The first 60 days: Carcinoma in situ and dysplasia of the gallbladder
Dysplasia means the cells lining the gallbladder have become abnormal but have not invaded; carcinoma in situ (stage 0) is the most abnormal form, with cancer cells still confined to the lining. Both are found by the pathologist after a gallbladder is removed and are cured by that removal when the margin is clear. Cancer Research UK notes some doctors do not regard stage 0 as a true cancer. Below, week by week, is what OnCo's record of Carcinoma in situ and dysplasia of the gallbladder 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.
- RadiologistNamed in the standard of care for: Gallbladder polyp in primary sclerosing cholangitis.
- SurgeonNamed in the standard of care for: Tis or dysplasia with a clear cystic duct margin, Positive cystic duct margin or Rokitansky-Aschoff sinus involvement, Gallbladder polyp in primary sclerosing cholangitis.
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.
No further surgery; follow-up because occasional late recurrences reflect a field effect.
Consider bile duct margin re-excision or further surgery at a hepatobiliary centre.
Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present.
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 of dysplasia, Absence of invasion through the basement membraneversus lamina propria invasion, Cystic duct margin status, Rokitansky-Aschoff sinus involvement, Pyloric and intestinal metaplasia in the background mucosa), 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 Low-grade biliary intraepithelial neoplasiaof the gallbladder, High-grade biliary intraepithelial neoplasia, carcinoma in situ of the gallbladder, Carcinoma in situ extending into Rokitansky-Aschoff sinuses.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Tis or dysplasia with a clear cystic duct margin
- For my situation (tis or dysplasia with a clear cystic duct margin), which of the standard options do you recommend and why?Guideline options include: No further surgery; follow-up because occasional late recurrences reflect a field effect.
Positive cystic duct margin or Rokitansky-Aschoff sinus involvement
- For my situation (positive cystic duct margin or rokitansky-aschoff sinus involvement), which of the standard options do you recommend and why?Guideline options include: Consider bile duct margin re-excision or further surgery at a hepatobiliary centre.
Gallbladder polyp in primary sclerosing cholangitis
- For my situation (gallbladder polyp in primary sclerosing cholangitis), which of the standard options do you recommend and why?Guideline options include: Cholecystectomy advised for polyps of any size by international guidelines; a 2020 cohort supports short-interval imaging first when no high-risk feature is present.
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.
- Carcinoma in situ and dysplasia of the gallbladder: the full pageDysplasia means the cells lining the gallbladder have become abnormal but have not invaded; carcinoma in situ (stage 0) is the most abnormal form, with cancer cells still confined to the lining. Both are found by the pathologist after a gallbladder is removed and are cured by that removal when the margin is clear. Cancer Research UK notes some doctors do not regard stage 0 as a true cancer.
- 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.
- Gallbladder polyp (polypoid lesion): A small growth on the inside wall of the gallbladder, usually spotted by chance on an ultrasound scan.
- Rokitansky-Aschoff sinus: Tiny pouches where the gallbladder lining pushes down into the muscle wall, common in gallbladders damaged by stones and inflammation.
- Dysplasia (pre-cancerous change): Abnormal-looking cells in a surface lining that are not yet cancer but are on the way.
- 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.
- Carcinoma in situ (CIS): Cancer cells that fill the lining layer where they started but have not broken through the basement membrane into the tissue beneath.
- 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.
Every term links to the glossary.