Gallbladder adenocarcinoma
Adenocarcinoma is the usual form of gallbladder cancer, about nine in ten cases, starting in the mucus-making gland cells of the lining. Everything on the main gallbladder cancer page (causes, staging, surgery, chemotherapy with immunotherapy) is written about this type unless it says otherwise.
Overview
Adenocarcinoma of the gallbladder arises from the glandular epithelium of the mucosa, usually on a background of chronic cholecystitis and gallstones, and in the WHO classification (5th edition, 2019) is subdivided by pattern: the common biliary (pancreatobiliary) type, intestinal type, gastric foveolar, mucinous, signet-ring, clear cell, hepatoid and other rare patterns (Nagtegaal 2020; Roa 2022). Cancer Research UK uses a simpler split into non-papillary, papillary and mucinous adenocarcinoma. In the largest pathology series conventional pancreatobiliary-type adenocarcinomas had a female to male ratio of 3.9 and a mean size of 2.9 cm (Dursun 2012, in which they were the comparator for mucinous carcinoma). Grade (1 well, 2 moderate, 3 poorly differentiated), depth of invasion (T category), the T2a or T2b side, lymphovascular and perineural invasion, node number and the cystic duct margin are the pathological findings that drive treatment (CRUK stages and grades; Shindoh 2015; Aloia 2015).
Because adenocarcinoma is the type every guideline and trial assumes, its management is the main page's: simple cholecystectomy suffices for Tis and T1a, radical cholecystectomy from T1b, adjuvant capecitabine after resection (BILCAP), and gemcitabine and cisplatin with durvalumab or pembrolizumab for advanced disease (TOPAZ-1, KEYNOTE-966), with HER2-directed therapy for the HER2-positive subset. The mucinous, papillary, adenosquamous and neuroendocrine pages describe how the rarer types differ.
State of the art
Red cards
From the labels and guidelines behind the standard of care. Your team's thresholds win.- Emergency services nowBleeding or bruising
Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
- Emergency services nowHypophysitis or adrenal crisis
Persistent headache with extreme tiredness, nausea, dizziness on standing or low blood pressure. Vomiting, severe weakness or collapse is adrenal crisis.
- Emergency services nowBlood clot (lenalidomide, pomalidomide, thalidomide)
A swollen painful calf, or sudden breathlessness with chest pain; venous and arterial thromboembolism is a boxed warning and blood-thinning prophylaxis is recommended.
- Check before combiningFood and drink: Pembrolizumab
No pharmacokinetic interactions expected (antibody). See the irAE guide for toxicity management.
- Good to knowImmune-related endocrinopathies (thyroiditis, hypophysitis)
Immunotherapy can attack hormone-producing glands: most often the thyroid (usually ending in an under-active thyroid needing lifelong tablets), and less often the pituitary (hypophysitis) or adrenal glands, which can be life-threatening if missed.
See all on the product pages:CapecitabineDurvalumabGemcitabine + cisplatinPembrolizumab·Printable cards in the navigator
Anatomy and lymph node drainage
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- Gallbladder
- Nodes: peripancreatic
- Nodes: hepatic hilar
- Nodes: coeliac and superior mesenteric
Most pancreatic cancers arise in the head next to the bile duct, which is why jaundice is the presenting sign; bile duct cancers are named by where along the tree they sit.
