Gallbladder cancer in the UK and the NHS
Around 1,300 people a year are diagnosed with gallbladder cancer in the UK, most of them women and most over 75. Half are diagnosed as emergencies. This page follows the NHS route from suspicion to treatment, names the specialist hepatobiliary centres, lists what the NHS funds today with the NICE and SMC decisions behind it, the genomic tests to ask for, the trials open in the UK, and where England, Scotland, Wales and Northern Ireland differ.
Your pathway in the NHS
How the cancer usually comes to light, then the national standards that time each step. The standards are England's unless the four-nations section says otherwise.
Many gallbladder cancers are found when the gallbladder is removed for stones and the pathologist finds a tumour, or on a scan done for another reason. The pathology report's T stage then decides whether a second, wider operation is offered; that decision belongs to a specialist HPB team, not the local surgical unit.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma (Gut 2023;73:16-46) (2023-12-07)
NICE NG12 tells GPs to consider an urgent direct-access ultrasound scan for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder (recommendation 1.2.10), and to refer anyone aged 40 and over with jaundice on a suspected cancer pathway (1.2.4). In England 17 percent of gallbladder cancers diagnosed in 2019 came through an urgent suspected cancer referral.
Sources: NICE NG12: suspected cancer, recommendations by site (gall bladder cancer 1.2.10; jaundice 1.2.4) (2015); Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Half of gallbladder cancers in England (2019) were diagnosed after an emergency presentation, typically jaundice, pain or a blocked bile duct needing a stent. The emergency team should hand the case to the specialist HPB MDT before any treatment decision.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24); NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 1Day 0: referralUrgent suspected cancer referral or direct-access scan
The clock starts when the GP refers on the suspected cancer pathway, a screening or other route flags cancer, or (in Wales) at the point of suspicion. From 1 October 2023 England no longer measures the old two-week wait to first appointment; the 28-day Faster Diagnosis Standard replaced it.
Sources: NICE NG12: suspected cancer, recommendations by site (gall bladder cancer 1.2.10; jaundice 1.2.4) (2015); NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01)
- 228 days: diagnosis or all-clearFaster Diagnosis Standard: told you have cancer, or that you do not, within 28 daysTarget 75%, rising to 80% by March 2026
NHS England's Faster Diagnosis Standard applies to urgent suspected cancer, breast symptomatic and screening referrals. For HPB cancers NHS England's timed pathway asks teams to complete the diagnostic process within 21 days where possible, because these cancers are aggressive.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: implementing a timed HPB cancer diagnostic pathway
- 3Specialist HPB MDTEvery case discussed at the weekly specialist multidisciplinary team meeting
The specialist HPB MDT (Level 3 in NHS England's model) takes every treatment decision for gallbladder cancer, including incidental cancers found after cholecystectomy and recurrences, with surgery and oncology present. It must preserve tissue for molecular profiling and consider trial recruitment for every patient.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 431 days: decision to first treatmentTreatment starts within 31 days of the decision to treatTarget 96%
Applies to first and subsequent treatments: surgery, chemotherapy with immunotherapy, radiotherapy or a stent as definitive palliation.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01)
- 562 days: referral to first treatmentFirst treatment within 62 days of the urgent referralTarget 85% (planning target 75% by March 2026)
The headline standard for the whole route. Monthly trust-level performance is published by NHS England; HPB pathways often run long because tissue diagnosis needs an endoscopy or biopsy and surgery needs fitness assessment.
Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); NHS England: cancer waiting times statistics
- 6TreatmentSurgery at the HPB centre; drug treatment locally under the centre's MDT
Curative surgery (re-resection of the liver bed and lymph nodes after an incidental finding, or a planned radical cholecystectomy) is done only at the specialist centre. Chemotherapy and immunotherapy may be given at a local cancer unit, but the specialist MDT keeps the decision and receives the outcome.
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09)
- 7Molecular profilingNational Genomic Test Directory tests through the Genomic Laboratory Hub
At diagnosis of advanced disease the team should request the biliary panel (FGFR2 and NTRK fusions, IDH1, mismatch repair or MSI) and HER2 testing, so that a second-line option is known before it is needed.
Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); NHS England: National Genomic Test Directory
Where you would be treated
24 specialist centre entries across 4 nations. Surgery happens only at these centres; chemotherapy and immunotherapy may be given closer to home under the centre's MDT.
