Clinical History and examination: The doctor will ask for symptoms such as pain in the abdomen, bloating, fever, weight loss, nausea and jaundice as well as do an abdominal examination.
Biopsy: A biopsy is a tissue sample removed from the suspicious area and analysed under a microscope. It can confirm the presence or absence of cancer as well as provide key insights for the clinical team to decide the best path forward. The tissue sample could be retrieved during surgery itself, with a fine-needle guided by a CT scan or ultrasound scan or with an endoscope (a thin, lighted, flexible tube) through the mouth.
Endoscopic retrograde cholangiopancreatography (ERCP): This procedure allows the gastroenterologist to look inside the gut. The patient is sedated, and an endoscope is passed through the mouth, down the esophagus, stomach and into the small bowel. A smaller tube is then passed through the endoscope and into the bile ducts to inject a dye. Post this, an x-ray is taken that reveals whether a tumour is present in the area.
Percutaneous cholangiography: A thin needle is inserted through the skin and into the gallbladder area to inject the dye for X-ray visualisation. The clinician will use these films to be able to confirm a gall bladder tumour.
Laparoscopy: This procedure uses an endoscope to look at the gallbladder and other internal organs by passing them through a small incision in the abdomen.
Blood tests: The patient’s blood is collected to check for specific markers of liver or gall bladder related complications. These are chemicals include bilirubin. Bilirubin is a chemical that reaches a high level in gallbladder cancer due to blockage of the ducts by a tumour. Your doctor may also order carcinoembryonic antigen - CEA test or CA19-9 test.
Radiological tests: Computed tomography (CT scan): A CT scan creates takes pictures of the inside of the body using x-rays and combines these images into a detailed, 3D image. Sometimes, a special dye is given before the scan to provide better detail on the image. It is used to measure the tumour size.
Positron emission tomography (PET) scan: A PET scan allows the visualisation of organs and tissues inside the body using a small amount of a radioactive sugar-like substance. This substance is taken up by active cells which are detected when scanned. Tumour cells tend to take up this substance and hence is useful to detect spread (metastasis).
Magnetic resonance imaging (MRI): An MRI uses magnetic fields, not X-rays, to produce detailed images of the body and can be used to find out whether the cancer has spread outside the gallbladder. MRI can be used to measure the tumour’s size. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow. A specialized MRI used for the gallbladder is called MRI cholangiopancreatography. A contrast medium may be given before the MRI to create a clearer picture. Ultrasound: Ultrasound uses sound waves to create a picture of the internal organs and is used by a radiologist to detect a tumour or a suspicious mass inside the body.
Endoscopic ultrasonography: A long flexible endoscope, is inserted through the mouth and reaches the stomach and some of the intestine. It has an ultrasound probe at the end that can be used to look for tumours through an internal ultrasound.
The management of cancer depends on various factors, including the stage of the cancer, additional health issues, age etc. Surgery, radiation or chemotherapy may be used.
Sources: National Cancer Institute ; American Cancer Society;