The first 60 days: 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. Below, week by week, is what OnCo's record of Gallbladder adenocarcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Resectable disease.
- Medical oncologistNamed in the standard of care for: Resectable disease, Advanced disease.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
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.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?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?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?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?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?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?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of BILCAP apply to someone like me?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?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?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?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?Supportive care improves quality of life and helps patients complete treatment.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Gallbladder adenocarcinoma: the full pageAdenocarcinoma 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.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side): Two labels for a gallbladder cancer that has grown through the muscle layer but is still inside the gallbladder.
- Segment IVb and V liver resection (versus wedge resection): Two ways of removing the piece of liver the gallbladder sits on during a gallbladder cancer operation: a wedge of about two centimetres around the gallbladder bed, or the whole of the two anatomical liver segments (IVb and V) that touch it.
- Cystic duct margin: The cut end of the short duct that joined the gallbladder to the main bile duct, examined by the pathologist after a gallbladder is removed.
- Simple cholecystectomy: The standard operation to remove the gallbladder, almost always by keyhole surgery for gallstones.
- Radical (extended) cholecystectomy: The cancer operation for gallbladder cancer: the gallbladder (if still present) is removed together with a rim of the liver it sits against and the lymph nodes along the bile duct and liver blood vessels.
- Grade: How abnormal the cancer cells look under the microscope, from grade 1 (close to normal, slow) to grade 3 or 4 (wildly abnormal, fast).
Every term links to the glossary.