- HPB and liver surgery
- Sheila Sherlock Liver Centre
- ABC and SAFIR-ABC10 trial site
- HPB surgery
- Liver transplantation
- Specialist HPB MDT
- HPB surgery
- Liver unit
- Biliary trials
- Medical pancreato-biliary service and surgical outpatients (HPB surgery moved to the Royal Free)
- SAFIR-ABC10 UK sponsor
- Zanidatamab early access study
- HPB surgery
- Liver transplantation
- Biliary trials
- HPB surgery
- Liver unit and transplantation
- Biliary trials
- HPB and transplant surgery
- ATTR-01 trial site
- HPB surgery
- Liver transplantation
- HPB surgery
- Oncology and the ABC trials at The Christie
- HPB and liver surgery for Merseyside, Cheshire, North Wales and the Isle of Man
- Oncology at Clatterbridge
- HPB surgery
- BILCAP lead centre
- HPB surgery
- ATTR-01 and biliary microbiome study site
- HPB surgery for Nottingham, Mansfield, Lincolnshire and Derby
- HPB surgery
- BILCAP site
- HPB surgery (Northern General and Royal Hallamshire)
- Oncology at Weston Park
- HPB surgery
- Oncology at the Bristol Haematology and Oncology Centre
- HPB surgery for Devon, Cornwall and the Isles of Scilly
- Trusts the National Pancreatic Cancer Audit lists as HPB specialist centres; ask which one your Cancer Alliance refers gallbladder cancer to
- HPB surgery for the West of Scotland
- Oncology at the Beatson
- HPB surgery for South East Scotland
- Liver transplantation
- Oncology at the Western General
- Surgical centres for NHS Scotland North, serving Grampian, Tayside, Highland, Orkney, Shetland and the Western Isles
- HPB surgery for South Wales
- Oncology at Singleton and Velindre
- Liver surgery
- Oncology at Velindre
- Northern Ireland's HPB surgical service
- Systemic treatment at the Northern Ireland Cancer Centre
In England, surgery for gallbladder cancer is a specialised service commissioned by NHS England under service specification 2260 (September 2024). A specialist HPB cancer service must serve a catchment of at least two million people and perform at least 150 liver operations a year for cancer (75 of them major), hold a weekly specialist MDT with surgery and oncology present, take every treatment decision including for incidental cancers found at cholecystectomy, preserve tissue for molecular profiling and build trial recruitment into its work. Local hospitals (Levels 1 and 2) do the first scans and give palliative care under the centre's guidance. The English trust list comes from the National Pancreatic Cancer Audit's HPB specialist centre table, which also covers pancreatic and periampullary cancer; gallbladder surgery sits with the same HPB teams in most trusts, so confirm with your Cancer Alliance which centre takes your referral. Scotland, Wales and Northern Ireland run their own networks (listed above from Pancreatic Cancer UK and AMMF).
Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); NHS England: service specification, HPB liver, biliary tract and gallbladder cancers (2024-09); National Pancreatic Cancer Audit 2025, methodology supplement, Table 7: trust codes for HPB specialist centres (2025-11); Pancreatic Cancer UK: your local specialist centre (covers pancreatic, liver, gallbladder and bile duct cancers) (2025-11); AMMF: UK centres with cholangiocarcinoma expertise (2023-03)
What the NHS funds today
By line of treatment: England's NICE decision (which binds Wales and is adopted in Northern Ireland) and Scotland's SMC decision, each with its reference and date. Generic medicines were never appraised and are funded through national chemotherapy protocols.
