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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Gallbladder cancer starts in the small bile-storing sac under the liver and is one of the biliary tract cancers. Most cases are found late, or by chance when a gallbladder is removed for gallstones. It is rare in the UK, with about 1,300 cases a year, and much commoner in Chile, Bolivia and northern India. Found early, an operation can cure it.
The gallbladder is a pear-shaped pouch about 8 cm long under the right lobe of the liver that concentrates and stores bile; it is not essential and people digest normally without it (CRUK, what is gallbladder cancer). Cancer here is grouped with cholangiocarcinoma as biliary tract cancer, and most systemic-therapy evidence comes from mixed biliary trials, but gallbladder cancer differs in its causes (gallstones and chronic inflammation rather than liver fluke or primary sclerosing cholangitis), its geography, the way it is found (often incidentally in a cholecystectomy specimen), its staging (a separate AJCC chapter with the T2a and T2b split) and its molecular profile (HER2 alterations more often than FGFR2 fusions or IDH1 mutations). Hundal and Shaffer describe it as the commonest biliary tract cancer, 80 to 95 percent of biliary tract cancers in their review, and Roa and colleagues note that most cases are discovered incidentally after cholecystectomy for symptomatic stones.
World: the IARC gallbladder fact sheet, served today with the GLOBOCAN 2024 estimates, gives 126,384 new cases (22nd commonest cancer, age-standardised rate 1.2 per 100,000) and 92,029 deaths (20th, 0.82 per 100,000) a year, with 72.4 percent of cases in Asia, 10.0 percent in Europe, 8.8 percent in Latin America and the Caribbean and 4.3 percent in Northern America. The highest national age-standardised incidence on the sheet is Bolivia (6.7 per 100,000, both sexes; 6.0 in men) and Chile (7.6 per 100,000 in women); the highest regions are South Central Asia, South America and Eastern Asia. Earlier GLOBOCAN rounds gave lower counts, so the version matters when figures are compared. Randi and colleagues (2006) recorded the highest registry rates in women in Delhi (21.5 per 100,000), South Karachi (13.8) and Quito (12.9), high rates in Korea, Japan and parts of central and eastern Europe, and a female to male ratio of about 3. In the United States about 3,700 people a year were diagnosed in 2007 to 2011 (1.13 per 100,000) and 2,000 died (0.62 per 100,000), two thirds of them women, with rates three times higher in American Indian and Alaska Native people (Henley 2015); a 2026 meta-analysis found 3 to 3.5-fold higher incidence in Native American people nationally and 6 to 8.5-fold in the Southwest and Alaska (Kosuru 2026). SEER incidence fell by 1.65 percent a year from 1973 but has been flat since 2002 (Low 2022). In India a Tata Memorial registry of 1,950 patients (2019 to 2022) found 84.6 percent came from, or had migrated from, the Gangetic belt, and 60 percent had metastatic disease at presentation (Patkar 2025); in Pakistan a prospective series of 233 cases was 77 percent women with a mean age of 55 (Malik 2003).
| Setting | Approach | Guideline |
|---|---|---|
| Suspected cancer in primary care | Urgent direct-access ultrasound for an upper abdominal mass consistent with an enlarged gallbladder (NICE NG12 1.2.10); urgent referral for jaundice; the UK pathway page carries the detail. | not mapped |
| Diagnosis and staging | Ultrasound, contrast CT, MRI with MRCP, FDG PET-CT before radical surgery, staging laparoscopy; frozen section rather than needle biopsy when the mass is resectable. | not mapped |
| Tis or T1a found in the cholecystectomy specimen | No further surgery when the cystic duct margin is clear; the simple cholecystectomy is curative in almost all cases. | not mapped |
| T1b, T2 or T3 (incidental or suspected before surgery) | Radical (extended) cholecystectomy: resection of the liver bed (wedge or segments IVb and V) with portal lymphadenectomy, bile duct resection only when the cystic duct margin is positive; re-resection 4 to 8 weeks after an incidental diagnosis; port sites not routinely excised. | not mapped |
| After resection | Adjuvant capecitabine for six months (BILCAP, a UK trial in a mixed biliary population that required muscle-invasive gallbladder cancer for entry); the BILCAP record carries the figures, and the UK CAPBIL cohort saw no matched benefit, so ACTICCA-1 is awaited. | not mapped |
| Unresectable or metastatic disease, first line | Gemcitabine and cisplatin with durvalumab (TOPAZ-1, in which 25 percent of patients had gallbladder cancer; NICE TA944) or with pembrolizumab (KEYNOTE-966; not appraised by NICE), with molecular profiling including HER2 at diagnosis and biliary drainage first if jaundiced. Second-line, HER2-directed and other targeted options follow in the rows below. | not mapped |
| Polyps and precursors (prevention) | Cholecystectomy for polyps of 10 mm or more, or 6 to 9 mm with a risk factor; ultrasound surveillance at 6, 12 and 24 months otherwise; no follow-up for polyps of 5 mm or less without risk factors (ESGAR, EAES, EFISDS and ESGE 2022). | not mapped |
| Jaundice from a blocked bile duct: stent or bypass | A stent placed by ERCP, or through the skin (PTC), is the usual way to relieve jaundice; metal stents stay open longer than plastic and are used when surgery to remove the cancer is not planned; a surgical bypass (joining the bile duct above the blockage to the small bowel) is reserved for people already having an operation or when a stent cannot be placed. Jaundice must be relieved before chemotherapy can be given safely. | not mapped |