplinary teams with specialist palliative care referral; there is no gallbladder-specific supportive care trial.

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: Coeliac plexus block; Celiac plexus neurolysis; Malignant ascites drainage; Tunnelled peritoneal catheter

## Sources

- Wong et al., JAMA 2004: neurolytic coeliac plexus block versus opioids alone, randomised controlled trial (100 patients): https://doi.org/10.1001/jama.291.9.1092
- Tenckhoff tunnelled peritoneal catheter for malignant ascites: technical and clinical outcome (Radiol Oncol 2016, 94 patients): https://doi.org/10.1515/raon-2016-0002

## Connected records

- cancers: [Biliary tract cancer (cholangiocarcinoma)](https://onco.cc/cancers/cholangiocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- technologies: [Early integrated palliative care](https://onco.cc/technologies/palliative-care/)
- terms: [Biliary drainage routes: ERCP stent, percutaneous (PTC) and EUS-guided](https://onco.cc/terms/biliary-drainage-routes/), [Cancer cachexia](https://onco.cc/terms/cachexia/), [Duodenal stenting and gastrojejunostomy for malignant gastric outlet obstruction](https://onco.cc/terms/duodenal-stenting-gastric-outlet/), [Obstructive jaundice and biliary obstruction](https://onco.cc/terms/obstructive-jaundice/), [Peritoneal metastasis](https://onco.cc/terms/peritoneal-metastasis/)

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