| Line | Treatment | England (NICE) | Scotland (SMC) | Wales and Northern Ireland |
|---|---|---|---|---|
| After surgery (adjuvant) | Capecitabine for six months (BILCAP) BILCAP was a UK trial; capecitabine is the only adjuvant treatment with a randomised trial behind it. | NHS England Routinely available: a generic medicine never appraised by NICE, given under national SACT protocols; the BSG guideline recommends it | SMC Not appraised (generic); used under regional protocols | Wales: As England. NI: As England. |
| Advanced, first line | Gemcitabine and cisplatin with durvalumab (TOPAZ-1) | SMC SMC25822023-11-13 Accepted for use within NHSScotland (end of life and orphan equivalent process) | Wales: Follows NICE TA944. NI: Follows NICE TA944. | |
| Advanced, first line (alternative) | Gemcitabine and cisplatin with pembrolizumab (KEYNOTE-966) Durvalumab is the funded immunotherapy partner across the UK. | NICE TA9662024-04-24 Not available: appraisal terminated because Merck Sharp and Dohme made no evidence submission | Wales: Not available (no NICE recommendation). NI: Not available. | |
| Advanced, second line (no target) | FOLFOX (oxaliplatin, fluorouracil, folinic acid) after gemcitabine-cisplatin (ABC-06) | NHS England Routinely available: generic medicines under national SACT protocols; the ABC-06 trial was UK-run | SMC Not appraised (generics); used under regional protocols | Wales: As England. NI: As England. |
| Second line, FGFR2 fusion or rearrangement | Pemigatinib The licence and the NICE wording say cholangiocarcinoma; FGFR2 fusions are found mainly in intrahepatic cholangiocarcinoma and are uncommon in gallbladder cancer. Ask the MDT how a gallbladder tumour with an FGFR2 fusion would be handled. | NICE TA7222021-08-25 Recommended within its marketing authorisation for cholangiocarcinoma after systemic therapy, with a commercial arrangement (routine commissioning, not the Cancer Drugs Fund) | Wales: Follows NICE TA722. NI: Follows NICE TA722. | |
| Second line, FGFR2 fusion or rearrangement (alternative) | Futibatinib | NICE TA10052024-09-11 Recommended for previously treated advanced cholangiocarcinoma with an FGFR2 fusion or rearrangement, with a commercial arrangement | Wales: Follows NICE TA1005. NI: Follows NICE TA1005. | |
| Second line, IDH1 R132 mutation | Ivosidenib IDH1 mutations are also concentrated in intrahepatic cholangiocarcinoma. | NICE TA9482024-01-31 Recommended for advanced cholangiocarcinoma with an IDH1 R132 mutation after one or more systemic treatments, with a commercial arrangement | Wales: Follows NICE TA948. NI: Follows NICE TA948. | |
| Second line, HER2-positive (IHC 3+) | Zanidatamab (HERIZON-BTC-01) The most relevant targeted option for gallbladder cancer, where HER2 over-expression is commoner than in the bile ducts. Needs HER2 immunohistochemistry on the tumour. | NICE TA11532026-05-07 Recommended for HER2-positive (IHC 3+) unresectable or metastatic biliary tract cancer after at least one line of systemic treatment, with a commercial arrangement | SMC Under consideration: full submission listed, publication date to be confirmed | Wales: Follows NICE TA1153. NI: Follows NICE TA1153. |
| Any line, MSI-high or mismatch repair deficient | Pembrolizumab alone after prior therapy | NICE TA9142023-09-20 Recommended for unresectable or metastatic biliary cancer with high MSI or MMR deficiency that has progressed after at least one prior therapy | SMC SMC25892024-01-15 Accepted for use within NHSScotland for MSI-H or dMMR biliary cancer after at least one prior therapy | Wales: Follows NICE TA914. NI: Follows NICE TA914. |
| Any line, NTRK fusion | Entrectinib or larotrectinib (tumour-agnostic) NTRK fusions are rare in any biliary cancer; the test is bundled with the FGFR2 panel. | NICE TA630 and TA644 · CDF2020 Recommended through the Cancer Drugs Fund for NTRK fusion-positive solid tumours when there are no satisfactory treatment options (larotrectinib TA630, entrectinib TA644) | SMC Larotrectinib accepted; check the SMC for entrectinib | Wales: Follows NICE. NI: Follows NICE. |
NICE has published six technology appraisals on biliary tract cancer medicines and terminated one; the topic page lists them all. A NICE recommendation binds NHS England and NHS Wales to fund the medicine within 90 days for the appraised indication; Northern Ireland adopts NICE appraisals through its Department of Health; Scotland decides separately through the Scottish Medicines Consortium. Several of the licences say cholangiocarcinoma rather than gallbladder cancer, so eligibility for a gallbladder tumour with the same mutation is a question for the MDT. The Cancer Drugs Fund list on NHS England's site records which medicines sit in managed access; OnCo could not read that page automatically on the check date, so verify there.
Sources: NICE: all guidance on biliary tract cancers (2026-09-24); NHS England: national Cancer Drugs Fund list; Scottish Medicines Consortium: medicines advice, cholangiocarcinoma (2026-09-24)
The NHS position of every approved product is on the NHS coverage page; the same decisions by country are on HTA decisions.
