With less than 5,000 cases of gallbladder cancer reported each year in the United States, gallbladder cancer is viewed to be very rare. Unfortunately, most gallbladder cancers are fatal because it is difficult to diagnose early. Symptoms do not appear until later stages of the disease and often mimic other non-malignant conditions.  This can lead to gallbladder cancer being mistaken for something else, or missed completely.

Misdiagnosis and Missed Diagnosis of Gallbladder Cancer

Misdiagnosis occurs when a physician diagnoses the wrong condition during a patient examination. This sometimes leads doctors to administer treatment that is inappropriate or detrimental to the patient’s health, or to incorrectly determine that no treatment is required. Gallbladder cancer can be misdiagnosed as gallbladder stones (gallstones) because it is a common condition that can produce symptoms that are similar to gallbladder cancer.  Additionally, gallbladder cancer can often be confused with liver cancer or binary tract cancer because the gallbladder is an important component.

Since there are very few early signs and symptoms of gallbladder cancer doctors and medical staff sometimes fail to detect a medical condition altogether, resulting in missed diagnosis.  A missed diagnosis can result in time lost in receiving the correct treatment and is the difference between confronting a highly-treatable condition, or a life-threatening disease. Doctors, nurses, and medical professionals should be able to distinguish between a malignancy and something less serious through a series of medical tests and examinations.

Are you a victim of a wrong or missed diagnosis of gall bladder cancer? The following information outlines signs and symptoms that your doctor should have caught and the tests that should have been administered to receive an accurate diagnosis.

Primary Function of Gallbladder

The gallbladder is a hollow, pear-shaped organ, located just below the liver and is responsible for storing bile. The gallbladder squeezes bile up through ducts to the small intestine to help digest fats.

The gallbladder is a fairly small organ, only a few inches long and about an inch wide. It’s a powerful organ for digestion; however, it is not vital in the human body. Many who have had their gallbladder removed have gone on to lead normal lives.

What is gallbladder cancer?

Gallbladder cancer is a cancer that begins in the gallbladder. It is a particularly rare cancer in the United States, with less than 5,000 cases reported each year; however, most gallbladder cancer is fatal and difficult to diagnose early. Most gallbladder cancers are discovered in the late stages of the disease – often times this results in a poor prognosis.

There are different types of gallbladder cancer because there are many different types of cells in the gallbladder itself. The most common type is adenocarcinoma, but there are other, rarer types of gallbladder cancer that is based upon which cell the cancer originated.  Any cancer than starts in gland cells is called adenocarcinoma. For gallbladder cancer, this cancer begins in the gland cells that are in the lining of gallbladder. There are three different types of adenocarcinoma:

• Non papillary
• Papillary
• Mucinous

Most gallbladder cancers are non papillary; approximately 6% are papillary and 2% are mucinous. Papillary gallbladder cancer develops in the connective tissues of the gallbladder and is less likely to spread to other organs or lymph nodes. Those diagnosed with papillary gallbladder cancer typically have a better prognosis. A mucinous adenocarcinoma type of cancer produces too much “mucin,” which in some cases causes the cancer spread more quickly, resulting in difficult treatment.

Other less common gallbladder cancers are squamous cell cancer, adenosquamous, small cell, sarcoma, and neuroendoctrine tumor.

Signs and Symptoms – What Your Doctor Should Look For

Symptoms of gallbladder cancer are typically not apparent until the cancer is in the later stages, making it more difficult to treat. However, there are some common signs to look out for, that could give an indication that something is wrong:

• Abdominal Pain
• Nausea
• Jaundice
• Lumps in the stomach
• Loss of appetite/weight loss
• Swelling in abdomen
• Fever
• Itchy Skin
• Dark Urine
• Light colored or greasy stools

Since gallbladder cancer is uncommon, and physical issues such as gallbladder stones are, it can be difficult to diagnose, especially when something like gallbladder stones can cause similar symptoms such as abdominal pain.

Diagnosing Gallbladder Cancer – Did Your Doctor Run the Correct Tests?

Gallbladder cancer is extremely rare, and because symptoms of the disease typically do not appear until the cancer is in advanced stages, gallbladder cancer can be tricky to diagnose early on. That is why it is important that your doctor not only take into account your signs and symptoms, but also your risk factors and family medical history. Those who have a family history, or have preexisting conditions such as: gallstones, polyps, or abnormal bile ducts, are at a much higher risk of developing the cancer than those who do not.

In some instances, gallbladder cancer can be mistaken for something less serious, especially if the individual already has a pre-existing condition like gallstones. Gallstones, which are cholesterol deposits formed in the gallbladder, can cause inflammation and sometimes produce symptoms similar to that of gallbladder cancer. By looking at your medical history, and by running a series of physical exams, blood tests, imaging tests, surgery, and biopsies your doctor should be able to distinguish between the malignancy and something less serious.

Your medical/family history and the physical exam is one of the first steps in diagnosing gall bladder cancer. The results of the physical examination will determine if other testing needs to be done to futher explore the possibility of cancer. By focusing mainly on your abdomen, the doctor will feel for lumps, tenderness, or a build-up of fluid. Lymph nodes are examined, as well as the eyes and skin – to look for the yellow discoloration associated with jaundice.

Blood tests/Liver Function Tests

Testing for abnormalities in your blood can help diagnose gallbladder cancer. Having a high amount of the following substances in your blood could indicate problems in the gallbladder, bile ducts, and liver.