- Pancreatic head (most PDAC)
- Body and tail
- Ampulla
- Islets (pancreatic NET)
- Intrahepatic ducts
- Perihilar (Klatskin)
- Distal bile duct
- GallbladderBiliary (pancreatobiliary) type gallbladder adenocarcinoma, the commonest · Intestinal-type gallbladder adenocarcinoma · Mucinous gallbladder adenocarcinoma (own page) · Papillary gallbladder carcinoma (own page)
- peripancreatic
- hepatic hilar
- coeliac and superior mesenteric
Same organ: Pancreatic ductal adenocarcinoma, Biliary tract cancer (cholangiocarcinoma), Intrahepatic cholangiocarcinoma, Extrahepatic cholangiocarcinoma (perihilar and distal), Biliary tract cancer (all types), Neuroendocrine tumours, Pancreatic neuroendocrine tumours, Grade 3 well-differentiated neuroendocrine tumour, Extrapulmonary neuroendocrine carcinoma, Gallbladder cancer, Papillary carcinoma of the gallbladder, Mucinous carcinoma of the gallbladder, Adenosquamous and squamous carcinoma of the gallbladder, Neuroendocrine carcinoma of the gallbladder, Incidental gallbladder cancer (found after cholecystectomy), Carcinoma in situ and dysplasia of the gallbladder, Cystic duct carcinoma, Ampullary cancer (ampulla of Vater), Resectable pancreatic ductal adenocarcinoma, Borderline resectable pancreatic ductal adenocarcinoma, Locally advanced unresectable pancreatic ductal adenocarcinoma, Metastatic pancreatic ductal adenocarcinoma, KRAS G12C-mutant pancreatic ductal adenocarcinoma, KRAS wild-type pancreatic ductal adenocarcinoma, BRCA or PALB2-mutant pancreatic ductal adenocarcinoma, Mismatch repair deficient (MSI-high) pancreatic ductal adenocarcinoma, Pancreatic acinar cell carcinoma, Intraductal papillary mucinous neoplasm and other pancreatic cystic precursors, Pancreatoblastoma
About 90 percent of gallbladder cancers (Cancer Research UK); 96.7 percent of gallbladder neoplasms recorded in the US National Cancer Database in 2011 to 2020 were adenocarcinomas when compared with neuroendocrine carcinomas (Louis 2025).
Cases by country
No country-level case numbers. This cancer is not mapped to a GLOBOCAN site.
One section per setting: the options named, what each is for, the trials behind them, the recorded trade-offs and the questions to ask.
Simple cholecystectomy for Tis and T1a; radical cholecystectomy with liver bed and portal lymphadenectomy from T1b; adjuvant capecitabine (BILCAP).
Gemcitabine and cisplatin with durvalumab or pembrolizumab; zanidatamab for HER2-positive disease after chemotherapy.
Subtypes & biomarkers
top- Biliary (pancreatobiliary) type gallbladder adenocarcinoma, the commonest
- Intestinal-type gallbladder adenocarcinoma
- Mucinous gallbladder adenocarcinoma (own page)
- Papillary gallbladder carcinoma (own page)
- Signet-ring, clear cell and hepatoid variants (rare)
- Grade 1 to 3
- T category and T2a or T2b side
- Node number (N1 one to three, N2 four or more)
- Cystic duct margin
- HER2, mismatch repair, BRAF V600E and NTRK on the molecular page
How often this target appears
Dated changes read from the records linked to this cancer: approvals, regulatory steps, reported trials, guideline versions and milestones. Newest first; no date is inferred.
On EdgeAll 4 changes by month →What is in development for Gallbladder adenocarcinoma, drawn from the whole corpus: 0 items. Drugs are grouped by the most advanced trial phase they have reached anywhere; approved treatments sit under standard of care. Technologies are the methods being tested for this cancer, trials are the studies recorded here, and ideas are proposals not yet in a trial.
Nothing recorded in development for this cancer yet.
Open problems and what is being done
Trials
topTrials recruiting now
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
Landmark trials
Expert centres
topExpert centres
Baltimore · cancer center | United States | 0 | 2,962 | 42,161 | #10 | ||
Cambridge · hospital | United Kingdom | none recorded | 1 | not matched | - | - | |
London · consortium | United Kingdom | none recorded | 1 | not matched | - | none recorded | - |
Plymouth · hospital | United Kingdom | none recorded | 1 | not matched | - | - | |
Rozzano (Milan) · hospital | Italy | none recorded | 0 | 1,031 | 10,720 | - | |
Madrid · hospital | Spain | none recorded | 0 | 765 | 13,961 | - | |
Lausanne · hospital | Switzerland | none recorded | 0 | 509 | 9,176 | - | |
Brussels · cancer center | Belgium | none recorded | 0 | 489 | 8,689 | - | |
Philadelphia, PA · consortium | United States | none recorded | 0 | 165 | 1,237 | - | |
Neu-Isenburg · consortium | Germany | none recorded | 0 | 94 | 1,947 | none recorded | - |
Chicago, IL · consortium | United States | none recorded | 0 | 42 | 482 | - |
These are the things we can measure; they are not a ranking of quality. Each column is a field on the institution record or a count over what OnCo has linked; a centre that treats many patients with Gallbladder adenocarcinoma but is thinly recorded here will look small.