Tests you can ask for
National Genomic Test Directory entries with their codes, what a result opens, and how the request is made. Ask at diagnosis of advanced disease, not at progression.
| Target | Code | Test | What a positive result opens | How to get it |
|---|---|---|---|---|
| FGFR2 fusion or rearrangement | M220.1 | Multi-target NGS panel for structural variants (NTRK1, NTRK2, NTRK3, FGFR2) on formalin-fixed tumour | Pemigatinib (TA722, SMC2399) or futibatinib (TA1005, SMC2661) after first-line treatment | Your oncologist or the MDT requests it through the regional Genomic Laboratory Hub using the Test Directory code; an existing biopsy or surgical specimen is usually enough. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); NHS England: National Genomic Test Directory |
| NTRK1, NTRK2, NTRK3 fusions | M220.1 | Same structural-variant panel as FGFR2 | Entrectinib or larotrectinib (TA644, TA630, Cancer Drugs Fund) | Comes with the FGFR2 request; no separate sample. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| IDH1 R132 mutation | M220.6 | Multi-target NGS panel for small variants including IDH1 | Ivosidenib (TA948, SMC2664) after one or more systemic treatments | Requested alongside M220.1; the GeNotes page notes the result can also aid diagnosis. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| Mismatch repair deficiency or MSI-high | M220.5 | Microsatellite instability testing (or mismatch repair immunohistochemistry in pathology) | Pembrolizumab alone (TA914, SMC2589); a positive result also prompts a Lynch syndrome conversation | Mismatch repair IHC is done by the pathology lab; MSI testing (M220.5) where IHC is not done. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| HER2 (ERBB2) over-expression | pathology | HER2 immunohistochemistry, with in-situ hybridisation for equivocal results, on the tumour block | Zanidatamab for IHC 3+ disease after one line (TA1153) | Not a Test Directory code: ask the MDT to request HER2 IHC from histopathology, as for breast or stomach cancer. NICE TA1153 (May 2026) makes this the test most likely to change a gallbladder cancer plan. Sources: NICE TA1153: zanidatamab (2026-05-07) |
| Whole genome sequencing | M232 | Whole genome sequencing of tumour and blood for any solid tumour once standard-of-care testing and treatment are exhausted | Trial matching, for example SAFIR-ABC10, and rare targets | Needs fresh-frozen tumour and a blood sample, so it is best planned before surgery or biopsy; a record of discussion form is required. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
| DPYD variants (before capecitabine or fluorouracil) | M220.3 | Germline DPYD hotspot test on a blood sample | Dose adjustment or avoidance of fluoropyrimidines (capecitabine after surgery, FOLFOX second line) to prevent severe toxicity | Requested before the first dose; no record of discussion form needed. Sources: NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24) |
In England the National Genomic Test Directory sets which tests the NHS funds and the seven Genomic Laboratory Hubs run them; the codes above are those GeNotes lists for cholangiocarcinoma, reviewed 24 February 2025. Scotland requests through its four regional laboratories and the Scottish Genomic Test Directory; Wales through the All Wales Medical Genomics Service; Northern Ireland through the Regional Molecular Diagnostics Service in Belfast. Turnaround times are set by each laboratory and are not published here.
Sources: NHS England: National Genomic Test Directory; NHS Genomics Education Programme, GeNotes: patient with biliary tract cancer (reviewed 24 February 2025) (2025-02-24); GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06)
Match a report to targets and drugs on the biomarker matrix.
Trials open in the UK
Registered trials with UK sites, from the ISRCTN registry and the sponsors' pages, with the setting each is for. Eligibility is decided by the trial team.
Patients are profiled and offered one of seven targeted therapies matched to the result; about 800 participants worldwide.
Registry or sponsor page →Early-phase; eligibility is by tumour type and prior treatment.
Registry or sponsor page →ISRCTN is the UK registry; searches for gallbladder, biliary tract cancer and cholangiocarcinoma were run through its public API on the check date. Trials registered only on ClinicalTrials.gov with UK sites appear on the trial records linked from the cancer page. The NIHR's Be Part of Research site lets you search by condition and postcode and register interest; it could not be read automatically here, so open it directly.
Sources: ISRCTN registry search: gallbladder; NIHR Be Part of Research: gallbladder cancer
Run through the National Cancer Research Network and led from Manchester and London, ABC-02 randomised 410 people with advanced biliary tract cancer, including gallbladder cancer, to gemcitabine alone or gemcitabine with cisplatin. The combination lengthened survival and became the first-line standard everywhere; TOPAZ-1 and KEYNOTE-966 later added immunotherapy on top of it rather than replacing it.