• Bilirubin
• Albumin
• Alkaline phosphate
• AST
• ALT
• GGT

Imaging Tests

Imaging tests are done through a variety of techniques to take an image of what is inside your body, to have a better understanding and a clearer picture of not only  help diagnose, but also determine if the cancer has spread, or if treatment is working. The following image tests are used for detecting gallbladder cancer:

• Computed Tomography (CT) scan
• Magnetic Resonance Imaging (MRI) scan
  • MR Cholangiopancreatography (MRCP) – to examine bile ducts
  • MR Angiography (MRA) -  to examine blood vessels
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Percutaneous Transhepatic Cholangiography (PTC)

Surgery

While surgery is typically thought of as a treatment option for most cancer, for gallbladder cancer, surgery can help to diagnose.  By making a small incision to access the gallbladder/liver, the doctor is able to fit in a small tube with a camera on the end of it. This procedure is called a laparoscopy and is helpful in determine the stage of the cancer.

Biopsies

A common procedure in determining if cancer cells are present, a biopsy is when tissue samples are taken from the area in question and then examined under the microscope. In many cases, a biopsy is critical in determining the diagnosis.

Treatment – Did Your Doctor Explain Your Options?

There are many different types of treatments for gallbladder cancer and it is up to you and your doctor to figure out the best course of action. The most common treatments are surgery, chemotherapy, radiation, and palliative therapy.

Surgery

Different types of surgery are expedited based upon what type of gallbladder cancer you have, if it’s resectable, and how much the cancer has spread. Doctors will use your tests results to figure out which option will be the most productive in removing and curing your cancer.

Palliative Surgery – If tests show that the cancer is too widespread, the doctor will opt for the palliative surgery which removes only portions of the tumor. This surgery is not meant to cure, and is typically used in advanced stages of the cancer to relieve pain and symptoms.

Potentially Curative Surgery

This type of surgery is for when the doctors believe that they can remove all of the cancer, based upon imaging tests and results of earlier surgeries. This is a rarer surgical option because often times the cancer is unresectable; it has spread too far.

Cholecystectomy

Operation to remove the gallbladder in its entirety.

Extended Cholecystectomy

If the gallbladder cancer has begun to spread to other organs, the doctor may perform an extended cholecystectomy and remove liver tissue and lymph nodes that in in the surrounding area.

Other surgical removals might include:

• Common bile duct
• Larger portion of the liver
• Ligament between the liver and the intestines
• Lymph nodes around the pancreas
• Pancreas
• The duodenum

Chemotherapy

If you are not a candidate for surgery, chemotherapy treatment options are available to those who qualify. Taken by either the mouth or vein, chemotherapy treatments are given in rounds over time, to target and kill cancer cells. Gallbladder cancer can be complex, and sometimes chemotherapy given through the vein can be ineffective. In these cases, doctors will administer chemotherapy directly through the main artery in the liver – the heptic artery. However, many cannot tolerate chemotherapy through the heptic artery because it requires surgery to insert a catheter.

Chemotherapy can be used after surgery and is often used in instances where the gallbladder cancer was resectable, to prevent the cancer from returning. The following are the most common gallbladder cancer chemotherapy drugs:

• Gemcitabine (Gemzar ®)
• Cisplatin (Platinol ®)
• 5-florouracil (5-FU)
• Capecitabine (Xeloda ®)
• Oxaliplatin (Eloxatin ®)

Radiation

Radiation works by producing high-energy x-rays to the affected areas, thus causing damage to the DNA of the cancerous cells. Radiation, while painless, is also sometimes used with surgery, to help kill any remaining cells that perhaps surgery could not.

A radiation team will take measurements to determine where to target the radiation beams for most effectiveness using either one of two methods: 3-D conformal radiation therapy (3D-CRT) and Intensity modulated radiation therapy (IMRT). Radiation can be used with chemotherapy (chemoradiation), and also as a palliative therapy.

Palliative Therapy

Palliative therapy treatments are not meant to cure cancer, but are mean to control pain and reduce symptoms. Palliative therapies are more common in advanced stages of cancer and different options are available depending on your symptoms and diagnosis. Alcohol injections and pain medicines weaken and kill nerves that carry pain sensations.

Those suffering from jaundice or other abdominal issues might have a blocked duct, preventing bile from being carried to the liver or small intestine. A biliary stent or biliary catheter may be inserted to help drain the bile.

Stent

a small plastic tube that opens the ducts, allowing bile to drain

Catheter

a tube that is connected to a bag outside the body. The tube is inserted through a hole in the stomach and drains fluid into the bag. The bag needs to be emptied regularly and can be done so by the patient.

Other ways to get bile to drain from the gallbladder and the liver involve surgery.

Choledochojejunostomy

bile duct is joined to the second half the small intestine

Gastrojejunostomy  (gastric bypass)

joins the stomach to the second half of the small intestine

Hepaticojejunostomy

the duct that carries the bile is connected to the second half of the small intestine

When it comes to a misdiagnosis or missed diagnosis of gallbladder cancer, many factor come into play. The doctor should be able to determine which mode of testing will the most effective based upon the symptoms experienced from the patient. Often times, lab tests are completed at a different medical facilities and information needs to be relayed back through the doctor. This increases chances for human error as results could be misheard, or not read correctly.

See if you can answer the following questions to determine if you are a victim of a misdiagnosis/missed diagnosis of gall bladder cancer:

1. What tests were administered? Did your doctor explain why that test was done?
2. Was the cancer detected in any other parts of the body? Did the doctor test for that?
3. Were you informed of the severity of the cancer? (what stage)
4. Any other tests should have been done?
5. How do I know if my test results are accurate?
6. Were my lab tests sent to another facility?
7. Where was that facility located?
8. How do I know if the information was relayed back correctly?