Not known: OnCo holds no case-volume or outcome figures for centres, so none are shown. Where a national audit or registry publishes them, the centre's page links to it. Default order: Newsweek rank, then trials for this cancer, then research output.
Questions to ask
topQuestions to ask your oncologist about Gallbladder adenocarcinoma
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Why: Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Grade 1 to 3, T category and T2a or T2b side, Node number, Cystic duct margin, HER2, mismatch repair, BRAF V600E and NTRK on the molecular page), and what were the results?Why: These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Why: Recognised subtypes for this cancer include Biliarytype gallbladder adenocarcinoma, the commonest, Intestinal-type gallbladder adenocarcinoma, Mucinous gallbladder adenocarcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Why: Inherited variants can change treatment and matter for relatives.
Resectable disease
- For my situation (resectable disease), which of the standard options do you recommend and why?Why: Guideline options include: Simple cholecystectomy for Tis and T1a; radical cholecystectomy with liver bed and portal lymphadenectomy from T1b; adjuvant capecitabine (BILCAP).
- Am I a candidate for Capecitabine, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of BILCAP apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Advanced disease
- For my situation (advanced disease), which of the standard options do you recommend and why?Why: Guideline options include: Gemcitabine and cisplatin with durvalumab or pembrolizumab; zanidatamab for HER2-positive disease after chemotherapy.
- Am I a candidate for Gemcitabine + cisplatin, Durvalumab, Pembrolizumab or related drugs, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Why: Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Why: Supportive care improves quality of life and helps patients complete treatment.
Newly diagnosed? Read the first 60 days with Gallbladder adenocarcinoma, then print the one-page appointment sheet with room for the answers.
Print this page for your appointment (your browser's print command). These prompts are for discussion; your clinical team knows your case.
Direct links plus the targets, companies, and technologies of this cancer's products.
technologies
4targets
3drugs
5companies
6terms
6trials
3Latest papers
topQuery for this cancer: (TITLE:"Gallbladder adenocarcinoma" OR ABSTRACT:"Gallbladder adenocarcinoma" OR TITLE:"Adenocarcinoma of the gallbladder" OR ABSTRACT:"Adenocarcinoma of the gallbladder" OR TITLE:"Non-papillary adenocarcinoma of the gallbladder" OR ABSTRACT:"Non-papillary adenocarcinoma of the gallbladder" OR TITLE:"Pancreatobiliary-type gallbladder adenocarcinoma" OR ABSTRACT:"Pancreatobiliary-type gallbladder adenocarcinoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Gallbladder adenocarcinoma, not a curated reading list.
Similar pages
not linked directly; found by shared links- CancerCystic duct carcinoma
Shares Cystic duct margin, Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gemcitabine + cisplatin and the tags gallbladder, biliary, subtype-page.
- TermRokitansky-Aschoff sinus
Shares Mucinous carcinoma of the gallbladder, Carcinoma in situ and dysplasia of the gallbladder, Gallbladder cancer and the tags gallbladder, biliary.
- TermGallbladder polyp (polypoid lesion)
Shares Papillary carcinoma of the gallbladder, Carcinoma in situ and dysplasia of the gallbladder, Gallbladder cancer and the tags gallbladder, biliary.
- TermPort-site metastasis
Shares Incidental gallbladder cancer (found after cholecystectomy), Radical (extended) cholecystectomy, Gallbladder cancer and the tags gallbladder, biliary.
- TermAnomalous pancreaticobiliary junction (pancreaticobiliary maljunction)
Shares Biliary tract cancer (cholangiocarcinoma), Gallbladder cancer and the tags gallbladder, biliary.
- TermPorcelain gallbladder
Shares Gallbladder cancer and the tags gallbladder, biliary.
- RoadmapGallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials
Shares KEYNOTE-966, TOPAZ-1, BILCAP, Incidental gallbladder cancer (found after cholecystectomy) and the tags gallbladder, biliary.
- TechnologySurgery for gallbladder cancer: simple versus radical cholecystectomy, re-resection and lymphadenectomy
Shares T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side), Segment IVb and V liver resection (versus wedge resection), Simple cholecystectomy, Cystic duct margin.