Sources: Valle et al, Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer (ABC-02), NEJM 2010 (2010-04-08); ISRCTN82956140: ABC-02
Led from Southampton, BILCAP randomised 447 people who had had their biliary cancer removed to capecitabine tablets for six months or observation. Median survival was longer with capecitabine in the pre-specified analysis, and the trial made adjuvant capecitabine the standard offered after gallbladder cancer surgery in the UK and in international guidelines.
Sources: Primrose et al, Capecitabine compared with observation in resected biliary tract cancer (BILCAP), Lancet Oncology 2019 (2019-05); ISRCTN72785446: BILCAP
ABC-06 was the first randomised trial of second-line treatment in biliary cancer. It compared FOLFOX plus active symptom control with active symptom control alone after gemcitabine-cisplatin, and showed a modest but real survival gain, which is why FOLFOX is the NHS's default second-line chemotherapy when no targetable change is found.
Sources: Lamarca et al, second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06), Lancet Oncology 2021 (2021-05)
UK data
Each figure with its nation, period and the page it was read from. Survival figures are population averages and sit behind the usual disclosure.
Around 900 in women and 380 in men; less than 1 percent of all cancers.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Rates peak at ages 85 to 89 (13 percent of cases).
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
Up by a third in the last decade; projected to rise a further 43 percent by 2038-2040, to about 3,100 cases a year.
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
About 15 cases a year. Wales does not report stage for gallbladder cancer because numbers are small; an England stage split was not published on the pages read.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
22 percent had systemic anti-cancer therapy and 2 percent radiotherapy.
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Show survival figures (2)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 11.8% five-year survival (England, diagnosed 2016-2020).
- 18.2 percent for people aged 15 to 54 against 6.7 percent for those aged 75 to 99. Population averages, not a personal prognosis.
Sources: Cancer Research UK: gallbladder cancer survival (2026-09-24)
Show survival figures (1)
Averages across everyone diagnosed, often years ago. Your stage, subtype, age, fitness and the treatment you receive matter more than the average, and the numbers are improving quickly.
- 15% ten-year survival (England, diagnosed 2009-2013).
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Sources: Cancer Research UK: gallbladder cancer statistics (2026-09-24)
Sources: Cancer Research UK: gallbladder cancer incidence (2026-09-24)
Support in the UK
Charities with a biliary focus, the general cancer charities, and the official schemes that help with costs. Each link goes to the organisation's own page.
- Information on biliary cancers, treatments, molecular profiling and trials
- List of UK centres with expertise
- Patient discussion groups and webinars
- Research grants and an annual conference
- Support line and online community
- Macmillan nurses in many HPB teams
- Grants and benefits advice
- Drop-in centres beside major cancer hospitals
- Benefits advice, psychological support and courses, free
- Nurse helpline and Cancer Chat forum
- Plain-English information on gallbladder cancer
- The UK statistics quoted on this page
- People with cancer in England qualify for a medical exemption certificate covering all prescriptions
- Help with fares to hospital for people on qualifying benefits or low income; matters when the HPB centre is far from home
- Non-means-tested payment for people under State Pension age whose illness or treatment affects daily living or mobility; special rules give a fast decision for terminal illness (SR1 form)
- Scotland has Adult Disability Payment instead
- For people over State Pension age who need help with personal care; special rules for terminal illness
- One-off payments for costs such as heating, travel or clothing; a nurse or social worker applies with you
More schemes by country on Assistance; costs of care on Costs.
Across the four nations
Where England, Scotland, Wales and Northern Ireland run different rules for the same step.
