Appointment sheet
Gallbladder cancer
Prepared with OnCo (onco.cc/prep/gallbladder/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
17 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example T stage on cholecystectomy pathology, HER2 IHC/ISH, MSI / mismatch repair, BRAF V600E, NTRK fusions), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Incidental cancer at cholecystectomy, T1b or deeper
- 5.For my situation (incidental cancer at cholecystectomy, t1b or deeper), which of the standard options do you recommend and why?
After resection
- 6.For my situation (after resection), which of the standard options do you recommend and why?
- 7.How do the results of BILCAP apply to someone like me?
Unresectable or metastatic, first line
- 8.For my situation (unresectable or metastatic, first line), which of the standard options do you recommend and why?
- 9.Am I a candidate for Gemcitabine + cisplatin, Durvalumab, Pembrolizumab, and what side effects should I expect?
- 10.How do the results of TOPAZ-1 and KEYNOTE-966 apply to someone like me?
Second line and biomarker-directed
- 11.For my situation (second line and biomarker-directed), which of the standard options do you recommend and why?
- 12.Am I a candidate for FOLFOX (5-FU, leucovorin, oxaliplatin), Zanidatamab, Dabrafenib + trametinib or related drugs, and what side effects should I expect?
Any stage
- 13.Are there clinical trials I could join, for example of Zanidatamab, HERIZON-BTC-302, Trastuzumab deruxtecan, Gemcitabine-cisplatin + PD-(L)1 blockade in biliary cancer?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “Most patients present too late for surgery; ultrasound-based surveillance in high-incidence regions and cholecystectomy policies are being evaluated”. How does that affect my plan?
- 17.I read that “Gallbladder cancer is under-represented and rarely analysed separately in biliary trials; HERIZON-BTC-302 and registry efforts are starting to report it as its own disease”. How does that affect my plan?
The words I may hear
- Intrahepatic, perihilar, distal and gallbladder cancer: Bile duct cancers are named by where they start: inside the liver, at the hilum where the ducts join, in the lower duct near the pancreas, or in the gallbladder.
- Lymphadenectomy (lymph node dissection): Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.
- Hepatectomy (liver resection): Cutting out the part of the liver containing tumour.
- CA 19-9: A sugar molecule shed into the blood by most pancreatic cancers; useful to follow treatment, not to screen.
- Obstructive jaundice and biliary obstruction: Yellowing of the skin and eyes because a tumour blocks the bile duct, most often pancreatic or bile duct cancer.
Tests and results to bring
Biomarker results to ask for: T stage on cholecystectomy pathology (T1a vs T1b or deeper decides re-resection), HER2 IHC/ISH (about one in six), MSI / mismatch repair, BRAF V600E, NTRK fusions, CA 19-9 (monitoring, not diagnosis), Cystic duct margin status.
Scans and tests linked to this cancer: Comprehensive genomic profiling.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Unresectable or metastatic, first line: Gemcitabine-cisplatin plus durvalumab (TOPAZ-1) or pembrolizumab (KEYNOTE-966), with molecular profiling at diagnosis. (Gemcitabine + cisplatin, Durvalumab, Pembrolizumab, TOPAZ-1, KEYNOTE-966, Gemcitabine-cisplatin + PD-(L)1 blockade in biliary cancer)
- Incidental cancer at cholecystectomy, T1b or deeper: Re-resection: liver bed (segments IVb/V) with portal lymphadenectomy, and bile duct excision if the cystic duct margin is positive; port sites are no longer routinely excised. (Hepatectomy (liver resection), Lymphadenectomy (lymph node dissection))
- After resection: Adjuvant capecitabine for six months (BILCAP; ASCO guideline 2019); chemoradiation considered for positive margins or node-positive disease. (BILCAP)
- Second line and biomarker-directed: FOLFOX (ABC-06); zanidatamab for HER2-positive disease after prior therapy (HERIZON-BTC-01); tumour-agnostic options for MSI-high (pembrolizumab), BRAF V600E (dabrafenib-trametinib) and NTRK fusions (larotrectinib, entrectinib). (FOLFOX (5-FU, leucovorin, oxaliplatin), Zanidatamab, HER2, Dabrafenib + trametinib, Larotrectinib, Entrectinib)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call