| Topic | England | Scotland | Wales | Northern Ireland |
|---|---|---|---|---|
| Waiting-time standards Sources: NHS England: changes to cancer waiting times standards from 1 October 2023 (2023-10-01); NHS England: 2025/26 priorities and operational planning guidance (2025-01); Public Health Scotland: cancer waiting times, 1 January to 31 March 2026 (2026); Welsh Government: suspected cancer pathway quality report; NHS Wales Performance and Improvement: Suspected Cancer Pathway; Department of Health (Northern Ireland): cancer waiting times; Department of Health (Northern Ireland): cancer waiting time statistics, January to March 2026 (2026) | 28-day Faster Diagnosis Standard (75%, 80% by March 2026); 31 days from decision to treat (96%); 62 days from referral to first treatment (85%, planning target 75% by March 2026). | 62 days from urgent suspicion of cancer referral to first treatment and 31 days from decision to treat, both set at 95%; 72.2% met the 62-day standard in January to March 2026. | Single Suspected Cancer Pathway: 62 days from the point of suspicion to first definitive treatment, target 75% (the clock starts at suspicion, not referral). | 31 days from decision to treat (98%) and 62 days from urgent GP referral (95%); performance is published quarterly by the Department of Health. |
| Who decides drug funding Sources: NICE: all guidance on biliary tract cancers (2026-09-24); Scottish Medicines Consortium: medicines advice, cholangiocarcinoma (2026-09-24) | NICE technology appraisals; the Cancer Drugs Fund for managed access; NHS England commissions. | Scottish Medicines Consortium; all five biliary medicines it has assessed are accepted (pemigatinib, durvalumab, ivosidenib, futibatinib, pembrolizumab for MSI-high); zanidatamab pending. | Follows NICE appraisals; the All Wales Medicines Strategy Group appraises medicines NICE has not. | The Department of Health endorses NICE appraisals for the HSC. |
| Genomic testing route Sources: NHS England: National Genomic Test Directory; GeNotes: genomic testing in the devolved nations (reviewed 6 August 2026) (2026-08-06) | National Genomic Test Directory, seven Genomic Laboratory Hubs (codes M220.1, M220.5, M220.6, M232). | Scottish Genomic Test Directory; four regional laboratories in Aberdeen, Dundee, Edinburgh and Glasgow. | All Wales Medical Genomics Service. | Northern Ireland Regional Molecular Diagnostics Service, Belfast. |
| Where surgery happens Sources: NHS England service specification 2260: HPB, primary liver, secondary liver, perihilar biliary tract and gallbladder cancers (September 2024) (2024-09); Pancreatic Cancer UK: your local specialist centre (covers pancreatic, liver, gallbladder and bile duct cancers) (2025-11) | Specialised HPB cancer centres commissioned by NHS England under specification 2260 (catchment of at least two million; 150 liver operations a year). | Regional networks: Glasgow Royal Infirmary (West), Royal Infirmary of Edinburgh (South East), Aberdeen, Dundee and Inverness (North). | Morriston Hospital, Swansea for South Wales; North Wales patients go to Liverpool; some mid-Wales patients to Stoke-on-Trent. | One HPB service in the Belfast Trust. |
| Cancer statistics Sources: NDRS: Cancer Registration Statistics, England 2023; Cancer Research UK: gallbladder cancer statistics (2026-09-24) | National Disease Registration Service (NDRS): Cancer Registration Statistics, England. | Public Health Scotland cancer incidence publications. | Welsh Cancer Intelligence and Surveillance Unit; stage for gallbladder cancer is not reported because numbers are small. | Northern Ireland Cancer Registry (Queen's University Belfast); reports stage for gallbladder cancer. |
What could not be sourced
Named gaps, so a missing figure is never mistaken for a zero.
- NDRS Cancer Registration Statistics, England 2023 could not be read automatically (the pages return 403 to scripts), so the England-only count for ICD-10 C23 in 2023 is not quoted; the UK figures above come from Cancer Research UK, which builds on the four registries.
- No England stage-at-diagnosis split for gallbladder cancer was found on the pages read; Cancer Research UK publishes one for Northern Ireland only.
- Scotland- and Wales-specific gallbladder incidence counts were not sourced; Public Health Scotland and WCISU publications group small sites.
- Turnaround times for Test Directory tests are set by each Genomic Laboratory Hub and are not published centrally.
- The NHS England Cancer Drugs Fund list and the cancer waiting times pages block automated reading; the standards are quoted from NHS England's published explanations found through search, and the CDF status should be checked on the list itself.
- GIRFT has no gallbladder or biliary report; its pancreatic cancer national report (November 2025) is the nearest HPB review.
- Be Part of Research is rendered in the browser and could not be searched automatically; ISRCTN was searched through its API.
- The Scottish Medicines Consortium has not yet published on zanidatamab; the submission is listed as under consideration.
- Prescription charge rules in Scotland, Wales and Northern Ireland were not sourced on the check date, so only the England exemption certificate is stated.